Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a disease in pregnancy characterized by maternal alloantibodies directed against the human platelet antigen (HPA). These antibodies can... Show moreFetal and neonatal alloimmune thrombocytopenia (FNAIT) is a disease in pregnancy characterized by maternal alloantibodies directed against the human platelet antigen (HPA). These antibodies can cause intracranial hemorrhage (ICH) or other major bleeding resulting in lifelong handicaps or death. Optimal fetal care can be provided by timely identification of pregnancies at risk. However, this can only be done by routinely antenatal screening. Whether nationwide screening is cost-effective is still being debated. HPA-1a alloantibodies are estimated to be found in 1 in 400 pregnancies resulting in severe burden and fetal ICH in 1 in 10.000 pregnancies. Antenatal treatment is focused on the prevention of fetal ICH and consists of weekly maternal IVIg administration. In high-risk FNAIT treatment should be initiated at 12-18 weeks gestational age using high dosage and in standard-risk FNAIT at 20-28 weeks gestational age using a lower dosage. Postnatal prophylactic platelet transfusions are often given in case of severe thrombocytopenia to prevent bleedings. The optimal threshold and product for postnatal transfusion is not known and international consensus is lacking. In this review practical guidelines for antenatal and postnatal management are offered to clinicians that face the challenge of reducing the risk of bleeding in fetuses and infants affected by FNAIT. Show less
Willems, A.; Patte, P.; Groote, F. de; Linden, P. van der 2019
The studies presented in this thesis explored several pathogenic mechanisms underlying von Willebrand disease that is characterized by a quantitative or functional deficiency of von Willebrand... Show moreThe studies presented in this thesis explored several pathogenic mechanisms underlying von Willebrand disease that is characterized by a quantitative or functional deficiency of von Willebrand factor, in particular with respect to intracellular storage in Weibel-Palade body and regulated secretion of von Willebrand factor. By using molecular biology, confocal and electron microscopic techniques, storage and secretion of von Willebrand factor were analyzed for von Willebrand disease variants identified in the patients. These studies advanced our understanding of von Willebrand disease at the molecular and cellular levels. HEK293 cells and endothelial cells derived from patients__ peripheral blood were established as two useful model-systems for examining von Willebrand factor structure-function relationships in the context of von Willebrand disease. Using these model-systems we have demonstrated that von Willebrand factor mutations may impair its storage and secretion and thus lead to a quantitative deficiency of this factor in the patients. Furthermore, we demonstrated that alteration in the structure of von Willebrand factor, by natural mutations that occur in von Willebrand disease patients, modulates von Willebrand factor string formation and function. We propose that alteration in von Willebrand factor string formation and function may be another new mechanism that contributes to the bleeding tendency in von Willebrand disease. Show less
Microparticles (MPs) have important physiological and pathological roles in blood coagulation, inflammation and tumor progression. In recent years MPs also have been recognized to participate in... Show moreMicroparticles (MPs) have important physiological and pathological roles in blood coagulation, inflammation and tumor progression. In recent years MPs also have been recognized to participate in important biological processes, such as in signaling and in the horizontal transfer of their specific proteins and mRNAs. However, studies of MPs have been hampered by the lack of methods for the sensitive detection and accurate quantification of MPs. Thus, we have developed a new methodology by using atomic force microscopy (AFM) and cryo-electron microscopy (cryo-EM) to detect, quantify and characterize MPs in plasma. We have shown that AFM detects 1000-fold more platelet derived-MPs than a conventional flow cytometry does. These MPs have diameters ranging from 10-475 nm with a peak at 67.5 nm, which is clearly far below the detection limit of flow cytometry. By using cryo-EM we found that the number of lipoprotein particles exceeds that of MPs or exosomes in plasma. We also demonstrated that by using immuno-magnetic beads selected subset of MPs could directly be captured/depleted from plasma and assessed for MP-associated tissue factor activity. In the future the measurement of MPs will perhaps serve as a diagnostic tool to identify and predict diseases, like cancer. Show less
