Background: Neonatal alloimmune thrombocytopenia (NAIT) is caused when maternal alloantibodies react with paternally inherited antigens present on the fetal PLTs, a reaction mainly due to antibodies against human PLT antigens. Cases in which NAIT has been caused by HLA antibodies are relatively rare. In this study, three cases of NAIT associated with HLA antibodies that occurred in a 1-year period are reported.
Study design and methods: The presence of HLA antibodies in these three NAIT case studies was elucidated by examining reactions of the neonatal and maternal sera with lymphocytes, PLTs, and beads from an HLA antibody screening test (FlowPRA, One Lambda Inc.). Absorption and elution tests with paternal cells were also conducted. In addition, the influence of titer and specificity of HLA antibodies on NAIT was analyzed in light of 24 other documented cases in Japan.
Results: In the three case studies presented herein, antibodies against human PLT antigens were found in neither the maternal nor neonatal sera, while specific HLA antibodies were identified in both sera. Absorption of maternal serum with paternal PLTs eliminated the reactivity against paternal PLTs and lymphocytes.
Conclusion: Transplacental passage of maternal HLA antibodies was observed in the three neonates cited in the present study.