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Maternal HPA ‐1a antibody level and its role in predicting the severity of Fetal/Neonatal Alloimmune Thrombocytopenia: a systematic review
Author(s) -
Kjær Mette,
Bertrand Gerald,
Bakchoul Tamam,
Massey Edwin,
Baker Jillian M.,
Lieberman Lani,
Tanael Susano,
Greinacher Andreas,
Murphy Michael F.,
Arnold Donald M.,
Baidya Shoma,
Bussel James,
Hume Heather,
Kaplan Cécile,
Oepkes Dick,
Ryan Greg,
Savoia Helen,
Shehata Nadine,
KjeldsenKragh Jens
Publication year - 2019
Publication title -
vox sanguinis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.68
H-Index - 83
eISSN - 1423-0410
pISSN - 0042-9007
DOI - 10.1111/vox.12725
Subject(s) - neonatal alloimmune thrombocytopenia , medicine , prospective cohort study , antibody , obstetrics , pregnancy , isoantibodies , fetus , retrospective cohort study , predictive value of tests , immunology , antenatal screening , biology , genetics
Background and Objectives In Caucasians, fetal/neonatal alloimmune thrombocytopenia ( FNAIT ) is most commonly due to maternal HPA ‐1a antibodies. HPA ‐1a typing followed by screening for anti‐ HPA ‐1a antibodies in HPA ‐1bb women may identify first pregnancies at risk. Our goal was to review results from previous published studies to examine whether the maternal antibody level to HPA ‐1a could be used to identify high‐risk pregnancies. Materials and Methods The studies included were categorized by recruitment strategies: screening of unselected pregnancies or samples analyzed from known or suspected FNAIT patients. Results Three prospective studies reported results from screening programmes, and 10 retrospective studies focused on suspected cases of FNAIT . In 8 studies samples for antibody measurement, performed by the monoclonal antibody immobilization of platelet antigen ( MAIPA ) assay, and samples for determining fetal/neonatal platelet count were collected simultaneously. In these 8 studies, the maternal antibody level correlated with the risk of severe thrombocytopenia. The prospective studies reported high negative predictive values (88–95%), which would allow for the use of maternal anti‐ HPA ‐1a antibody level as a predictive tool in a screening setting, in order to identify cases at low risk for FNAIT . However, due to low positive predictive values reported in prospective as well as retrospective studies (54–97%), the maternal antibody level is less suited for the final diagnosis and for guiding antenatal treatment. Conclusion HPA ‐1a antibody level has the potential to predict the severity of FNAIT .