Marshall L R, Brogden F E, Roper T S, Barr A L
Pathology Department, King Edward Memorial Hospital for Women, Subiaco, Western Australia.
Transfusion. 1994 Nov-Dec;34(11):961-5. doi: 10.1046/j.1537-2995.1994.341195065033.x.
Maternal platelet antibodies can cause fetomaternal alloimmune thrombocytopenia (FMAT), which has significant mortality and morbidity even in a first pregnancy. Prenatal diagnosis of FMAT has not previously been possible in the first affected pregnancy.
Using flow cytometry, a sensitive, inexpensive test for the detection of platelet antibodies has been developed. It was adapted for use as a possible antenatal screening test, and 600 pregnant women were tested in a pilot study.
In the study group, two women tested positive for platelet-specific IgG antibodies, one for anti-HPA-1a and the other for anti-HPA-1a with anti-HLA. In each case, the fetus was found to be affected in utero, and treatment was initiated before successful delivery. Another woman was shown to have a platelet-reactive autoantibody without IgG specificity, and her infant was unaffected. A total of 95 (15.8%) of the women tested had HLA antibodies alone, and the majority demonstrated IgG specificity. On follow-up of 62 infants born to these women, none had thrombocytopenia; thus HLA antibodies were not shown to lead to FMAT in this study.
The flow cytometry-based test for platelet antibodies can detect clinically significant maternal antibodies, and it may be that early diagnosis and treatment in utero can enhance outcome in FMAT. A population screening program is planned to determine the predictive power of this test, in addition to its sensitivity, specificity, and efficiency.
母体血小板抗体可导致胎儿-母体同种免疫性血小板减少症（FMAT），即使在首次妊娠时也具有显著的死亡率和发病率。此前，在首次受影响的妊娠中无法对FMAT进行产前诊断。
利用流式细胞术开发了一种检测血小板抗体的灵敏且廉价的检测方法。该方法被改编用于可能的产前筛查试验，并在一项试点研究中对600名孕妇进行了检测。
在研究组中，两名女性血小板特异性IgG抗体检测呈阳性，一名为抗HPA-1a，另一名为抗HPA-1a合并抗HLA。在每种情况下，均发现胎儿在子宫内受到影响，并在成功分娩前开始治疗。另一名女性被证明有血小板反应性自身抗体但无IgG特异性，其婴儿未受影响。共有95名（15.8%）接受检测的女性仅具有HLA抗体，且大多数表现出IgG特异性。对这些女性所生的62名婴儿进行随访，无一例出现血小板减少症；因此，在本研究中未显示HLA抗体可导致FMAT。
基于流式细胞术的血小板抗体检测可检测出具有临床意义的母体抗体，并且子宫内的早期诊断和治疗可能会改善FMAT的结局。除了该检测方法的敏感性、特异性和效率外，还计划开展一项群体筛查项目以确定其预测能力。
