Correlation between the Amount of Anti-D Antibodies and IgG Subclasses with Severity of Haemolytic Disease of Foetus and Newborn

Emilija Velkova

doi:10.3889/oamjms.2015.058

Authors

Emilija Velkova Institute of Transfusion Medicine in Republic of Macedonia, Vodnjanska 17, 1109 Skopje

DOI:

https://doi.org/10.3889/oamjms.2015.058

Keywords:

Ð°llosensibilisation, alloantibody, haemolitic desease of the foetus and newborn (HDFN), immunization, red blood cells, antenatal â€“ postnatal, profilaxis, IgIG (hyperimun gamaglobulin)

Abstract

AIM: The aim of this study was to investigate the influence of subclasses to IgG anti-D on the intensity of hemolytic disease of fetus and newborn (HDFN) at 45 fetuses/newborns with symptoms of mild and severe HDFN in Republic of Macedonia.

MATERIAL AND METHODS: In retrospective and prospective studies, in a period of 10 years, from 2004 to 2014, there have been immunohemathology tests performed on 22 009 samples on serums of pregnant women.

RESULTS: At 37.78% of the total number of tested patients, IgG1 and IgG3 was the reason for severe HDFN. At 17.77% of the total number of tested patients, which had only IgG1detected, was the reason for serious intensity of HDFN. The correlation of the titer to anti-D antibodies in the motherâ€™s serum and the intensity of HDFN were researched in 48 newborns. The titers between 1:8 and 1:32 resulted in 3 cases of HDFN with symptoms of severe disease and in 4 cases there were no signs of HDFN. At 12 women that had a titre between 1:32 and 1:512, five of the newborns developed severe HDFN, and seven had symptoms of mild and weak intensity form. In 3 cases the titer was higher than 512, and out of them one newborn had weak symptoms of HDFN, one developed severe HDFN and one ended with foetal death. Only in one case the titer reached a value higher than 1000, and it ended with a fetal death.

CONCLUSIONS: The titers of the pregnant women serum those are lower than 32 and those higher than 1000 can well predict HDFN. The titers of anti-D antibodies between 64 and 512 have no exact predictive value. IgG1 and IgG3 subclasses of anti-D have no predictive value by themselves, and cannot foresee the outcome of HDFN. The research study results suggest that IgG1 and IgG3 should be included in a multi â€“ parameter protocol for evaluation of the HDFN intensity. They can give a real assessment of the expected HDFN intensity in combination with the titer hight and the significance of the antibodies.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Cherif-Zahar B, Mattei MG, Le Van Kim C, et al. Localization of the human Rh blood group gene structure to chromosome 1p34.3-1p36.1 region by in situ hybridization. Hum Genet. 1991; 86:398-400. DOI: https://doi.org/10.1007/BF00201843

Ridgwell K, Spurr NK, Laguda B, et al. Isolation of cDNA clones for a 50Kda glycoprotein of the human erythrocyte membrane associated Rh (Rhesus) blood-group antigen expression. Biochem J. 1992; 287:223-228. DOI: https://doi.org/10.1042/bj2870223

Mollison PL, Engelfreit CP, Contreras M. Blood Transfusion in Clinical Medicine, 10th ed. Oxford, Blackwell Scientific, 1997.

Kennedy MS, Wilson S and Kelton JG. eds. Perinatal Transfusion Medicine, Arlington VA: American Assosiation of Blood Banks, 1990.

Reid ME, Lomas-Francis C. The Blood Group Antigen FactsBook, 2nded, London, Academic Press, Elsevier, 2004. DOI: https://doi.org/10.1016/B978-012586585-2/50029-9

Bowman JM. Controversies in Rh prophylaxis. Who needs Rh immune globulin and when should it be given? Am J Obstet Gynecol. 1985;151:289â€“94. DOI: https://doi.org/10.1016/0002-9378(85)90288-1

American College of Obstetricians and Gynecologists. ACOG Practicem Bulletin No. 75: management of alloimmunization. Obstet Gynecol. 2006; 108(2):457-464. DOI: https://doi.org/10.1097/00006250-200608000-00044

James LS. Shock in the newborn inrelation to hidrops. In: Robertson JG, Dambrosio F, eds. The Rh problem. Proceeding of the International symposium on the manegment of the Rh problem. Milan: Instituti Clinici di Perfezionamento, 1970: 193-5.

Hadley A, Soothill P. Ed: Alloimmune Disorders of Prenancy. Cambrige University Press, 2002. DOI: https://doi.org/10.1017/CBO9780511527043

Urbaniak SJ, Greiss MA. RhD haemolytic disease of the fetus and the newborn. Blood Reviews. 2000; 14: 44-61. DOI: https://doi.org/10.1054/blre.1999.0123

Brecher M (ed): Technical Manual, 14th ed. Bethesda, MD, American Association of Blood Banks, 2002.

PollÐ°ck JM Bowman JM. Anti-Rh(D) IgG subclasses and severity of Rh haemolytic disease of the new born. Vox Sang. 1990; 59:176-179. DOI: https://doi.org/10.1159/000461196

Zupanska B, Thompson E, Brojer E, Merry AH. Phagocytosis of erythroÂ¬cytes sensitized with known amount of IgG and IgG3 antibodies. Vox Sang. 1987; 53:96-101. DOI: https://doi.org/10.1111/j.1423-0410.1987.tb04926.x

Nicolaides KH, Rodeck CH. Maternal serum anti-D antibody concentration and assessment of rhesus isoimmunisation. Br Med J. 1992; 304:1155â€“6. DOI: https://doi.org/10.1136/bmj.304.6835.1155

Duguid JKM. Antenatal serological testing and prevention of hemolytic disease of the newborn. J Clin Pathol. 1997; 50:193. DOI: https://doi.org/10.1136/jcp.50.3.193

Management of isoimmunization in pregnancy. ACOG Educational Bulletin no 227, August 1996.

Van Dijk BA, Dooren MC, Overbeeke AM. Red cell antibodies in pregnancy: There is no critical titre. Transfusion Med. 1995; 4:199. DOI: https://doi.org/10.1111/j.1365-3148.1995.tb00228.x

Antibody Screening in the Antenetal & Perinatal Setting. 3nd Ed. 2007. ASBT â€œGuidelines for Blood Grouping & Antibody Screenin During Pregnancyâ€, june 1999.

Issit PD, Anstee DJ. Applied Blood Group Serology, 4th ed. Montgomery Scientific Publications, Durham, 1998.

Bianchi DW, Neil AD, Costa JM et al. Non-invasive prenatal diagnosis of fetal Rhesus D. Obstet Gynecol. 2005; 106:841-844. DOI: https://doi.org/10.1097/01.AOG.0000179477.59385.93

Mari G, Deter RL, Carpenter RL et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N Engl J Med. 2000; 342:9-14. DOI: https://doi.org/10.1097/00006254-200006000-00005

Van Kamp IL, Klumper FJ, Meerman RH et al. Treatment of fetal anemia due to red-cell alloimmunization with intrauterine transfusions in the Netherlands, 1998-1999. Acta Obstet Gynecol Scand. 2004; 83:731-737. DOI: https://doi.org/10.1080/j.0001-6349.2004.00394.x

ACOG Practice Bulletin. Management of alloimmunization during pregnancy. Number 75, August 2006.

Moise KJ. Management of rhesus alloimmunization in pregnancy. Obstet Gynecol. 2008; 112:164-176. DOI: https://doi.org/10.1097/AOG.0b013e31817d453c