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- W2995502384 abstract "A 36-year-old female (Wo) delivered a full-term girl in the 40th week of gestation with no signs of bleeding. Her neonatal platelet count was 29 G/L (dropping to 20 G/L), and fetal-neonatal alloimmune thrombocytopenia (FNAIT) was suspected. In the serological work-up, no anti-platelet antibodies were detectable using PAK Lx (Immucor Medizinische Diagnostik). Genetic testing did not reveal incompatibility for HPA-1, -2, -3, -4, -5, -6, -9 and -15. Two years later, Mrs. Wo gave birth to a white European full-term boy in the 39th week of gestation, again with no signs of bleeding. The neonatal platelet count was 31 G/L. Platelet antibody testing in the monoclonal antibody of platelet specific antigens (MAIPA) assay using random donor platelets was negative. In contrast, a MAIPA cross-match analysis between maternal serum and paternal platelets showed positive reactions with αIIbβ3, indicating an alloimmunization against a low-frequency antigen. On Day 1, the newborn was transfused with random donor platelets. The platelet count rose to 170 G/L, remained above 50 G/L without further transfusions, and was in normal range at Day 28. Full-length sequencing of ITGA2B and ITGB3 was carried out as described previously.1 Briefly, coding regions of paternal genomic DNA were PCR amplified with primers corresponding to intronic sequence surrounding all exons. PCR was carried out using a Fast-Start High Fidelity PCR system (Roche Diagnostic Corp.). Automated sequence analysis was performed in both directions on a genetic analyzer (ABI 3100, Applied Biosystems). Nucleotide sequences of PCR primers, sequencing, and reaction conditions are available upon request. Full-length β3 cDNA encoding for the Woa variant was produced by site-directed mutagenesis using the Quick Change Mutagenesis Kit (Stratagene) as previously described.2 Allele specific constructs encoding wild-type β3 (Gln132) or mutant β3 (Arg132) were transfected into HEK 293F cells, together with an αIIb construct. Surface expression of αIIbβ3 was measured by flow cytometry (FACS Canto II, Becton Dickinson), as outlined previously.2 To confirm that p.Gln132Arg is responsible for the formation of the Woa epitope, 3 x 105 transfected cells per well were used in a modified MAIPA.3 Sequencing ITGB3 from paternal DNA showed the presence of a nucleotide substitution c.473A > G located in exon 4 of ITGB3 (Fig. 1A). This mutation predicts Gln (CAG) at position 132 in Woa-negative and Arg (CGG) in Woa-positive individuals (p.Gln132Arg). The mutation was deposited in GenBank (accession number MN624129). No sequence variation was detected in ITGA2B. The ITGB3 c.473A > G mutation was also detectable in heterozygous state when sequencing DNA from the newborn. In a glycoprotein specific assay (Fig. 1B), HEK 293F cells expressing αIIb in complex with either wild-type (Gln132) or mutant (Arg132) β3 were incubated with maternal serum, healthy control donor serum, or serum containing anti-HPA-1a antibodies, demonstrating the specific recognition of p.Gln132Arg by anti-Woa. Summary data from the Exome Aggregation Consortium indicate allele frequencies of 0.99999 for ITGB3 c.473A and 0.00001 for ITGB3 c.473G.4 We observed a case of FNAIT in a newborn with a platelet count of 31 G/L. Serological analysis of the maternal serum revealed an immunization against αIIbβ3 on paternal platelets only, indicating the presence of an antibody against a rare alloantigen. Sequencing analysis and studies with mutant transfected cells showed that ITGB3 c.473A > G (p.Gln132Arg) is responsible for the formation of a new antigenic determinant on β3, termed Woa. The antibody was overlooked in the initial work-up of the elder sibling where no cross-match study was performed. This demonstrates once more that a serological cross-match between paternal platelets and maternal serum should always be performed whenever FNAIT is suspected. The excellent technical support from Lida Röder and Heike Berghöfer, Giessen, Germany, is highly acknowledged. The authors also like to thank Dr. Brian Curtis, Platelet & Neutrophil Immunology Laboratory at Versiti Diagnostic Labs, Milwaukee, WI, USA, who confirmed the presence of Woa both genetically and serologically." @default.
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- W2995502384 date "2019-12-20" @default.
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- W2995502384 title "A point mutation c.473A > G of ITGB3 is responsible for the formation of the Wo a human platelet alloantigen" @default.
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- W2995502384 doi "https://doi.org/10.1111/trf.15640" @default.
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