Versorgung einer Zweitschwangerschaft nach fetaler/neonataler Alloimmunthrombozytopenie (FNAIT) von HPA-1a-heterozygotem Vater

 

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Zusammenfassung

Die fetale/neonatale Alloimmunthrombozytopenie (FNAIT) ist das thrombozytäre Äquivalent zum Morbus haemolyticus neonatorum, kann jedoch im Gegensatz zu diesem bereits in der ersten Schwangerschaft auftreten. Die Ursache sind plazentagängige mütterliche Alloantikörper gegen vom Vater vererbte humane Plättchenantigene (HPA). Am häufigsten sind Anti-HPA-1a-Antikörper, die klinisch eher mit schwerwiegenden Verläufen einschließlich Hirnblutungen assoziiert sind. Das Wiederholungsrisiko für Folgeschwangerschaften beträgt meist 100 %, bei HPA-1a-heterozygotem Vater jedoch nur 50 %. Anhand einer Kasuistik wird über neuere diagnostische und therapeutische Optionen unter besonderer Berücksichtigung der fetalen HPA-Typisierung aus peripherem mütterlichem Blut berichtet.

Abstract

Fetal/neonatal alloimmune thrombocytopenia (FNAIT) is the platelet counterpart to the haemolytic disease of the newborn, but may already occur during the first pregnancy. It is caused by maternal allo-antibodies against human platelet antigens (HPA) that the fetus inherited from the father. The most common specificity is anti-HPA-1a, which is associated with rather severe clinical courses including intracranial haemorrhages. Unfortunately, the recurrence risk for further pregnancies is quite often 100 %. However, it is only 50 % if the father is heterozygous for HPA-1a. New options in diagnosis and therapy are reported based on a recent case with focus on the fetal HPA-1 genotyping from maternal peripheral blood.

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