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Background Fetal or neonatal alloimmune thrombocytopenia (FNAIT) results from a maternal alloimmunization against fetal platelet antigens. Since the implementation of serological methods for the detection of antiplatelet alloantibodies, it has been demonstrated that anti-HPA-3a alloantibodies have considerable heterogeneity. Consequently, the serologic diagnosis of FNAIT may be hampered, despite severe clinical signs and the absence of other causes of thrombocytopenia. Here, we report the first HPA-3a feto-maternal alloimmunization observed in the Chinese population.Case study A 28-year-old woman gave birth to her first child. After 2 h of life, the newborn presented signs of multiple subcutaneous bleeding and severe thrombocytopenia (7 9 10 9 platelets/l). Three years later, the woman gave birth to a second newborn, with petechial and signs of bleeding at 15 min of life. Brain ultrasound revealed the presence of an intracranial haemorrhage. The newborn recovered after 23 days.Results Investigations revealed the presence of a feto-maternal HPA-3a incompatibility (mother: HPA-3bb; newborn: HPA-3ab). Maternal anti-HPA-3a alloantibodies were detected using the MAIPA method. Both children were transfused with compatible HPA-3bb platelets and perfused with intravenous immunoglobulins associated with corticoids.Conclusions This case shows that anti-HPA-3 maternal alloimmunization is a potentially devastating disease. The detection of anti-HPA-3 alloantibodies may be a challenge for platelet immunologists to ascertain the diagnosis. In case of bleeding, platelet transfusion is the therapy to be used in an emergency. For subsequent pregnancies, the mother should be followed up in a referral centre and antenatal management may be proposed.

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