抗HPA-3a抗体所致新生儿同种免疫性血小板减少性紫癜一例并文献复习  

A case of neonatal alloimmune thrombocytopenia purpura caused by anti HPA-3a antibody and litera-ture review

作　　者：周燕 钟周琳 李丽兰 申卫东 刘金莲 吴国光 

机构地区：[1]南宁中心血站南宁输血医学研究所,530003

出　　处：《中华血液学杂志》2013年第1期45-48,共4页Chinese Journal of Hematology

基　　金：广西科学研究与技术开发计划项目（主席资金08160-05）

摘　　要：目的探讨抗血小板特异性抗原（HPA）-3a抗体所致新生儿同种免疫性血小板减少性紫癜（NAITP）的诊断和治疗。方法采用多重PCR及基因测序技术检测1例出血伴血小板减少新生儿及其父母HPA-1～21bw系统基因型，采用流式细胞术（FCM）和血小板抗原单克隆抗体特异性免疫固定检测技术（MAIPA）检测患儿及其母亲血清血小板特异性抗体并进行特异性鉴定。结果患儿出生后2h出现全身多发皮下出血点、血尿及咖啡色呕吐物。基因分型显示患儿为HPA-3ab、母亲为HPA-3bb、父亲为HPA-3aa；患儿及母亲血清中均含与患儿父亲血小板反应的特异性抗体，经MAIPA技术鉴定为抗HPA-3a抗体。结论发现1例抗HPA-3a抗体所致NAITP患者，通过临床特征分析为该病的诊断和治疗提供借鉴与参考。Objective To explore the diagnosis and treatment of a case of neonatal alloimmune thrombocytopenia purpura （NAITP） caused by anti HPA-3a antibody. Methods The platelet counts and purpuric symptom in the newborn were clinical examined. The HPA-1-21bw genotypes of the newborn and his parents were detected by multiple DNA-PCR, gene sequencing and genotyping. The HPA specificity antibody in the sera of newborn and his mother were detected by flow cytometry （ FCM）, and the HPA specificity anti- body was identified by monoclonal antibody-specific immobilization of platelet antigens （MAIPA）. Results The newborn had the typical symptom of NAITP, multiple subcutaneous petechia, hematuria and coffee -like vomitus. The HPA genotype of the newborn was HPA-3ab, while that of his mother and his father were HPA- 3bb and HPA-3aa, respectively. The sera of newborn and his mother existed antibody against the platelet of newborn＇ s father. The HPA antibody of the newborn and his mother were identified as anti HPA-3a. The newborn was approved a patient of NAITP caused by anti HPA-3a antibody. Conclusion The diagnosis and treatment for NAITP newborn caused by anti HPA-3a antibody in this study was the first domestic report. It could provide successful experiences and references for the similar cases.

关 键 词：血小板减少 新生儿同种免疫性 流式细胞术 抗原 人血小板 聚合酶链反应 

分 类 号：R722.1[医药卫生—儿科]