Anti‐human platelet antigen‐5b antibodies and fetal and neonatal alloimmune thrombocytopenia; incidental association or cause and effect?

Summary Most cases of fetal and neonatal thrombocytopenia (FNAIT) are caused by maternal anti‐human platelet antigen‐1a antibodies (anti‐HPA‐1a). Anti‐HPA‐5b antibodies are the second most common antibodies in suspected FNAIT cases. Given the high prevalence of anti‐HPA‐5b antibodies in pregnant wom...

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Published in:	British journal of haematology Vol. 198; no. 1; pp. 14 - 23
Main Authors:	Alm, Julia, Duong, Yalin, Wienzek‐Lischka, Sandra, Cooper, Nina, Santoso, Sentot, Sachs, Ulrich J., Kiefel, Volker, Bein, Gregor
Format:	Journal Article
Language:	English
Published:	England Blackwell Publishing Ltd 01-07-2022
Subjects:	Antibodies Antigens Antigens, Human Platelet - immunology anti‐HPA‐5b Epidemiology Female fetal and neonatal alloimmune thrombocytopenia Fetal Diseases - diagnosis Fetal Diseases - immunology fetal medicine Fetus Fetuses Hematology Hemorrhage Humans Infant, Newborn Infant, Newborn, Diseases Integrin beta3 Literature reviews Neonates Platelet Count Platelets Pregnancy Prenatal Care Retrospective Studies Thrombocytopenia Thrombocytopenia, Neonatal Alloimmune - diagnosis Thrombocytopenia, Neonatal Alloimmune - immunology fetal and neonatal alloimmune thrombocytopenia anti-HPA-5b fetal medicine
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Summary:	Summary Most cases of fetal and neonatal thrombocytopenia (FNAIT) are caused by maternal anti‐human platelet antigen‐1a antibodies (anti‐HPA‐1a). Anti‐HPA‐5b antibodies are the second most common antibodies in suspected FNAIT cases. Given the high prevalence of anti‐HPA‐5b antibodies in pregnant women delivering healthy newborns, the association with FNAIT may be coincidental. This review of the literature related to FNAIT using the MEDLINE database was conducted according to PRISMA guidelines. A retrospective analysis of a single‐centre cohort of 817 suspected FNAIT cases was conducted. The pooled prevalence of anti‐HPA‐5b antibodies in unselected pregnant women of European descent was 1.96% (n = 3113), compared with 3.4% (n = 5003) in women with suspected FNAIT. We found weak evidence that a small proportion of pregnant women presenting with anti‐HPA‐5b antibodies will give birth to a newborn with mild thrombocytopenia. The neonatal platelet counts were not different between suspected FNAIT cases (n = 817) with and without maternal anti‐HPA‐5b antibodies. The prevalence of maternal anti‐HPA‐5b antibodies was not different between neonates with intracranial haemorrhage and healthy controls. The current experimental and epidemiological evidence does not support the hypothesis that anti‐HPA‐5b antibodies cause severe thrombocytopenia or bleeding complications in the fetus or newborn.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	0007-1048 1365-2141
DOI:	10.1111/bjh.18173