title: Fatal alloimmune thrombocytopenia due to anti-HLA alloimmunization in a twin pregnancy: A very infrequent complication of assisted reproduction.
abstract: The most frequently involved antigen in severe fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the human platelet antigen 1a. Platelets express the HLA-A and B antigens on their membrane and some studies report that maternal anti-HLA class I antibody can also cause FNAIT. We report here a very unusual case of a first twin pregnancy produced in vitro by oocyte and semen donation where the mother developed markedly elevated HLA antibodies, in the absence of anti-platelet or anti-neutrophil antibodies, that provoked in one of the twins a profound thrombocytopenia and intracranial hemorrhage and a mild thrombocytopenia and neutropenia in the second twin lasting until the fourth month of life. In addition, anti-D alloimmunization provoked hemolytic disease of the newborn with intrauterus anemia detected in the first twin and post-natal anemia in the second twin that required red blood cell transfusion and phototherapy. We hypothesize that the complete HLA-incompatible twin pregnancy due to the oocyte donation might have contributed to the severity of the clinical manifestations.
authors.affiliation: Department of Obstetrics, Gynecology and Reproduction, Salut de la Dona Dexeus, Hospital Universitari Quiron Dexeus, Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Meler
authors.affiliation: Department of Pediatrics, Neonatal Unit, Hospital Universitari Quiron Dexeus, Barcelona, Spain.
authors.forename: Roser
authors.initials: R
authors.lastname: Porta
authors.affiliation: Immunohematology Laboratory, Banc de Sang i Teixits, Barcelona, Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: Canals
authors.affiliation: Department of Obstetrics, Gynecology and Reproduction, Salut de la Dona Dexeus, Hospital Universitari Quiron Dexeus, Barcelona, Spain.
authors.forename: Bernat
authors.initials: B
authors.lastname: Serra
authors.affiliation: Department of Transfusion, Labco, Hospital Universitari Quiron Dexeus, Barcelona, Spain. Electronic address: servicio-transfusiones.dexeus@labco.eu.
authors.forename: Miguel
authors.initials: M
authors.lastname: Lozano
mesh_terms: D017809:Fatal Outcome; D005260:Female; D005307:Fertilization in Vitro; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D059285:Pregnancy, Twin; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000276:immunology* / Q000473:pathology / Q000503:physiopathology
chemical_list: D006680:HLA Antigens
keywords: Alloimmune neutropenia; Alloimmune thrombocytopenia; Assisted reproduction; HLA; Neonatal