Neonatal alloimmune thrombocytopenia and neutropenia associated with
maternal human leucocyte antigen antibodies and drug-induced hemolytic
anemia
Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is commonly
associated with antibodies against platelet antigens, and alloimmune
neonatal neutropenia (ANN) is frequently caused by anti-neutrophil
antibodies. Human leukocyte antigen (HLA) antibodies are rarely reported
to result in FNAIT or ANN, let alone the combination of FNAIT and ANN.
We report here a very unusual case of a first twin pregnancy produced in
vitro by donated oocytes where the mother developed markedly elevated
HLA antibodies in the absence of anti-platelet or anti-neutrophil
antibodies that provoked severe thrombocytopenia and neutropenia in one
of the twins. In addition, drug-induced hemolytic anemia (DIHA) that
required red blood cell transfusion was detected in this twin. We
hypothesize that the complete HLA-incompatible twin pregnancy due to
oocyte donation might have contributed to the severity of the clinical
manifestations.