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Successful management of a hydropic fetus with severe anemia and thrombocytopenia caused by anti-CD36 antibody

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Abstract

Cases of CD36 deficiency are not rare in Asian populations, foetal and neonatal alloimmune thrombocytopenia (FNAIT) caused by anti-CD36 isoantibodies appears more frequent than other HPA alloantibodies. However, little is known about the treatment of anti-CD36 mediated FNAIT in this region. A Chinese male foetus, whose mother had a history of multiple intrauterine foetal demise and/or hydrops, was diagnosed with severe FNAIT at 27 weeks of gestational age. Immunological analysis revealed total absence of CD36 on platelets and monocytes from mother, caused by a 329–330delAC mutation of the CD36 gene. Anti-CD36 and anti-HLA class I antibodies were detected in the maternal serum, whereas only anti-CD36 isoantibodies were detectable in the foetal blood sample. Serial intrauterine transfusions with red blood cells (RBC) and platelets from a CD36null donor were performed to improve the severe anaemia and thrombocytopenia. The baby (2250 g; Apgar scores 10) was delivered vaginally at 32 weeks of gestation with normal haemoglobin (186 g/L) but low platelet count (48 × 109/L). After 2 days the platelet count rose to 121 × 109/L. This report suggests that intrauterine transfusions with compatible RBC and CD36null platelets are useful in preventing the deleterious clinical effects of anti-CD36-mediated severe FNAIT.

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Acknowledgements

This work was supported by the grant from National Natural Science Foundation of China (Ref. number: 81601451), by the Natural Science Foundation of Guangdong Province of China (no. 2016A030313124/no. 2016A030313123), by the German Research Foundation, Excellence Cluster Cardiopulmonary System (to S. S.), and by Science and Technology and Innovative Commission of Guangzhou City (no. 201607010007/no. 201509010009/no. 201707010021).

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Author notes

  1. Xiuzhang Xu and Lin Li contributed equally to this work.

Authors and Affiliations

  1. Institute of Blood Transfusion, Guangzhou Blood Centre, 31 LuYuan Road, Guangzhou, 510095, Guangdong, People’s Republic of China

    Xiuzhang Xu, Wenjie Xia, Haoqiang Ding, Dawei Chen, Jing Liu, Jing Deng, Yangkai Chen, Jiali Wang, Yuan Shao, Sentot Santoso & Xin Ye

  2. Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University, Giessen, Germany

    Xiuzhang Xu & Sentot Santoso

  3. Fetal Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, 58 ZhongShan 2nd Road, Guangzhou, 510080, Guangdong, People’s Republic of China

    Lin Li, Zhiming He & Qun Fang

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  1. Xiuzhang Xu
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Correspondence to Xin Ye or Qun Fang.

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Xu, X., Li, L., Xia, W. et al. Successful management of a hydropic fetus with severe anemia and thrombocytopenia caused by anti-CD36 antibody. Int J Hematol 107, 251–256 (2018). https://doi.org/10.1007/s12185-017-2310-5

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  • DOI: https://doi.org/10.1007/s12185-017-2310-5

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