Successful management of a hydropic fetus with severe anemia and thrombocytopenia caused by anti-CD36 antibody
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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.
KeywordsFoetal and neonatal alloimmune thrombocytopenia Anti-CD36 antibody Foetal anaemia and hydrops Intrauterine transfusion
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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Conflict of interest
All authors declare that there is no conflict of interest.