Serologic analysis of three cases of neonatal alloimmune thrombocytopenia associated with HLA antibodies.
BACKGROUND
Neonatal alloimmune thrombocytopenia (NAIT) is caused when maternal alloantibodies react with paternally inherited antigens present on the fetal PLTs, a reaction mainly due to antibodies against human PLT antigens. Cases in which NAIT has been caused by HLA antibodies are relatively rare. In this study, three cases of NAIT associated with HLA antibodies that occurred in a 1-year period are reported.


METHODS
The presence of HLA antibodies in these three NAIT case studies was elucidated by examining reactions of the neonatal and maternal sera with lymphocytes, PLTs, and beads from an HLA antibody screening test (FlowPRA, One Lambda Inc.). Absorption and elution tests with paternal cells were also conducted. In addition, the influence of titer and specificity of HLA antibodies on NAIT was analyzed in light of 24 other documented cases in Japan.


RESULTS
In the three case studies presented herein, antibodies against human PLT antigens were found in neither the maternal nor neonatal sera, while specific HLA antibodies were identified in both sera. Absorption of maternal serum with paternal PLTs eliminated the reactivity against paternal PLTs and lymphocytes.


CONCLUSIONS
Transplacental passage of maternal HLA antibodies was observed in the three neonates cited in the present study.
Saito
Satoshi
S
Department of Legal Medicine, Shinshu University School of Medicine, Matumoto, Japan. stsaito@poplar.ocn.ne.jp
Ota
Masao
M
Komatsu
Yumi
Y
Ota
Satoshi
S
Aoki
Shigeru
S
Koike
Kenichi
K
Tokunaga
Izumi
I
Tsuno
Takahisa
T
Tsuruta
Goro
G
Kubo
Tetsuo
T
Fukushima
Hirofumi
H
D000327:Adsorption; D000918:Antibody Specificity; D016824:Antigens, Human Platelet / Q000276:immunology; D001788:Blood Grouping and Crossmatching; D001792:Blood Platelets / Q000276:immunology*; D005220:Fathers; D006680:HLA Antigens / Q000276:immunology*; D015235:HLA-B Antigens / Q000276:immunology; D059947:HLA-B40 Antigen; D006650:Histocompatibility Testing; D006801:Humans; D007231:Infant, Newborn; D007518:Isoantibodies / Q000276:immunology*; D007519:Isoantigens / Q000276:immunology; D008297:Male; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D013921:Thrombocytopenia / Q000276:immunology*
D016824:Antigens, Human Platelet; D006680:HLA Antigens; D015235:HLA-B Antigens; D059947:HLA-B40 Antigen; C035270:HLA-B5 antigen; D007518:Isoantibodies; D007519:Isoantigens