Programmpunkt

09:30

Titel: Availability of CD36 negative platelets in a case of Anti-CD36 induced neonatal alloimmune thrombocytopenia (NAIT)
ID: VS-17-5
Art: Abstractvortrag
Redezeit: 10 + 5 min
Session:
Blut- und Zellprodukte: neue Verfahren und Strategien
VS-17

Referent: Brigitte K. Flesch (Bad Kreuznach)


Abstract - Text

Offenlegung Interessenkonflikt:

Es bestehen keine Interessenkonflikte. 

Methods

Platelet antibody testing was performed by Luminex PAKLx, MAIPA and flow cytometry. About 1.100 volunteer individuals from Arabian countries and Iran were screened for the presence of CD36 by flow cytometry applying double immunofluorescence on EDTA anti-coagulated peripheral blood with anti FITC labelled CD36 moab clone FA6-152 and PE labelled CD42b moab clone HIP1. Samples with CD36 deficient or borderline antigen expression were subjected to genomic DNA sequencing.

Results

An Arabian child was born with 27 platelets/nl without bleeding. Anti-CD36 was detected in the maternal serum by PAKLx. The mother"s platelets and monocytes completely lacked CD36 in flow cytometry. DNA sequencing showed compound heterozygosity for CD36*c.1079T>G (Leu360Stop) and CD36*c.220C>T (Gln74Stop) in the mother and the heterozygous CD36*c.220C>T mutation in the child. From 1,087 volunteer donors from Arabian countries, the platelets of 38 individuals were negative (2.76%) or borderline (0.74%) for CD36 and exhibited a total of 30 non-synonymous CD36 mutations. The neonate first was transfused with CD36 unselected platelets and remained stable but a CD36 negative unit was available thereafter for the case of ongoing refractoriness.

Background

CD36 isoantibodies have been reported as elicitor of neonatal alloimmune neutropenia (NAIT) in non-Caucasian individuals. Transfusion of compatible CD36 negative platelets to affected neonates is challenging when CD36 negative donors hardly can be found within the domestic donor population. We describe the successful platelet transfusion strategy in CD36 isoantibody induced NAIT in a neonate of Arabian ancestry and the CD36 screening approach in Arabian individuals.

Conclusion

In non-Caucasians CD36 is highly variable with a multitude of non-synonymous mutations inducing CD36 deficiency and potential CD36 isoimmunization. Because of increasing migration blood transfusion services should develop strategies to include donors of the respective origin in order to provide compatible platelet products for immunized patients. If no CD36 negative platelet donor should be available in NAIT cases, the first choice is transfusion of ABO matched but further unselected platelets.