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Persistent neonatal thrombocytopenia can be caused by IgA anti platelet antibodies of breast milk of immune thrombocytopenic mothers

Hagit Hauschner, Nurit Rosenberg, Uri Seligsohn, Rafael Mendelsohn, Aryeh Simmonds, Yakov Shiff, Yaakov Schachter, Shraga Aviner and Nechama Sharon

Key points

  • Persistent thrombocytopenia was observed in breastfed neonates of ITP women.

  • Breast milk of ITP women may contain IgA anti platelet antibodies which target αIIbβ3 integrin.

Abstract

Immune thrombocytopenia (ITP) in pregnant women can cause neonatal thrombocytopenia by transport of anti platelet autoantibodies across the placenta. Usually, infant's platelet count normalizes within two months. We observed neonatal thrombocytopenia that persisted more than four months and disappeared following discontinuation of breastfeeding. The aim of our study was to discern whether breast milk of ITP mothers contained anti platelet antibodies causing persistent thrombocytopenia. We collected milk samples from 3 groups of women: ITP - 7 women who had ITP during the pregnancy, R-ITP – 6 women who recovered from ITP before pregnancy and 9 healthy controls. We found increased levels of anti-platelet antibodies of the immunoglobulin A type in the milk of ITP patients compared to the other 2 groups. Similar increase was demonstrated for antibodies binding to αIIbβ3 expressed in cultured cells. Thus, transfer of anti-platelet antibodies from ITP mothers by breastfeeding can be associated with persistent neonatal thrombocytopenia.

  • Submitted December 2, 2014.
  • Accepted June 9, 2015.