Background: Neonatal alloimmune thrombocytopenia is a rare condition due to passively acquired maternal antibodies directed against paternal platelet antigens inherited by the infant. Only 5 cases have been reported due to antibodies against HPA-1b (PLA2) (Zwb). Case Report: We report a case of neonatal alloimmune thrombocytopenia due to anti-HPA-1b in the second pregnancy of a 26-year-old Caucasian female. The male infant was treated with a 5-day course of intravenous immunoglobulin without complications. We report the HLA phenotype of the infant’s mother and summarize the previous case reports due to anti-HPA-1b. Conclusion: Based on this case and a review of the literature, intravenous immunoglobulin as well as random donor exchange transfusion and random donor platelet transfusions are effective in the treatment of neonatal alloimmune thrombocytopenia due to anti-HPA-1b. Obvious associations between HLA alleles and sensitization to HPA-1b have not been elucidated.

1.
Blanchette VS: Neonatal alloimmune thrombocytopenia: A clinical perspective. Curr Stud Hematol Blood Transfus 1988, pp 112–126.
2.
Blanchette VS, Chen L, de Freidberg ZS, Hogan VA, Trudel E, Decary F: Alloimmunization to the PLA1 platelet antigen: Results of a prospective study. Br J Haematol 1990;74:209–215.
3.
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;1:363–366.
4.
Mueller-Eckhardt C, Becker T, Weisheit M, Witz C, Santoso S: Neonatal alloimmune thrombocytopenia due to fetomaternal Zwb incompatibility. Vox Sang 1986;50:94–96.
5.
Maslanka K, Lucas GF, Gronkowska A, Davis JG, Zupanska B: A second case of neonatal alloimmune thrombocytopenia associated with anti-PLA2 (Zwb) antibodies. Haematologia (Budap) 1989;22:109–113.
6.
Kuijpers RW, van den Anker JN, Baerts W, von dem Borne AE: A case of severe neonatal thrombocytopenia with schizencephaly associated with anti-HPA-1b and anti-HPA-2a. Br J Haematol 1994;87:576–579.
7.
van den Anker J, Huiskes E, Porcelein L, von dem Borne AE: Anti-HPA-1b really causes neonatal thrombocytopenia. Br J Haematol 1995;89:428.
8.
Moser R, Fae I, Neumeister A, Pober M, Mutz I, Panzer S: Neonatal allo-immune thrombocytopenia due to fetomaternal HPA-1 incompatibility of a homozygous HPA-1a mother and a homozygous HPA-1b father. A case report. Eur J Pediatr 1994;153:95–97.
9.
Mercier P, Chicheportiche C, Reviron D, Dabanian C, Bourgue F, Chiaroni J, Diallo M, Delord Y: Neonatal thrombocytopenia in HLA-DR, -DQ, -DP-typed mother due to rare anti-HPA-1b (PLA2) (Zwb) fetomaternal immunization. Vox Sang 1994;67:46–51.
10.
Kroll H, Kiefel V, Mueller-Eckhardt G, Santoso S, Mueller-Eckhardt C: 219 Zw(a) positive mothers of children with clinically suspected neonatal alloimmune thrombocytopenia. Beitr Infusionsther 1990;26:397–400.
11.
Schechter Y, Zeides I, Shalev E, Sharon R: Neonatal alloimmune thrombocytopenia. Harefuah 1994;127:505–508, 576.
12.
Kuijpers RW, von dem Borne AE, Kiefel V, Eckhardt CM, Waters AH, Zupanska B, Barz D, Taaning E, Termijtelen A, Ouwehand WH: Leucine33-proline33 substitution in human platelet glycoprotein IIIa determines HLA-DRw52a (Dw24) association of the immune response against HPA-1a (Zwa/PLA1) and HPA-1b (Zwb/PLA2). Hum Immunol 1992;34:253–256.
13.
Mueller-Eckhardt C, Mueller-Eckhardt G, Willen-Ohff H, Horz A, Kuenzlen E, O’Neill GJ, Schendel DJ: Immunogenicity of and immune response to the human platelet antigen Zwa is strongly associated with HLA-B8 and DR3. Tissue Antigens 1985;26:71–76.
14.
de Waal LP, van Dalen CM, Engelfriet CP, von dem Borne AE: Alloimmunization against the platelet-specific Zwa antigen, resulting in neonatal alloimmune thrombocytopenia or posttransfusion purpura, is associated with the supertypic DRw52 antigen including DR3 and DRw6. Hum Immunol 1986;17:45–53.
15.
Mueller-Eckhardt C, Kiefel V, Kroll H, Mueller-Eckhardt G: HLA-DRw6, a new immune response marker for immunization against the platelet alloantigen Bra. Vox Sang 1989;57:90–91.
16.
Menitove JE, Pereira J, Hoffman R, Anderson T, Fried W, Aster RH: Cyclic thrombocytopenia of apparent autoimmune etiology. Blood 1989;73:1561–1569.
17.
McFarland JG, Aster RH, Bussel JB, Gianopoulos JG, Derbes RS, Newman PJ: Prenatal diagnosis of neonatal alloimmune thrombocytopenia using allele-specific oligonucleotide probes. Blood 1991;78:2276–2282.
18.
Olerup O, Zetterquist H: HLA-DR typing by PCR amplification with sequence-specific primers (PCR-SSP) in 2 hours: An alternative to serological DR typing in clinical practice including donor-recipient matching in cadaveric transplantation. Tissue Antigens 1992;39:225–235.
19.
Panzer S, Fischer G: Neonatal thrombocytopenia in HLA-DR, -DQ, -DO-typed mother due to a rare anti-HPA-1b (PLA2) (Zwb) fetomaternal immunization (letter; comment). Vox Sang 1995;68:258.
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