Diagnostik und Therapie einer Anti-CD36-induzierten neonatalen Alloimmunthrombozytopenie

Zusammenfassung

Mütterliche Antikörper gegen das HPA-1a auf kindlichen Thrombozyten sind der Hauptverursacher einer fetalen oder neonatalen Alloimmunthrombozytopenie (FNAIT). In asiatischen Populationen wurden wiederholt Isoantikörper gegen CD36 als ursächlich im Zusammenhang mit der FNAIT beschrieben, wohingegen in Mitteleuropa die CD36-Defizienz und damit die Möglichkeit einer Immunisierung praktisch unbekannt sind. Das erschwert deutlich die Transfusion mit kompatiblen Thrombozyten bei FNAIT-Fällen, z. B. bei Neugeborenen asiatischer Abstammung. Bei einem Neugeborenen arabischstämmiger Eltern wurde eine Anti-CD36-induzierte FNAIT diagnostiziert. Die Thrombozytenwerte konnten erfolgreich durch die Gabe HPA-unausgewählter Apheresethrombozytenkonzentrate (ATK) stabilisiert werden. Durch ein vorangegangenes Forschungsprojekt zum CD36-Screening bei Blutspendern arabischer Herkunft stand zusätzlich kurz darauf ein ATK mit sehr schwacher CD36-Expression zur Verfügung, das aber nicht mehr benötigt wurde. Dieser Fall weist somit alternative Therapiemöglichkeiten bei einer Anti-CD36-induzierten FNAIT auf.

Abstract

Maternal antibodies to HPA-1a on platelets of the child are the main cause of fetal or neonatal alloimmune thrombocytopenia (FNAIT). In Asian populations isoantibodies to CD36 have been described repeatedly as causative for FNAIT whereas CD36 deficiency and thus the chance to get immunized are virtually unknown in middle European countries. This circumstance aggravates the transfusion of compatible platelets in FNAIT, e.g. in newborns of Asian ancestry. A newborn of Arabian origin was diagnosed with an anti-CD36 induced FNAIT. Platelet counts could be successfully stabilized by transfusion of HPA unselected apheresis platelets. As a result of an earlier research project on a CD36 screening within Arabian blood donors, additionally a platelet concentrate with very weak CD36 expression was available shortly thereafter but was not needed any longer. This case demonstrates alternative therapeutic approaches in CD36 induced FNAIT.

Schlüsselwörter

fetale/neonatale Alloimmunthrombozytopenie (FNAIT) - CD36-spezifischer Isoantikörper - Mutter-Kind-Unverträglichkeit

Key words

fetal/neonatal alloimmune thrombocytopenia (FNAIT) - CD36-specific iso-antibody - feto-maternal incompatibility

Publikationsverlauf

Artikel online veröffentlicht:
27. August 2021

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