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Is it time to implement HPA-1 screening in pregnancy?

Husebekk, Annea,b; Killie, Mette Ka; Kjeldsen-Kragh, Jensc; Skogen, Bjørna,b

doi: 10.1097/MOH.0b013e3283317be9
Transfusion medicine and immunohematology: Edited by Martin L. Olsson

Purpose of review The purpose of the review is to argue for and against introduction of HPA-1 typing of all pregnant women to reduce morbidity and mortality caused by foetal/neonatal alloimmune thrombocytopenia (FNAIT).

Recent finding Several groups have done HPA-1 typing in cohorts of pregnant women. Results from a Norwegian study (>100 000 pregnancies) indicate that screening combined with simple intervention decreases morbidity and mortality due to FNAIT and is cost effective in Norway. Results from this study and several other studies show that there is correlation between the level of anti-HPA-1a antibodies in the mother and the severity of thrombocytopenia in the newborn. An important finding is that about 75% of women with antibodies are immunized in connection with delivery. Only 25% of the women are immunized during pregnancy.

Summary Screening for FNAIT does not fully meet the criteria presented by the WHO. Nevertheless, the results of the Norwegian study strongly indicate that morbidity and mortality related to FNAIT can be reduced. If the recent attempts to make a vaccine aimed at prevention of immunization and/or tolerizing peptides or neutralizing antibodies for already immunized women are shown to be successful, screening must be implemented.

aUniversity Hospital North Norway, Norway

bInstitute of Medical Biology, University of Tromsø, Tromsø, Norway

cDepartment of Immunology and Transfusion Medicine, Oslo University Hospital, Faculty Division Oslo University Hospital, University of Oslo, Oslo, Norway

Correspondence to Anne Husebekk, Centre for Clinical Research and Education, University Hospital North Norway, 9038 Tromsø, Norway Tel: + 47 48141286; e-mail: anne.husebekk@unn.no

© 2009 Lippincott Williams & Wilkins, Inc.