The implementation of surface plasmon resonance technique in monitoring pregnancies with expected fetal and neonatal alloimmune thrombocytopenia

Background Maternal anti‐HPA‐1a alloantibodies are responsible for most cases of severe fetal and neonatal alloimmune thrombocytopenia (FNAIT). The presence of HPA‐1a alloantibodies in maternal blood alone does not predict the fetal platelet (PLT) count, and the predictivity of antibody titers deter...

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Bibliographic Details
Published in:Transfusion (Philadelphia, Pa.) Pa.), 2013-09, Vol.53 (9), p.2078-2085
Main Authors: Bakchoul, Tamam, Bertrand, Gérald, Krautwurst, Annika, Kroll, Hartmut, Bein, Gregor, Sachs, Ulrich J., Santoso, Sentot, Kaplan, Cécile
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Antigens, Human Platelet - immunology
Biological and medical sciences
Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis
Female
Hematologic and hematopoietic diseases
Humans
Immunoglobulins - therapeutic use
Infant, Newborn
Isoantibodies - immunology
Medical sciences
Medical treatment
Platelet diseases and coagulopathies
Pregnancy
Steroids - therapeutic use
Surface Plasmon Resonance - methods
Thrombocytopenia, Neonatal Alloimmune - diagnosis
Thrombocytopenia, Neonatal Alloimmune - drug therapy
Thrombocytopenia, Neonatal Alloimmune - immunology
Transfusions. Complications. Transfusion reactions. Cell and gene therapy
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Summary:Background Maternal anti‐HPA‐1a alloantibodies are responsible for most cases of severe fetal and neonatal alloimmune thrombocytopenia (FNAIT). The presence of HPA‐1a alloantibodies in maternal blood alone does not predict the fetal platelet (PLT) count, and the predictivity of antibody titers determined by enzyme immunoassays (EIAs) is debated. In contrast to EIA, surface plasmon resonance (SPR) provides information on antibody‐binding properties. Study Design and Methods Sequential sera from pregnant women with expected FNAIT were assessed for HPA‐1a alloantibodies using SPR. Group I (n = 6) was treated with intravenous immunoglobulin (IVIG) and steroids beginning at 19 weeks of gestation (w.g.), and Group II (n = 4) received intrauterine PLT transfusions (IUT) beginning at 22 w.g. Maternal alloantibodies were quantified using an HPA‐1a monoclonal antibody (MoAb) as a standard. Antibody avidity was determined as the ratio of B700 (end of the dissociation phase) to B350 (end of the association phase); the area under the curve (AUC) was calculated to determine overall antibody binding. Results After 22 w.g., alloantibody characteristics remained stable in both groups, while there was a steep decrease in B700 and B350 values between 16 and 22 w.g. (assessed only in Group I), indicating a decrease in anti‐HPA‐1a alloantibody concentrations. Interestingly, the AUCs of the last maternal sample before elective delivery appeared to be correlated with fetal and neonatal PLT counts (p = 0.014 and 0.017, respectively). Conclusion SPR provides quantitative information on HPA‐1a alloantibody characteristics in addition to monoclonal antibody–specific immobilization of platelet antigens. SPR results can be calibrated using a MoAb standard and should be further assessed for a potential correlation with fetal PLT count.
ISSN:0041-1132
1537-2995
DOI:10.1111/trf.12051