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Does anti-HPA-1a affect birthweight in fetal and neonatal alloimmune thrombocytopenia?
McKelvy, Margaret; Tyagi, Srishti; Haar, Emilie Vander; Lakkaraja, Madhavi; Tomy, Tim; Corke, Stacy; Palmer, Thea; Rottenstreich, Amihai; Kapur, Rick; Zhi, Huiying; Newman, Debra; Scatz-Siemers, Nina; Bussel, James.
Afiliación
  • McKelvy M; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, USA.
  • Tyagi S; Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA.
  • Haar EV; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, USA.
  • Lakkaraja M; Department of Pediatrics, Fred Hutchinson Cancer Center, Department of Pediatrics, University of Washington School of Medicine, Seattle, USA.
  • Tomy T; Department of Pediatrics, Hurley Medical Center, Flint, Michigan, USA.
  • Corke S; Natibabies.org, Penzance, UK.
  • Palmer T; Natibabies.org, Penzance, UK.
  • Rottenstreich A; Department of Obstetrics and Gynecology, Laboratory of Blood and Vascular Biology, Rockefeller University, New York, New York, USA.
  • Kapur R; Division of Maternal- Fetal Medicine, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA.
  • Zhi H; Department of Experimental Immunohematology, Sanquin Research, and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
  • Newman D; Department of Pathology, Versiti Blood Center of Wisconsin, Blood Research Institute, Milwaukee, Wisconsin, USA.
  • Scatz-Siemers N; Department of Pathology, Versiti Blood Center of Wisconsin, Blood Research Institute, Milwaukee, Wisconsin, USA.
  • Bussel J; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA.
Pediatr Blood Cancer ; 71(4): e30835, 2024 Apr.
Article en En | MEDLINE | ID: mdl-38212881
ABSTRACT

BACKGROUND:

Fetal and neonatal alloimmune thrombocytopenia (FNAIT) ensues from parental incompatibility for platelet alloantigens with maternal sensitization. HPA-1a/1b incompatibility is the most common cause of FNAIT in Caucasians. Placental villitis and lower birthweight in FNAIT suggest anti-HPA-1a may have effects beyond inducing thrombocytopenia.

OBJECTIVES:

Does FNAIT secondary to anti-HPA-1a result in smaller newborns and, the corollary, does antenatal management of FNAIT increase birthweight? STUDY

DESIGN:

Birthweights of 270 FNAIT-affected newborns from a randomized clinical trial and a NAITbabies.org survey (135 paired siblings) were compared with those of published controls and treated to untreated FNAIT-affected siblings. Birthweights were converted to percentiles to account for gestational age, sex, and role of birth order in birth weight. Body weights of FNAIT-affected and -unaffected pups in a mouse FNAIT model were analyzed.

RESULTS:

Untreated siblings in both the clinical trial and NAITbabies.org cohorts were not small, compared with normal controls. However, treated siblings in both cohorts had significantly higher birthweight percentiles compared with their previous untreated affected sibling. After accounting for gestational age, sex, and birth order, increased birthweight percentile in treated compared with the untreated siblings remained significant in both cohorts. FNAIT-affected neonatal mice had lower bodyweights than FNAIT-unaffected pups.

CONCLUSIONS:

Untreated FNAIT-affected newborns were not small; however, treatment of FNAIT-affected pregnancies increased newborn birthweights despite corrections to account for other factors that might have influenced the results. High dose IVIG is believed to "block" FcRn and lower maternal anti-HPA-1a levels, and thus increase birthweights by reducing levels of maternal anti-HPA-1a and reducing placental villitis.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Antígenos de Plaqueta Humana / Trombocitopenia Neonatal Aloinmune Tipo de estudio: Clinical_trials / Prognostic_studies Límite: Animals / Female / Humans / Male / Newborn / Pregnancy Idioma: En Revista: Pediatr Blood Cancer Asunto de la revista: HEMATOLOGIA / NEOPLASIAS / PEDIATRIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Antígenos de Plaqueta Humana / Trombocitopenia Neonatal Aloinmune Tipo de estudio: Clinical_trials / Prognostic_studies Límite: Animals / Female / Humans / Male / Newborn / Pregnancy Idioma: En Revista: Pediatr Blood Cancer Asunto de la revista: HEMATOLOGIA / NEOPLASIAS / PEDIATRIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos