Recent progress in understanding the pathogenesis of fetal and neonatal alloimmune thrombocytopenia.
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) occurs in c. 1 in 1000 births and is caused by maternal antibodies against human platelet alloantigens that bind incompatible fetal platelets and promote their clearance from the circulation. Affected infants can experience bleeding, bruising and, in severe cases, intracranial haemorrhage and even death. As maternal screening is not routinely performed, and first pregnancies can be affected, most cases are diagnosed at delivery of a first affected pregnancy. Unlike its erythrocyte counterpart, Haemolytic Disease of the Fetus and Newborn, there is no prophylactic treatment for FNAIT. This report will review recent advances made in understanding the pathogenesis of FNAIT: the platelet alloantigens involved, maternal exposure and sensitization to fetal platelet antigens, properties of platelet Immunoglobulin G antibodies, maternal-fetal antibody transport mechanisms and efforts to develop an effective FNAIT prophylaxis.
Platelet & Neutrophil Immunology Laboratory and Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA.
Brian R
BR
Curtis
D000818:Animals; D000937:Antigen-Antibody Reactions / Q000276:immunology; D016824:Antigens, Human Platelet / Q000276:immunology; D004195:Disease Models, Animal; D005260:Female; D005315:Fetal Diseases / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control; D006801:Humans; D007111:Immunity, Cellular / Q000276:immunology; D007074:Immunoglobulin G / Q000276:immunology; D007231:Infant, Newborn; D018811:Maternal Exposure; D008431:Maternal-Fetal Exchange / Q000276:immunology; D051379:Mice; D021041:Placental Circulation / Q000502:physiology; D011247:Pregnancy; D018029:Rho(D) Immune Globulin / Q000627:therapeutic use; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control
D016824:Antigens, Human Platelet; D007074:Immunoglobulin G; D018029:Rho(D) Immune Globulin
fetal and neonatal alloimmune thrombocytopenia pathogenesis; human platelet antigens; neonatal alloimmune thrombocytopenia; platelet antibody; prophylaxis