Luminex법으로 증명한 항 HLA-A2 항체에 의한 신생아 동종면역성혈소판감소증 1예
Neonatal Alloimmune Thrombocytopenia Caused by Anti‐HLA‐A2 Alloantibodies Determined by Luminex Single Antigen Bead Assay
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초록
신생아동종면역성혈소판감소증은 주로 혈소판특이항원이나HLA 등의 신생아의 혈소판 표면에 발현된 항원에 대한 어머니의동종항체가 면역적인 파괴를 일으켜 발생한다. 저자들은 항 HLAA2항체에 의한 신생아동종면역성혈소판감소증을 보고하는 바이다. 환아와 산모의 혈청으로 혈소판특이항체와 HLA 항체 검사를효소면역법으로 시행하여 항 HLA 항체가 양성임을 확인하였고,Luminex 단일항원비드검사를 시행하여 항 HLA-A2 항체를 동정하였다. HLA형별검사에서 환아는 HLA-A2를 보이고 어머니는 HLAA2가음성이어서 어머니의 혈청 내 동종항체인 항 HLA-A2 항체가태반을 통과하여 발생한 신생아동종면역성혈소판감소증으로 판단하였다. 환아는 수회에 걸친 혈소판수혈과 스테로이드 및 정주용 감마글로불린 투여 후 생후 18일에 퇴원하였고 생후 90일째 혈소판수는 120×109/L까지 회복되었다. 본 증례에서 원인항체를 규명하기 위해 실시한 Luminex 단일항원비드검사는 높은 민감도와특이도를 가지고 항체특이성을 동정할 수 있으며, 기존의 패널 반응성 검사보다 빠르고 편리한 검사방법이므로 신생아동종면역성혈소판감소증을 진단하고, 신생아동종면역성혈소판감소증 환자에게 HLA 적합 혈소판을 수혈하는데 유용한 검사로 생각된다.
Abstract
Neonatal alloimmune thrombocytopenia (NAIT) occurs when maternal alloantibodies react to antigens expressed on fetal platelets, which is mainly platelet- specific alloantigen or HLA, resulting in their immune destruction. Here, we described a patient who suffered from NAIT caused by anti-HLA-A2 antibody. Sera from the mother and the newborn were screened for human platelet antigen-specific antibodies and HLA antibodies by ELISA, and HLA antibodies were detected in both of them. The antibody specificity was identified as anti-HLA-A2 by Luminex single antigen bead assay. HLA typing results showed that patient’s father descended HLA-A2 antigen on the patient and the mother was HLA-A2 negative. It is most conceivable that anti-HLA-A2 alloantibody in the mother’s sera crossed the placenta and subsequently caused NAIT in the case presented. The patient received platelet concentrates, oral steroid and intravenous globulin and platelet count increased to 120×109/L on the 90th day of life. The Luminex single antigen bead assay used in this case is highly sensitive and specific assay to determine antibody specificity and it is faster and more convenient for routine use in clinical laboratory so that this assay could be useful to diagnose NAIT caused by HLA antibodies and treat such NAIT patients with HLA matched platelet transfusion.
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