Risk of HPA-1a–immunization in HPA-1a–negative women after giving birth to an HPA-1a–positive child
(2019) In Transfusion 59(4). p.1344-1352- Abstract
BACKGROUND: Fetal/neonatal alloimmune thrombocytopenia (FNAIT) is the platelet counterpart of hemolytic disease of the newborn. Most severe cases of FNAIT are caused by antibodies against human platelet antigen-1a (HPA-1a). HPA-1a–negative women giving birth to an HPA-1a–positive child are at risk of becoming HPA-1a–immunized, particularly women who are HLA-DRB3*01:01–positive. The aim of the study was to estimate the risk of HPA-1a–immunization in both HPA-1a–negative/HLA-DRB3*01:01–positive and HPA-1a–negative/HLA-DRB3*01:01–negative women after delivery of an HPA-1a–positive child. STUDY DESIGN AND METHODS: A literature search was conducted, which identified 10 prospective FNAIT studies. The risk of becoming HPA-1a–immunized... (More)
BACKGROUND: Fetal/neonatal alloimmune thrombocytopenia (FNAIT) is the platelet counterpart of hemolytic disease of the newborn. Most severe cases of FNAIT are caused by antibodies against human platelet antigen-1a (HPA-1a). HPA-1a–negative women giving birth to an HPA-1a–positive child are at risk of becoming HPA-1a–immunized, particularly women who are HLA-DRB3*01:01–positive. The aim of the study was to estimate the risk of HPA-1a–immunization in both HPA-1a–negative/HLA-DRB3*01:01–positive and HPA-1a–negative/HLA-DRB3*01:01–negative women after delivery of an HPA-1a–positive child. STUDY DESIGN AND METHODS: A literature search was conducted, which identified 10 prospective FNAIT studies. The risk of becoming HPA-1a–immunized postpartum was calculated by Bayes' theorem. The results of HLA-DRB3/4/5 typing of 212,472 European Caucasians from the National Marrow Donor Program were used as estimate of the frequency of the HLA-DRB3*01:01 allele. RESULTS: In HPA-1a–negative/HLA-DRB3*01:01–positive women, the risk of HPA-1a–immunization after delivery of an HPA-1a–positive child was estimated to 12.7% (95% confidence interval, 8.6%–16.8%) as compared to 0.5% (95% confidence interval, 0.1%–0.9%) in women who were HLA-1a–negative/HLA-DRB3*01:01–negative. Potential differences between nulliparous and multiparous and the role of one versus two doses of HLA-DRB3*01:01 could not be determined. CONCLUSION: In HPA-1a–negative/HLA-DRB3*01:01–positive women, the risk of HPA-1a–immunization is 12.7% after delivery of an HPA-1a–positive child, which is 25 times higher than in HPA-1a–negative/HLA-DRB3*01:01–negative women. Thus, the risk of HPA-1a–immunization in high-risk pregnancies is in the same range as the risk of RhD immunization in RhD-negative women after delivery of a RhD-positive child without RhD prophylaxis.
(Less)
- author
- Kjeldsen-Kragh, Jens LU and Olsen, Klaus Juel
- organization
- publishing date
- 2019-02-06
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Transfusion
- volume
- 59
- issue
- 4
- pages
- 1344 - 1352
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85061313161
- pmid:30729532
- ISSN
- 0041-1132
- DOI
- 10.1111/trf.15152
- language
- English
- LU publication?
- yes
- id
- 63da3122-e566-406a-ae60-baeb38b49e52
- date added to LUP
- 2019-02-22 10:31:41
- date last changed
- 2024-06-11 05:28:49
@article{63da3122-e566-406a-ae60-baeb38b49e52, abstract = {{<p>BACKGROUND: Fetal/neonatal alloimmune thrombocytopenia (FNAIT) is the platelet counterpart of hemolytic disease of the newborn. Most severe cases of FNAIT are caused by antibodies against human platelet antigen-1a (HPA-1a). HPA-1a–negative women giving birth to an HPA-1a–positive child are at risk of becoming HPA-1a–immunized, particularly women who are HLA-DRB3*01:01–positive. The aim of the study was to estimate the risk of HPA-1a–immunization in both HPA-1a–negative/HLA-DRB3*01:01–positive and HPA-1a–negative/HLA-DRB3*01:01–negative women after delivery of an HPA-1a–positive child. STUDY DESIGN AND METHODS: A literature search was conducted, which identified 10 prospective FNAIT studies. The risk of becoming HPA-1a–immunized postpartum was calculated by Bayes' theorem. The results of HLA-DRB3/4/5 typing of 212,472 European Caucasians from the National Marrow Donor Program were used as estimate of the frequency of the HLA-DRB3*01:01 allele. RESULTS: In HPA-1a–negative/HLA-DRB3*01:01–positive women, the risk of HPA-1a–immunization after delivery of an HPA-1a–positive child was estimated to 12.7% (95% confidence interval, 8.6%–16.8%) as compared to 0.5% (95% confidence interval, 0.1%–0.9%) in women who were HLA-1a–negative/HLA-DRB3*01:01–negative. Potential differences between nulliparous and multiparous and the role of one versus two doses of HLA-DRB3*01:01 could not be determined. CONCLUSION: In HPA-1a–negative/HLA-DRB3*01:01–positive women, the risk of HPA-1a–immunization is 12.7% after delivery of an HPA-1a–positive child, which is 25 times higher than in HPA-1a–negative/HLA-DRB3*01:01–negative women. Thus, the risk of HPA-1a–immunization in high-risk pregnancies is in the same range as the risk of RhD immunization in RhD-negative women after delivery of a RhD-positive child without RhD prophylaxis.</p>}}, author = {{Kjeldsen-Kragh, Jens and Olsen, Klaus Juel}}, issn = {{0041-1132}}, language = {{eng}}, month = {{02}}, number = {{4}}, pages = {{1344--1352}}, publisher = {{Wiley-Blackwell}}, series = {{Transfusion}}, title = {{Risk of HPA-1a–immunization in HPA-1a–negative women after giving birth to an HPA-1a–positive child}}, url = {{http://dx.doi.org/10.1111/trf.15152}}, doi = {{10.1111/trf.15152}}, volume = {{59}}, year = {{2019}}, }