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Blood. 2015 Jul 30;126(5):661-4. doi: 10.1182/blood-2014-12-614446. Epub 2015 Jun 15.

Persistent neonatal thrombocytopenia can be caused by IgA antiplatelet antibodies in breast milk of immune thrombocytopenic mothers.

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Amalia Biron Research Institute of Thrombosis and Hemostasis, Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel;
Pediatric Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Ruth and Bruce Rappoport Faculty of Medicine, Technion, Haifa, Israel;
Ruth and Bruce Rappoport Faculty of Medicine, Technion, Haifa, Israel; Neonatology Unit, Laniado Hospital, Netanya, Israel;
Department of Pediatrics, Barzilai University Medical Center, Ashkelon, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; and.
Ruth and Bruce Rappoport Faculty of Medicine, Technion, Haifa, Israel; Pediatric Hemato-oncology Department, Laniado Hospital, Netanya, Israel.


Immune thrombocytopenia (ITP) in pregnant women can cause neonatal thrombocytopenia by transport of antiplatelet autoantibodies across the placenta. Usually, an infant's platelet count normalizes within 2 months. We observed neonatal thrombocytopenia that persisted more than 4 months and disappeared following discontinuation of breastfeeding. The aim of our study was to discern whether breast milk of ITP mothers contained antiplatelet antibodies causing persistent thrombocytopenia. We collected milk samples from 3 groups of women: ITP group, 7 women who had ITP during pregnancy; R-ITP group, 6 women who recovered from ITP before pregnancy; and 9 healthy controls. We found increased levels of antiplatelet antibodies of the immunoglobulin A type in the milk of ITP patients compared with the other 2 groups. Similar increase was demonstrated for antibodies binding to αIIbβ3 expressed in cultured cells. Thus, transfer of antiplatelet antibodies from ITP mothers by breastfeeding can be associated with persistent neonatal thrombocytopenia.

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