Objective Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is associated with life-threatening bleeding. This systematic review of postnatal management of FNAIT examined transfusion of human... Show moreObjective Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is associated with life-threatening bleeding. This systematic review of postnatal management of FNAIT examined transfusion of human platelet antigen (HPA) selected or unselected platelets, and/or IVIg on platelet increments, hemorrhage and mortality.Study design MEDLINE, EMBASE and Cochrane searches were conducted until 11 May 2018.Result Of 754 neonates, 382 received platelet transfusions (51%). HPA-selected platelets resulted in higher platelet increments and longer response times than HPA-unselected platelets. However, unselected platelets generally led to sufficient platelet increments to 30 x 10(9)/L, a level above which intracranial hemorrhage or other life-threatening bleeding rarely occurred. Platelet increments were not improved with the addition of IVIg to platelet transfusion.Conclusion Overall, HPA-selected platelet transfusions were more effective than HPA-unselected platelets but unselected platelets were often effective enough to achieve clinical goals. Available studies do not clearly demonstrate a benefit for addition of IVIg to platelet transfusion. Show less
Kjaer, M.; Bertrand, G.; Bakchoul, T.; Massey, E.; Baker, J.M.; Lieberman, L.; ... ; Int Collaboration Transfusion Med 2019
Background and Objectives In Caucasians, fetal/neonatal alloimmune thrombocytopenia (FNAIT) is most commonly due to maternal HPA-1a antibodies. HPA-1a typing followed by screening for anti-HPA-1a... Show moreBackground and Objectives In Caucasians, fetal/neonatal alloimmune thrombocytopenia (FNAIT) is most commonly due to maternal HPA-1a antibodies. HPA-1a typing followed by screening for anti-HPA-1a antibodies in HPA-1bb women may identify first pregnancies at risk. Our goal was to review results from previous published studies to examine whether the maternal antibody level to HPA-1a could be used to identify high-risk pregnancies. Materials and Methods The studies included were categorized by recruitment strategies: screening of unselected pregnancies or samples analyzed from known or suspected FNAIT patients. Results Three prospective studies reported results from screening programmes, and 10 retrospective studies focused on suspected cases of FNAIT. In 8 studies samples for antibody measurement, performed by the monoclonal antibody immobilization of platelet antigen (MAIPA) assay, and samples for determining fetal/neonatal platelet count were collected simultaneously. In these 8 studies, the maternal antibody level correlated with the risk of severe thrombocytopenia. The prospective studies reported high negative predictive values (88-95%), which would allow for the use of maternal anti-HPA-1a antibody level as a predictive tool in a screening setting, in order to identify cases at low risk for FNAIT. However, due to low positive predictive values reported in prospective as well as retrospective studies (54-97%), the maternal antibody level is less suited for the final diagnosis and for guiding antenatal treatment. Conclusion HPA-1a antibody level has the potential to predict the severity of FNAIT. Show less
When on 10 May 1925, the appellate sharica court of Biba annulled the marriages of three Upper Egyptian Baha'is to their Muslim wives, declaring that the Baha'i faith was not part of Islam and... Show moreWhen on 10 May 1925, the appellate sharica court of Biba annulled the marriages of three Upper Egyptian Baha'is to their Muslim wives, declaring that the Baha'i faith was not part of Islam and therefore Muslims embracing it were to be considered apostates, this verdict was, paradoxically, hailed by the international Baha'i community as 'the first Charter of the emancipation of the Cause of Baha'u'llah from the fetters of Islamic orthodoxy'. The National Spiritual Assembly (NSA) of the Baha'is of Egypt and the Sudan, one of the first NSAs to be founded worldwide, felt inspired by the verdict that finally made the Egyptian public aware of the existence of an active Baha'i community in their country. It was clear to everyone now that the Baha'i faith could no longer be regarded as an Islamic reform movement, as had been the case before World War I, when Abd'ul'baha's visits to Alexandria had caused a first wave of interest in the new religion. Show less
