Is it time to implement HPA-1 screening in pregnancy?
OBJECTIVE
The purpose of the review is to argue for and against introduction of HPA-1 typing of all pregnant women to reduce morbidity and mortality caused by foetal/neonatal alloimmune thrombocytopenia (FNAIT).


RESULTS
Several groups have done HPA-1 typing in cohorts of pregnant women. Results from a Norwegian study (>100,000 pregnancies) indicate that screening combined with simple intervention decreases morbidity and mortality due to FNAIT and is cost effective in Norway. Results from this study and several other studies show that there is correlation between the level of anti-HPA-1a antibodies in the mother and the severity of thrombocytopenia in the newborn. An important finding is that about 75% of women with antibodies are immunized in connection with delivery. Only 25% of the women are immunized during pregnancy.


CONCLUSIONS
Screening for FNAIT does not fully meet the criteria presented by the WHO. Nevertheless, the results of the Norwegian study strongly indicate that morbidity and mortality related to FNAIT can be reduced. If the recent attempts to make a vaccine aimed at prevention of immunization and/or tolerizing peptides or neutralizing antibodies for already immunized women are shown to be successful, screening must be implemented.
Husebekk
Anne
A
University Hospital North Norway, Norway. anne.husebekk@unn.no
Killie
Mette K
MK
Kjeldsen-Kragh
Jens
J
Skogen
Bjørn
B
D016824:Antigens, Human Platelet / Q000097:blood*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis*; D006801:Humans; D039661:Integrin beta3; D011247:Pregnancy; D011296:Prenatal Diagnosis; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000175:diagnosis*
D016824:Antigens, Human Platelet; C061248:ITGB3 protein, human; D039661:Integrin beta3