Prospects for risk stratification of anti-HPA-1a alloimmunized pregnant women

• Published in: Transfusion and apheresis science Vol. 59; no. 1; p. 102709
• Main Author: Sachs, Ulrich J.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-02-2020
• Subjects: Anti-endothelial activity; Antibody glycosylation; Antigens, Human Platelet - immunology; Female; Fetal/neonatal alloimmune thrombocytopenia; FNAIT; Health technology assessment; Humans; Pregnancy; Risk Assessment; Risk stratification; Anti-endothelial activity; Fetal/neonatal alloimmune thrombocytopenia; FNAIT; Antibody glycosylation; Risk stratification
• ISSN: 1473-0502; 1878-1683
• DOI: 10.1016/j.transci.2019.102709

A diagnosis of fetal/neonatal alloimmune thrombocytopenia (FNAIT) is made if a platelet-specific antibody is detected in the mother and the fetus or newborn carries the cognate antigen. Some children will experience very low platelet counts or even intracranial hemorrhage with devastating consequences, whereas others are largely unaffected. At the moment, predictive tools to forecast the severity of FNAIT during pregnancy are not available and over- or under-treatment may put the mother or the fetus at risk. A number of potential modulators of FNAIT severity have been reported. Maternal immune responses differ in respect to the IgG subtype composition, the glycosylation pattern of the antibodies, their fine specificity, and their functional effects on platelets, the trophoblast, and endothelial cells. In addition, antibody levels are variable. The efficacy of IgG transfer and, on the fetal side, gender and inflammatory responses, were also investigated for their potential impact on FNAIT severity. These potential risk modulators are scrutinized for available experimental and clinical evidence. Antibody glycosylation and anti-endothelial activity are hot candidates which, most likely in conjunction with the antibody level, should be explored further as tools to stratify fetal risk.