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Fetal alloimmunization

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https://www.readbyqxmd.com/read/29306729/adding-to-the-complexity-of-fetal-and-neonatal-alloimmune-thrombocytopenia-reduced-fibrinogen-binding-in-the-presence-of-anti-hpa-1a-antibody-and-hypo-responsive-neonatal-platelets
#1
E Refsum, S Meinke, G Gryfelt, A Wikman, P Höglund
BACKGROUND: In fetal and neonatal alloimmune thrombocytopenia (FNAIT), maternal alloantibodies directed against paternally-derived platelet antigens are transported across the placenta to the fetus, where they may cause thrombocytopenia. The most serious complication of FNAIT is an intracranial hemorrhage (ICH), which may cause death or life-long disability of the child. Apart from alloantibody-mediated platelet destruction, the clinical outcome in FNAIT may be affected by properties of neonatal platelets and possible functional effects on platelets caused by maternal alloantibodies...
December 29, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/29274715/no-133-prevention-of-rh-alloimmunization
#2
Karen Fung Kee Fung, Erica Eason
OBJECTIVE: To provide guidelines on use of anti-D prophylaxis to optimize prevention of rhesus (Rh) alloimmunization in Canadian women. OUTCOMES: Decreased incidence of Rh alloimmunization and minimized practice variation with regards to immunoprophylaxis strategies. EVIDENCE: The Cochrane Library and MEDLINE were searched for English-language articles from 1968 to 200 I, relating to the prevention of Rh alloimmunization. Search terms included: Rho(D) immune globulin, Rh iso- or aile-immunization, anti-D, anti-Rh, WinRho, Rhogam, and pregnancy...
January 2018: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/29250791/successful-management-of-severe-red-blood-cell-alloimmunization-in-pregnancy-with-a-combination-of-therapeutic-plasma-exchange-intravenous-immune-globulin-and-intrauterine-transfusion
#3
Laura C Nwogu, Kenneth J Moise, Kimberly L Klein, Hlaing Tint, Brian Castillo, Yu Bai
BACKGROUND: Antibodies to Rhesus and Kell antigens have been associated with severe hemolytic disease of the fetus and newborn (HDFN) necessitating intrauterine transfusion (IUT) of red blood cells (RBCs). We report a case series of five women with severe HDFN secondary to maternal RBC alloimmunization who were successfully managed with therapeutic plasma exchange (TPE), intravenous immune globulin (IVIG), and IUT. STUDY DESIGN AND METHODS: This is a retrospective case series of five women with severe HDFN who underwent a total of three TPE procedures during Weeks 10 to 13 of pregnancy, followed by weekly IVIG infusions...
December 17, 2017: Transfusion
https://www.readbyqxmd.com/read/29240037/fetal-anemia-causing-hydrops-fetalis-from-an-alpha-globin-variant-homozygous-hemoglobin-constant-spring
#4
Patcharee Komvilaisak, Ratana Komvilaisak, Arunee Jetsrisuparb, Surapon Wiangnon, Junya Jirapradittha, Pakaphan Kiatchoosakun, Goonapa Fucharoen
BACKGROUND: Fetal anemia is often assumed to be due to red cell alloimmunization and Parvovirus infection, and can lead to hydrops fetalis and death in utero. Other causes, such as mutations of hemoglobin alpha, are less commonly considered. METHODS: We report 7 cases with fetal anemia causing hydrops fetalis. Serial Doppler ultrasound for measurement peak systolic velocity (PSV) of middle cerebral artery (MCA) was used for evaluation of fetal anemia. Fetal anemia is suggested if the MCA/PSV ratio is >1...
December 12, 2017: Journal of Pediatric Hematology/oncology
https://www.readbyqxmd.com/read/29193111/clinical-input-of-anti-d-quantitation-by-continuous-flow-analysis-on-autoanalyzer-in-the-management-of-high-titer-anti-d-maternal-alloimmunization
#5
Cécile Toly-Ndour, Haifa Mourtada, Stéphanie Huguet-Jacquot, Emeline Maisonneuve, Stéphanie Friszer, Françoise Pernot, Pauline Thomas, Jean-Marie Jouannic, Bruno Carbonne, Anne Cortey, Agnès Mailloux
BACKGROUND: In addition to titration by indirect antiglobulin test most widely used, anti-D quantitation by continuous-flow analysis (CFA) may be performed to assess severity of maternal immunization. Only five studies have reported its added value in the management of pregnancies complicated by anti-D immunization. STUDY DESIGN AND METHODS: A retrospective study of 74 severe anti-D-immunized pregnancies was conducted from January 1, 2013, to December 31, 2014, in the Trousseau Hospital in Paris (France)...
November 29, 2017: Transfusion
https://www.readbyqxmd.com/read/29187036/persistence-of-villous-immaturity-in-term-deliveries-following-intrauterine-transfusion-for-parvovirus-b19-infection-and-rhd-associated-hemolytic-disease-of-the-fetus-and-newborn
#6
Whitney A McCarthy, Edwina J Popek
Common causes of fetal anemia and hydrops include parvovirus B19 infection during the first 2 trimesters of pregnancy, as well as maternal alloimmunization to RhD with subsequent hemolytic disease of the fetus and newborn (HDFN) in an RhD positive fetus. Although both of these conditions have historically caused significant fetal morbidity and mortality, the advent of intrauterine transfusion (IUT) over the last few decades have dramatically improved outcomes. Prior literature has extensively documented placental changes associated with untreated parvovirus infection and RhD HDFN in intrauterine fetal demises and preterm births; however, histopathologic changes in term placentas from term infants treated with IUT have not been reported...
January 1, 2017: Pediatric and Developmental Pathology
https://www.readbyqxmd.com/read/29177106/anti-m-alloimmunization-management-and-outcome-at-a-single-institution
#7
Bethany Stetson, Scott Scrape, Kara Beth Markham
Objective  The objective of this study was to review the management strategies and outcomes in gravidas with anti-M alloimmunization over 15 years. Study Design  Data collected from 195 pregnant patients with anti-M antibodies from July 2000 through June 2016 were reviewed retrospectively. We analyzed indirect antiglobulin test titer results, paternal or fetal/neonatal M antigen status, antepartum course, and perinatal outcomes. Results  Anti-M antibodies were found in 146 women and 195pregnancies. Among those with positive indirect antiglobulin tests, 193 pregnancies had titers at or below 1:4...
October 2017: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/29168253/genomewide-association-study-of-hla-alloimmunization-in-previously-pregnant-blood-donors
#8
Mark Seielstad, Grier P Page, Nathan Gaddis, Marion Lanteri, Tzong-Hae Lee, Ram Kakaiya, Lisa F Barcellos, Lindsey A Criswell, Darrell Triulzi, Philip J Norris, Michael P Busch
BACKGROUND: Alloimmunization through blood transfusion, transplantation, or circulating fetal cells during pregnancy is a significant concern. Some exposed individuals make alloantibodies while others do not, implying variation in genetic risk factors. STUDY DESIGN AND METHODS: We conducted a genomewide association study (GWAS) of 9,427,497 single-nucleotide polymorphisms (SNPs) to identify genetic variants for HLA alloimmunization in previously pregnant blood donors with (n = 752) and without (n = 753) HLA Class I or II alloantibodies...
November 22, 2017: Transfusion
https://www.readbyqxmd.com/read/29119564/intracranial-hemorrhages-in-neonates-born-from-32-weeks-of-gestation-low-frequency-of-associated-fetal-and-neonatal-alloimmune-thrombocytopenia-a-register-based-study
#9
Erle Refsum, Stellan Håkansson, Anette Mörtberg, Agneta Wikman, Magnus Westgren
BACKGROUND: Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a rare condition, with an estimated incidence of one in 1000 to 2000 live births. Predominantly, FNAIT is due to maternal alloantibodies that target paternally derived human platelet antigen (HPA) 1a. The most feared complication is an intracranial hemorrhage (ICH). The aim of this study was to determine the frequency of associated maternal platelet (PLT) alloimmunization in a population of neonates born from 32 weeks of gestation and diagnosed with an ICH...
November 8, 2017: Transfusion
https://www.readbyqxmd.com/read/29031020/fetal-mri-lower-acceptance-by-women-in-research-vs-clinical-setting
#10
Bloeme J van der Knoop, Roland J Vermeulen, Jonathan I M L Verbeke, Lourens R Pistorius, Johanna I P de Vries
AIM: To determine acceptance of pregnant women to undergo fetal magnetic resonance imaging (MRI) examination in research and clinical setting. METHODS: A prospective study included a research group [part of a study comparing brain ultrasound (US) to MRI in fetuses at risk for acquired brain damage] and a clinical group [fetuses with suspected (brain) anomalies after structural US examination] from 2011 to 2014. All women were advised to use sedatives. MRI declinations, use of sedation, MRI duration and imaging quality were compared between both groups...
October 14, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/29030871/fetal-neonatal-alloimmune-thrombocytopenia-due-to-anti-cd36-antibodies-antibody-evaluations-by-cd36-transfected-cell-lines
#11
Marie Lin, Xiuzhang Xu, Hui-Lin Lee, Der-Cheng Liang, Sentot Santoso
BACKGROUND: Isoantibodies against CD36 (platelet glycoprotein 4), developed in Type I CD36-deficient mothers are frequently reported as the cause of fetal/neonatal alloimmune thrombocytopenia in the Asian population. Therefore, further detailed characterization of anti-CD36-mediated fetal/neonatal alloimmune thrombocytopenia is warranted. Here, we report the characterization of a patient with fetal/neonatal alloimmune thrombocytopenia in a Taiwanese family caused by anti-CD36 isoantibodies using a novel antigen-capture method...
October 13, 2017: Transfusion
https://www.readbyqxmd.com/read/28937404/genotyping-to-prevent-rh-disease-has-the-time-come
#12
C Ellen van der Schoot, Masja de Haas, Frederik Banch Clausen
PURPOSE OF REVIEW: In this review, we analyzed the current literature on noninvasive fetal RHD typing to answer the question whether the administration of RhIg to prevent D-alloimmunization during pregnancy can be safely guided by fetal RHD typing. RECENT FINDINGS: Recently the first centers that implemented large-scale nationwide fetal RHD typing in the second trimester for targeted RhIg administration have published their studies evaluating the diagnostic accuracy of their screening programs...
November 2017: Current Opinion in Hematology
https://www.readbyqxmd.com/read/28837581/fetal-exposure-to-maternal-human-platelet-antigen-1a-does-not-induce-tolerance-an-analytical-observational-study
#13
Mette Kjær, Heidi Tiller, Gøril Heide, Jens Kjeldsen-Kragh, Bjørn Skogen, Anne Husebekk
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a disease that may cause severe bleeding complications with risk of perinatal death or lifelong disability. The main cause of FNAIT is maternal antibodies against human platelet antigen (HPA)-1a. Both fetomaternal bleeding and transplacental trafficking of fetal cells during pregnancy could be the cause of alloimmunization. Persistence of fetal cells in the mother (fetal microchimerism) and maternal cells in the child (maternal microchimerism) are well-recognized phenomena...
2017: PloS One
https://www.readbyqxmd.com/read/28794456/activated-nk-cells-cause-placental-dysfunction-and-miscarriages-in-fetal-alloimmune-thrombocytopenia
#14
Issaka Yougbaré, Wei-She Tai, Darko Zdravic, Brigitta Elaine Oswald, Sean Lang, Guangheng Zhu, Howard Leong-Poi, Dawei Qu, Lisa Yu, Caroline Dunk, Jianhong Zhang, John G Sled, Stephen J Lye, Jelena Brkić, Chun Peng, Petter Höglund, B Anne Croy, S Lee Adamson, Xiao-Yan Wen, Duncan J Stewart, John Freedman, Heyu Ni
Miscarriage and intrauterine growth restriction (IUGR) are devastating complications in fetal/neonatal alloimmune thrombocytopenia (FNAIT). We previously reported the mechanisms for bleeding diatheses, but it is unknown whether placental, decidual immune cells or other abnormalities at the maternal-fetal interface contribute to FNAIT. Here we show that maternal immune responses to fetal platelet antigens cause miscarriage and IUGR that are associated with vascular and immune pathologies in murine FNAIT models...
August 9, 2017: Nature Communications
https://www.readbyqxmd.com/read/28724194/paving-the-way-for-improved-management-of-severe-immune-thrombocytopenia-purpura-in-pregnancy
#15
A H James
No abstract text is available yet for this article.
July 19, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/28717357/high-levels-of-cxcl8-and-low-levels-of-cxcl9-and-cxcl10-in-women-with-maternal-rhd-alloimmunization
#16
Juliana Araújo de Carvalho Schettini, Thomás Virgílio Gomes, Alexandra Karla Santos Barreto, Claudeir Dias da Silva Júnior, Marina da Matta, Isabela Cristina Neiva Coutinho, Maria do Carmo Valgueiro Costa de Oliveira, Leuridan Cavalcante Torres
Maternal RhD alloimmunization is an inflammatory response against protein antigens in fetal red blood cells (RBC). However, not all women become alloimmunized when exposed to RhD(+) fetal RBC. Thus, this study aimed to evaluate levels of inflammatory chemokines in RhD(-) pregnant women with erythrocyte alloimmunization. CXCL8, CXCL9, CCL5, and CXCL10 levels were determined from cell culture supernatants by flow cytometry in 46 (30 non-alloimmunized RhD(-) and 16 previously alloimmunized RhD(-)) pregnant women...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/28686909/unraveling-the-role-of-maternal-anti-hla-class-i-antibodies-in-fetal-and-neonatal-thrombocytopenia-antibody-specificity-analysis-using-epitope-data
#17
Jesper Dahl, Erle Refsum, Maria Therese Ahlen, Torstein Egeland, Tore Jensen, Marte K Viken, Tor Brynjar Stuge, Ganesh Acharya, Anne Husebekk, Bjørn Skogen, Heidi Tiller
Anti-HLA class I antibodies have been suggested as a possible cause of fetal and neonatal alloimmune thrombocytopenia (FNAIT). The aim of this study was to characterize maternal anti-HLA class I alloantibodies in suspected cases of FNAIT. The study population consisted of all nationwide referrals of neonates with suspected FNAIT to the National Unit for Platelet Immunology in Tromsø, Norway, during 1998-2009 (cases), and 250 unselected pregnancies originally included in a prospective study (controls). Inclusion criterion was a positive screening for maternal anti-HLA class I antibodies...
June 27, 2017: Journal of Reproductive Immunology
https://www.readbyqxmd.com/read/28679510/neonatal-alloimmune-thrombocytopaenia-associated-with-maternal-hla-antibodies
#18
Kristina Wendel, Çiğdem Akalin Akkök, Stefan Kutzsche
Neonatal alloimmune thrombocytopaenia (NAIT) generally results from platelet opsonisation by maternal antibodies against fetal platelet antigens inherited from the infant's father. Newborn monochorionic twins presented with petechial haemorrhages at 10 hours of life, along with severe thrombocytopaenia. Despite the initial treatment with platelet transfusions and intravenous immunoglobulin, they both had persistent thrombocytopaenia during their first 45 days of life. Class I human leucocyte antigen (HLA) antibodies with broad specificity against several HLA-B antigens were detected in the maternal serum...
July 5, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28675682/imaging-and-management-of-fetuses-and-neonates-with-alloimmune-thrombocytopenia
#19
REVIEW
Arzu Kovanlikaya, Priyanka Tiwari, James B Bussel
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the most common cause of severe neonatal thrombocytopenia and intracranial bleeding in term newborns. Intracranial hemorrhage (ICH) commonly results in death or severe, lasting neurologic disability. The timing of ICH is also important for management of the next affected pregnancy in cases of FNAIT. This manuscript reviews the advantages and disadvantages of the different radiologic methodologies to identify and characterize ICH. It discusses the limits of ultrasound and the advantages of magnetic resonance imaging allowing avoidance of the radiation associated with computed tomography (CT) scans...
December 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/28673503/-thirty-years-of-platelet-immunology-in-fetal-and-neonatal-alloimmune-thrombocytopenia-management-current-situation
#20
R Petermann
Fetal and neonatal allo-immune thrombocytopenia (FNAIT) is considered as a rare disease due to the incidence (1/1000-1/2000 births). The major complication of severe thrombocytopenia is bleeding and particularly intra-cranial hemorrhage and neurologic sequelae following. Serology and molecular biology developments have reconfigured the platelet immunology diagnosis. Anti-HPA-1a allo-immunisation is responsible for more than 80% FNAIT cases with a high recurrence rate of severe bleeding complications. Therapeutic management has changed over the coming years from an invasive concept associating fetal blood sampling and in utero platelet transfusion to a non invasive treatment by intravenous immunoglobulins injection (IVIg)...
June 30, 2017: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
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