Background and Objectives: Neonatal alloimmune thrombocytopenia is usually attributable to HPA-la antibodies. We report a case of parental platelet antigen incompatibility associated with a severe neonatal thrombocytopenia secondary to alloimmunization to HPA-3a. Materials and Methods: Platelet antibodies were detected by the monoclonal antibody-specific immobilization of platelet antigens, genotyping of the platelets by PCR, and HLA typing by serologic procedures and PCR. Results: Genotyping of maternal and paternal platelets confirmed the incompatibility in the HPA-3a system. It is noteworthy that the mother is of the HLA type DRB3*0101, is ABO-incompatible with her husband, and also has HLA class I antibodies. Conclusion: Severe neonatal thrombocytopenia associated with HPA-3a alloimmunization is infrequent and all the factors mentioned above could have played a role in the severity of the disease.

Mueller-Eckhardt C, Kiefel V, Grubert A, Kroll H, Weisheit M, Schmidt S, Mueller-Eckhardt G, Santoso S: 348 cases of suspected neonatal alloimmune thrombocytopenia. Lancet 1989;i:363–366.
Durand-Zaleski I, Schlegel N, Blum-Boisgard C, Uzan S, Dreyfus M, Kaplan C: Screening primiparous women and newborns for fetal/neonatal alloimmune thrombocytopenia: A prospective comparison of effectiveness and costs. Am J Perinatol 1996;7:423–431.
Panzer S, Auerbach L, Cechova E, Fischer G, Holensteiner A, Kittl EM, Mayr WR, Putz M, Wagenbichler P, Walchshofer A: Maternal alloimmunization against fetal platelet antigen: A prospective study. Br J Haematol 1995;90:655–660.
Blanchette VS, Chen L, Salomon de Friedberg Z, Hogan VA, Trudel E, Decary F: Alloimmunization to the PlA1 platelet antigen: Results of a prospective study. Br J Haematol 1990;74:209–215.
Von dem Borne AEGK, van Leeuwen EF, von Riesz LE, van Boxtel CJ, Engelfriet CP: Neonatal alloimmune thrombocytopenia: Detection and characterization of the responsible antibodies by the platelet immunofluorescence test. Blood 1981;57:649–656.
Kiefel V, Santoso S, Katzmann B, Mueller-Eckhardt C: A new platelet-specific alloantigen Bra. Report of 4 cases with neonatal alloimmune thrombocytopenia. Vox Sang 1988;54:101–106.
Kaplan C, Morel-Kopp MC, Kroll H, Kiefel V, Schlegel N, Chesnel N, Mueller-Eckhardt C: HPA-5b (Bra) neonatal alloimmune thrombocytopenia: Clinical and immunological analysis of 39 cases. Br J Haematol 1991;78:425–429.
Friedman JM, Aster RH: Neonatal alloimmune thrombocytopenic purpura and congenital porencephaly in two siblings associated with a ‘new’ maternal antiplatelet antibody. Blood 1985;65:1412–1415.
Shibata Y, Matsuda I, Miyaji T, Ichikawa Y: Yuka, a new platelet antigen involved in two cases of neonatal immune thrombocytopenia. Vox Sang 1986;50:177–180.
Kekomäki R, Jouhikainen T, Ollikainen J, Westman P, Laes M: A new platelet antigen, Tua, on glycoprotein IIIa associated with neonatal alloimmune thrombocytopenia in two families. Br J Haematol 1993;83:306–310.
Kroll H, Kiefel V, Santoso S, Mueller-Eckhardt C: Sra, a private platelet antigen on glycoprotein IIIa associated with neonatal alloimmune thrombocytopenia. Blood 1990;76:2296–2302.
Kekomäki R, Raivio P, Kero P: A new low-frequency platelet alloantigen, Vaa, on glycoprotein IIb/IIIa associated with neonatal alloimmune thrombocytopenia. Transfus Med 1992;2:27–33.
Simsek S, Vlekke AB, Kuijpers RW, Goldschmeding R, von dem Borne AE: A new private platelet antigen, Groa, localised on glycoprotein IIIa, involved in neonatal alloimmune thrombocytopenia. Vox Sang 1994;67:302–306.
Noris P, Simsek S, de Bruijne-Admiraal LG, Porcelijn L, Huiskes E, van der Vlist GJ, van Leeuwen EF, van der Schoot CE, von dem Borne AE: Max(a), a new low-frequency platelet-specific antigen localised on glycoprotein IIb, is associated with neonatal alloimmune thrombocytopenia. Blood 1995;86:1019–1026.
Kiefel V, Santoso S, Weisheit M, Mueller-Eckhardt C: Monoclonal antibody-specific immobilization of platelet antigens (MAIPA): A new tool for the identification of platelet-reactive antibodies. Blood 1987;70:1722–1726.
Simsek S, Faber NM, Bleeker PM, Vlekke ABJ, Huiskes E, Goldschmeding R, von den Borne AEG: Determination of human platelet antigen frequencies in the Dutch population by immunophenotyping and DNA (allele-specific restriction enzyme) analysis. Blood 1993;81:835–840.
Cros P, Allibert P, Mandrand B, Tiercy J-M, Mach B: Oligonucleotide genotyping of HLA polymorphism on microtitre plates. Lancet 1992;340:870–873.
Kaplan C, Dehan M, Tchernia G: Fetal and neonatal thrombocytopenia. Platelets 1992;3:61–67.
Muller JY: Alloimmune thrombocytopenia in the newborn. Curr Stud Hematol Blood Transfus 1988;55:94–103.
Herman JH, Jumbelic MI, Ancona RJ, Kickler TS: In utero cerebral hemorrhage in alloimmune thrombocytopenia. Am J Pediatr Hematol Oncol 1986;8:312–317.
Giovangrandi Y, Daffos F, Kaplan C, Forestier F, Mac Aleese J, Moirot M: Very early intracranial haemorrhage in alloimmune thrombocytopenia. Lancet 1990;336:310.
Kuijpers RW, van den Anker JN, Baerts W, von dem Borne AEGK: A case of severe neonatal thrombocytopenia with schizencephaly associated with anti-HPA-1b and anti-HPA-2a. Br J Haematol 1994;87:576–579.
Von dem Borne AE, von Riesz E, Vergheut FW, ten Cate JW, Koppe JG, Engelfriet CP, Nijenhuis LE: Baka, a new platelet specific antigen involved in neonatal alloimmune thrombocytopenia. Vox Sang 1980;39:113–120.
Miller DT, Etzel RA, McFarland JG, Aster RH, White GC II: Prolonged neonatal alloimmune thrombocytopenic purpura associated with anti-Baka. Two cases in siblings. Am J Perinatol 1987;4:55–58.
Hidajat M, Deckx H, van Eygen M, Logghe N, Criel A: Neonatal alloimmune thrombocytopenic purpura induced by anti-Baka: A case report and review of the literature. Acta Clin Belg 1989;44:377–382.
McGrath K, Minchinton R, Cunningham I, Ayberk H: Platelet anti-Bakb antibody associated with neonatal alloimmune thrombocytopenia. Vox Sang 1989;57:182–184.
Nathan FE, Herman JH, Keashen-Schnell M, McFarland JG, Besa EC, Hadley C, Catalano PM: Anti-Bak(a) neonatal alloimmune thrombocytopenia: Possible prevention by intravenous immunoglobulin. Pediatr Hematol Oncol 1994;11:325–329.
Eisen M, Motum P, Gibson J, Uhr E, Gett M, Kronenberg H, Wylie B: Neonatal alloimmune thrombocytopenia caused by an antibody to the Bak(a) antigen. Pathology 1990;22:203–205.
Helmerhorst FM, van Oss JC, Bruynes ECE, Engelfriet CP, von dem Borne AEGK: Elution of granulocyte and platelet antibodies. Vox Sang 1982,43:196–204.
Holensteiner A, Walchshofer S, Adler A, Kittl EM, Mayr WR, Panzer S: Human platelet antigen gene frequencies in the Austrian population. Haemostasis 1995;25:133–136.
Morel-Kopp MC, Daviet L, McGregor J, Kaplan C: Drawbacks of the MAIPA technique in characterising human antiplatelet antibodies. Blood Coagul Fibrinolysis 1996;7:144–146.
Valentin N, Vergracht A, Bignon JD, Cheneau ML, Blanchard D, Kaplan C, Reznikoff-Etievant MF, Muller JY: HLA-DRW52 is involved in alloimmunization against P1-A1 antigen. Hum Immunol 1990;27:73–79.
Semana G, Zazoun T, Alizadeh M, Morel-Kopp MC, Genetet B, Kaplan C: Genetic susceptibility and anti-human antigen 5b alloimmunization. Role of HLA class II and TAP genes. Hum Immunol 1996;46:114–119.
Sternbach MS, Malette M, Nadon F, Guevin RM: Severe alloimmune neonatal thrombocytopenia due to specific HLA antibodies. Curr Stud Hematol Blood Transfus 1988;52:97–103.
Santoso S, Kiefel V, Mueller-Eckhardt C: Blood group A and B determinants are expressed on platelet glycoproteins IIa, IIIa and Ib. Thromb Haemost 1991;65:196–210.
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