Objective: This study aims to explore the ABO-dependent mechanism of ADAMTS13-mediated VWF cleavage in neonatal thrombocytopenia (NTP) during platelet transfusion.
Methods: Plasma VWF in AA, BB, OO, AO, BO group from NTP patients was measured by ELISA kit. Blood-derived VWF samples from NTP patients from February 2020 to December 2022 were divided according to ABP blood group, followed by incubation with the recombinant ADADMTS13 in static state or high-shear stress. Also, VWF from NTP patients was mixed with platelet suspension from healthy adults with alloantigen of ABO phenotype, followed by the digestion of rADAMTS13 in static state or high-shear stress. The VWF cleavage (176 kDa) was detected by western blot combined with non-reactive SDS-PAGE.
Results: Compared to OO group, plasma VWF in BO, AO, BB and AA increased successively. Both in static state and high-shear stress condition, the cleavage of NTP-derived VWF decreased in the following order: OO, BO, AO, BB and AA. Importantly, the cleavage of NTP-VWF in all ABO blood groups was increased in high-shear stress as compared to that in static state. With incubation with platelet suspension, the ADAMTS13-induced VWF cleavage decreased in the following order: OO, BO, AO, BB and AA in both static state and in high-shear stress condition. Also, exogenous VWF from platelet suspension increased VWF cleavage in all blood groups.
Conclusion: The VWF susceptibility to ADAMTS13 proteolysis was increased as follows: A, B and O blood phenotype during platelet transfusion, causing imbalance of neonatal hemostasis in an ABO-dependent manner.
Keywords: ABO blood group; ADAMTS13; Neonatal thrombocytopenia; VWF.
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