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Introducción. La isoinmunización Rh consiste en la producción de anticuerpos maternos en una gestante Rh negativa contra los antígenos de los eritrocitos Rh positivos fetales ocasionados por una hemorragia fetomaterna. En población gestante, el 15% son Rh negativo y la severidad de la afectación fetal está relacionada con una serie de procesos inmunológicos y la historia obstétrica. Si una gestante Rh negativa con riesgo de isoinmunización no recibe profilaxis con inmunoglobulina Anti-D se inmuniza el 16% en la primera gestación, el 30% en la segunda y el 50% después de la tercera. Con este reporte de caso queremos describir el subgrupo de pacientes gestantes con isoinmunización Rh bajas respondedoras. Presentación del caso. G9P5C1A2Gem1V7 de 43 años, remitida en semana 30 de gestación por isoinmunización Rh, no recibió inmunoglobulina Anti-D durante este embarazo, ni en los anteriores ni en el posparto, reporte de Coombs indirecto de 1/4 que se eleva a 1/16, seguimiento ecográfico normal. En semana 35.3 presenta anemia fetal leve y por tratarse de un embarazo alrededor del término se finaliza por cesárea. Recién nacido con adecuado peso para la edad gestacional, quien fue dado de alta a las 72 horas con evolución satisfactoria. Discusión. Las gestantes con isoinmunización Rh bajas respondedoras se sensibilizan con altos volúmenes sanguíneos sin repercusión hemodinámica in utero, produciendo una enfermedad hemolítica fetal leve. Esta respuesta inmune es poco frecuente y está asociada a factores protectores; sin embargo, son necesarios más estudios que sustenten esta condición. Conclusiones. El control prenatal y el Coombs indirecto cuantitativo seriado son las principales herramientas para la prevención de la isoinmunización. El conocimiento de la respuesta inmunológica permite identificar el subgrupo de las bajas respondedoras que tienen una evolución clínica más leve y menor morbilidad neonatal. Palabras clave: Embarazo; Isoinmunización Rh; Eritroblastosis Fetal; Globulina Inmune RHO(D); Hidropesía Fetal.
Introduction. Rh isoimmunization consists of a Rh-negative pregnant woman producing maternal antibodies against the antigens of fetal Rh-positive erythrocytes due to fetomaternal hemorrhage. 15% of the pregnant population is Rh negative, and the severity of fetal effects is related to a series of immunological processes and the obstetric history. If a Rh-negative pregnant woman at risk of isoimmunization does not receive a prophylaxis of Anti-D immunolobulin, 16% are immunized in the first pregnancy, 30% in the second and 50% after the third. In this case report we will describe the subgroup of low responder pregnant patients with Rh isoimmunization. Case Presentation. G9P5C1A2Gem1V7, 43 years old, referred on the 30th week of pregnancy due to Rh isoimmunization. She did not receive Anti-D immunolobulin during this pregnancy, nor in her previous pregnancies, nor during postpartum. Indirect Coombs report of 1/4, which increases to 1/16. Ultrasound monitoring is normal. At week 35.3 she presented mild fetal anemia, and because the pregnancy was near its term, it was ended by cesarean section. Newborn with adequate weight considering the gestational age, who was then discharged after 72 hours with satisfactory evolution. Discussion. Low responder pregnant women with Rh isoimmunization are sensitized with high blood volumes but without hemodynamic repercussions in utero, producing a mild fetal hemolytic disease. This immune response is infrequent and is associated with protective factors; however, further studies are required to support this condition. Conclusions. Prenatal control and serialized quantitative indirect Coombs testing are the main tools for the prevention of isoimmunization. Knowledge of the immunological response enables identifying the subgroup of low responders who present a milder clinical evolution and lower newborn morbidity. Keywords: Pregnancy; Rh Isoimmunization; Erythroblastosis, Fetal; RHO(D) Immune Globulin; Hydrops Fetalis.
Introdução. A isoimunização Rh consiste na produção de anticorpos maternos em uma gestante Rh negativa contra os antígenos dos eritrócitos fetais Rh positivos causados por hemorragia fetomaterna. Na população gestante, 15% são Rh negativos e a gravidade do envolvimento fetal está relacionada a uma série de processos imunológicos e ao histórico obstétrico. Se uma gestante Rh negativa com risco de isoimunização não receber profilaxia com imunoglobulina Anti-D, imuniza-se 16% na primeira gestação, 30% na segunda e 50% após a terceira. Com este relato de caso, queremos descrever o subgrupo de pacientes gestantes com isoimunização Rh de baixa resposta. Apresentação do caso. G9P5C1A2Gem1V7, 43 anos, encaminhada na 30ª semana de gestação para isoimunização Rh, não recebeu imunoglobulina Anti-D nesta gestação, nem nas anteriores nem no puerpério, laudo de Coombs indireto de 1/4 que sobe para 1/16, acompanhamento ultrassonográfico normal. Na semana 35,3, apresentou anemia fetal leve e por se tratar de uma gestação próxima ao termo, foi interrompida por cesariana. Recém-nascido com peso adequado para a idade gestacional, que recebeu alta às 72 horas com evolução satisfatória. Discussão. Gestantes com isoimunização Rh de baixa resposta são sensibilizadas com elevados volumes sanguíneos sem repercussões hemodinâmicas in utero, produzindo doença hemolítica fetal leve. Essa resposta imune é rara e está associada a fatores protetores; no entanto, mais estudos são necessários para fundamentar esta condição. Conclusões. O controle pré-natal e o Coombs indireto quantitativo seriado são as principais ferramentas para a prevenção da isoimunização. O conhecimento da resposta imunológica permite identificar o subgrupo de pacientes com baixa resposta que apresentam evolução clínica mais branda e menor morbidade neonatal. Palavras-chave: Gravidez; Isoimunização Rh; Eritroblastose Fetal; Inmunoglobulina RHO (D), Hidropisia Fetal.
Subject(s)
Rh Isoimmunization , Pregnancy , Hydrops Fetalis , Rho(D) Immune Globulin , Erythroblastosis, FetalABSTRACT
We report a case of hemolytic disease of the newborn (HDN) caused by anti-c antibody. The baby boy presented progressive jaundice on his face and trunk one hour after birth. Total bilirubin of 168.1 μmol/L was detected six hours after birth and positive results of direct antiglobulin test, serum free antibody test, and erythrocyte releasing antibody test were obtained. His blood type was O and RhDCcEe, while his mother was A and RhDCCee. IgG anti-c antibodies were identified in the maternal blood serum with the titer of 1∶4. After phototherapy, immunoglobulin infusion, and medication, the boy was recovered and discharged from the hospital. The boy was normal in both physical and neurobehavioral development at one and three months after discharge.
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Resumen | Hay pocos reportes de enfermedad hemolítica del feto y del recién nacido causada por aloanticuerpos contra el sistema de antígenos MNS, especialmente, porque los anticuerpos que se generan contra estos antígenos son del tipo IgM, los cuales tienen reactividad a temperaturas inferiores a los 37 °C, y, por lo tanto, no son de importancia clínica. A pesar de ello, se han reportado casos con presencia de anticuerpos anti-M de tipo IgG causantes de la enfermedad hemolítica del recién nacido e, incluso, casos de muerte intrauterina por incompatibilidad materno-fetal en el sistema MNS. El proceso hemolítico se asemeja al causado por los anticuerpos anti-Kell, con anemia progresiva por supresión hematopoyética que induce la destrucción de precursores hematopoyéticos en la médula ósea y ausencia de reticulocitos en la periferia. Se reporta el caso de una mujer con 38,5 semanas de gestación, que presentó discrepancia en la hemoclasificación directa y en la inversa. Como resultado, el recién nacido fue positivo en la prueba de Coombs directa sin que existiera incompatibilidad ABO con la madre. La correlación de estos resultados llevó a la detección de un anticuerpo anti-M en el suero materno. El diagnóstico definitivo fue posible gracias a la discrepancia en la hemoclasificación de la sangre materna. A pesar de que los anticuerpos anti-M usualmente no desempeñan un papel importante en la enfermedad hemolítica perinatal, este caso resalta la importancia de determinar la presencia de diferentes anticuerpos que pueden ser de vital interés a la hora de prevenir resultados graves asociados con dicha condición. Además, abre la puerta a nuevas recomendaciones relacionadas con la tamización y el tratamiento temprano de la hemólisis en los recién nacidos.
Abstract | There are few case reports of hemolytic disease in fetuses and newborns (HDFN) caused by alloantibodies against the MNS blood group system. The reason for this dearth is that antibodies toward these antigens are usually IgM, which not only cannot cross the placental circulation but also react at temperatures below 37°C. They are, therefore, of minimal clinical importance. Nevertheless, cases have been reported in which the presence of anti-M IgG antibodies caused severe HDFN and even intrauterine death in the presence of maternal-fetal MNS incompatibility indicating that they could have a high clinical impact. The hemolytic pattern observed in these cases is similar to that caused by anti-Kell antibodies. Progressive anemia is mediated and developed through hematopoietic suppression inducing the destruction of bone marrow precursor cells with the resulting absence of reticulocytes in peripheral blood. This occurred in the case of a woman at 38.5 weeks of gestation who showed a discrepancy between direct and reverse blood type determination. A direct Coombs test was performed on the newborn's blood, which was positive in the absence of maternal-fetal ABO incompatibility. Further tests were performed and anti-M antibodies were found in the maternal serum screening. Our final diagnosis was largely due to discrepancy issues in maternal blood. Although anti-M antibodies do not usually play a significant role in HDFN, this case stresses the importance of identifying the presence of antibodies that can be crucial in preventing HDFN and lead to new recommendations for the screening and prompt treatment of hemolysis in newborns.
Subject(s)
Blood Group Antigens , Erythroblastosis, Fetal , Blood Group Incompatibility , Coombs Test , Hyperbilirubinemia, Neonatal , Jaundice, NeonatalABSTRACT
Hemolytic disease in fetuses and newborns (HDFN) is a common perinatal condition caused by the destruction of erythrocytes of neonates or fetuses by maternal IgG antibodies. Fetal or neonatal hemolysis is HDFN's primary pathological process resulting in anemia and neonatal jaundice. This review summarized recent progress in the pathophysiology of HDFN, the clinical correlation between anti-erythrocyte alloantibodies and HDFN, laboratory tests for alloimmunization in pregnancy, clinical evaluation of high-risk cases of HDFN, and treatment and prevention of HDFN at home and abroad.
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Hemolytic disease in fetuses and newborns (HDFN) is a common perinatal condition caused by the destruction of erythrocytes of neonates or fetuses by maternal IgG antibodies.Fetal or neonatal hemolysis is HDFN's primary pathological process resulting in anemia and neonatal jaundice.This review summarized recent progress in the pathophysiology of HDFN,the clinical correlation between anti-erythrocyte alloantibodies and HDFN,laboratory tests for alloimmunization in pregnancy,clinical evaluation of high-risk cases of HDFN,and treatment and prevention of HDFN at home and abroad.
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This study reported the outcome of a case of fetal hemolytic disease after multiple intrauterine transfusions due to Rh incompatibility between the mother and fetus. The pregnant women had a history of termination for fetal edema at 29 weeks of gestation due to undecided reason as no relevant tests were conducted. Fetal edema was found and hemolytic disease (severe anemia) was diagnosed at 24 gestational weeks in the index pregnancy. After five intrauterine transfusions, fetal edema and anemia were improved. The baby who was born by cesarean section at 33 gestational weeks, was diagnosed with hemolytic disease and transferred to the neonatology department. After one month of treatment, the baby was improved and discharged. Whereafter he was followed up to one year of age without any abnormality in physical or mental development.
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This study reported the outcome of a case of fetal hemolytic disease after multiple intrauterine transfusions due to Rh incompatibility between the mother and fetus. The pregnant women had a history of termination for fetal edema at 29 weeks of gestation due to undecided reason as no relevant tests were conducted. Fetal edema was found and hemolytic disease (severe anemia) was diagnosed at 24 gestational weeks in the index pregnancy. After five intrauterine transfusions, fetal edema and anemia were improved. The baby who was born by cesarean section at 33 gestational weeks, was diagnosed with hemolytic disease and transferred to the neonatology department. After one month of treatment, the baby was improved and discharged. Whereafter he was followed up to one year of age without any abnormality in physical or mental development.
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Objective@#To summarize the clinical features of 7 rare cases of hemolytic disease of newborn (HDN), and to improve the understanding of rare HDN.@*Methods@#Data of clinical information, laboratory findings, treatments and outcomes were collected and analyzed for four cases with HDN due to anti-M, two cases due to anti-Kidd, and one case due to anti-Duffy. All of them were admitted to the Department of Neonatology, Beijing Children's Hospital Affiliated to Capital Medial University from July 2007 to June 2017.@*Results@#Among the four MN hemolytic babies, two were males and two were females. Jaundice was found in three cases. Two cases had hyperbilirubinemia, one of them had severe hyperbilirubinemia. All the four cases developed anemia, including severe anemia in three cases. Two cases of Kidd hemolytic disease and 1 case of Duffy hemolytic disease had jaundice and anemia, but did not reach the level of severe hyperbilirubinemia and severe anemia. MN hemolytic disease babies got negative results in direct antiglobulin test, whereas the Kidd and Duffy hemolytic disease babies had positive findings in direct antiglobulin test. None of the babies had blood transfusion, and they were discharged from the hospital.@*Conclusions@#Without maternal and fetal blood group incompatibility (ABO or Rh blood-group system), for early onset of jaundice, severe jaundice or anemia, antiglobulin test to mother and child earlier should be administered, and MN, Kidd, Duffy and other rare hemolytic disease of the newborn should be pay attention to.
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ObjectiveTo analyze the clinical manifestation of hemolytic disease of the newborn (HDN) due to anti-M and Rhesus system.MethodsClinical information was collected and analyzed for three cases with HDN due to anti-M and 64 with Rhesus hemolytic disease, who were admitted to Department of Neonatology, Beijing Children's Hospital Affiliated to Capital Medical University from February 2011 to January 2015, as well as another 28 cases of HDN due to anti-M with complete information retrieved from literature in Wanfang and China National Knowledge lnfrastructure (CNKI) Database from 1992 to 2014.Chi-square test was performed for statistical analysis.ResultsTwo out of the 64 Rh hemolytic babies gave up therapy due to kernicterus and another two out of the 31 MN hemolytic babies, obtained from literature, died 24 h after birth because of anemia or edema, while the rest survived. Although more babies were the first child of the family in HDN due to anti-M than those of Rh hemolytic disease [26%(8/31) vs 9%(6/64),χ2=4.487, P=0.034], but lower incidence of jaundice [81%(25/31) vs 98%(63/64),χ2=9.686,P=0.002], less proportion of presentation of jaundice within 24 h after birth [29% (9/31) vs 64%(41/64),χ2=10.279,P=0.001] and lower positive rate of direct antiglobulin test [39%(12/31) vs 100%(64/64), Fisher exact test,P=0.000] were shown in HDN due to anti-M. No significant difference was found in the incidences of hyperbilirubinemia [58%(18/31) vs 66%(42/64),χ2=0.513], severe hyperbilirubinemia [23%(7/31) vs 36%(23/64),χ2=1.724], anemia [81%(25/31) vs 89%(57/64),χ2=1.253] and severe anemia [29%(9/31) vs 34%(22/64),χ2=0.271] between HDN due to anti-M and Rh hemolytic babies (allP>0.05).ConclusionsHDN due to anti-M and Rhesus hemolytic disease can cause severe pathological jaundice and/or anemia in newborns. Indirect antiglobulin test should be offered when direct antiglobulin test is negative which is helpful in the diagnosis of HDN due to anti-M.
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Objective: To determine the incidence and the rate of red blood cell alloimmunization in polytransfused patients. Methods: A polytransfused patient was defined as having received at least 6 units of red cell concentrates during a 3-month period. The recordsof all patients (n = 12,904) who had received red blood cell units were examined retrospectively by searching the computer database at Hospital Israelita Albert Einstein in São Paulo, Brazil, over a 6-year period, between 2003 and 2009. Results: During this time, 77,049 red cell concentrate transfusions were performed in 12,904 patients. There were 3,044 polytransfused patients, 227 of whom (7.5%) presented with irregular erythrocyte antibodies. The prevalence of alloantibody specificity was: Anti-E>anti-D>anti-K>anti-C>anti-Dia>anti-c>anti-Jka>anti-S in 227 polytransfused patients. We found combinations of alloantibodies in 79 patients (34.8%), and the most commonspecificities were against the Rh and/or Kell systems. These antibodies show clinical significance, as they can cause delayed hemolytic transfusion reactions and perinatal hemolytic disease. About 20% of the patients showed an IgG autoantibody isolatedor combined with alloantibodies. Interestingly, a high incidence of antibodies against low frequency antigens was detected in this study, mainly anti-Dia. Conclusion: Polytransfused patients have a high probability of developing alloantibodies whetheralone or combined with autoantibodies and antibodies against low frequency antigens. Transfusion of red blood cells with a phenotype-compatible with RH (C, E, c), K, Fya, and Jka antigens is recommended for polytransfused patients in order to preventalloimmunization and hemolytic transfusion reactions.
Objetivo: Determinar a incidência e a taxa de aloimunização eritrocitária em pacientes politransfundidos. Métodos: Foram classificados como politransfundidos todos os pacientes que receberam no mínimo 6 unidades de concentrado de hemácias no período de 3 meses. Foram examinados retrospectivamente os prontuários de todos os pacientes(n = 12.904) que receberam transfusões de unidades de hemácias procurados nas bases de dados computadorizados do Hospital Israelita Albert Einstein, em São Paulo (SP), no período de 6 anos, entre 2003 e 2009. Resultados: Nesse período foram realizadas 77.049 transfusões de concentrado de hemácias em 12.904 pacientes. Os pacientes politransfundidos totalizaram 3.044, sendo que 227 (7,5%) apresentam anticorpos eritrocitários irregulares. A prevalência da especificidade dos aloanticorpos encontrados nos 227 pacientes politransfundidos foi: Anti-E>anti-D>anti-K>anti-C>anti-Dia>antic>anti-Jka>anti-S. Em 79 pacientes (34,8%) foram encontradas associações de aloanticorpos e as combinações mais freqüentes foram dos anticorpos dos sistemas Rh e/ou Kell. Esses anticorpos têm importância clínica, pois podem causar reações transfusionais hemolíticas tardias e doença hemolítica perinatal. Cerca de 20% dos pacientes apresentavam autoanticorpo IgG isolado ou em associação com aloanticorpos. Um achado interessante neste estudo foi a alta incidência de anticorpos contra antígenos de baixa frequência, com predomínio anti-Dia. Conclusão: Pacientes politransfundidos têm alta probabilidade de desenvolver aloanticorpos isolados ou em associação com autoanticorpos e anticorpos contra antígenos de baixa frequência. A transfusão de concentrado de hemácias com fenótipo compatível para os antígenos RH (C, E, c), K, Fya, e Jka deve ser recomendada para o grupo de pacientes politransfundidos, com objetivo de evitar a aloimunização e a reação transfusional hemolítica.
Subject(s)
Erythroblastosis, Fetal , Erythrocytes/immunology , Blood Transfusion/adverse effectsABSTRACT
Objective To investigate the clinical significance and coagulation function changes in newborn hemolytic disease. Method The newborn hemolytic disease ( 60 cases, hemolytic disease group ), non-hemolytic hyperbilirubinemia (60 cases, non-hemolytic hyperbilirubinemia group) and normal newborn (60 cases,control group) were selected as the study subjects, the prothrombin time (PT) and activated partial thromboplastin time (APTT) were measured, and the blood platelet count at the same time was detected. Results PT and APTT in hemolytic disease group were higher than those in non-hemolytic hyperbilirubinemia group[(28.79 ?.21) s vs. (18.98?.41) s and (58.52?.13) s vs. (47.26?.81) s], and they were apparently higher than those in control group [(13.81 ?1.83) s and (38.10 ?3.00) s], the difference had statistic significance (P 0.05). Conclusions The newborn hemolytic disease has the bleeding tendency, and the bleeding tendency has no relationship with the quantity of the blood platelet, but relates to the extension of PT and APTT. The more serious the case is, the more obvious the PT and APTT rise. PT and APTT can be as the detection index and evaluating effect of the newborn hemolytic disease coagulation function.
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ObjectiveTo investigate the change of D-dimer in haemolytic disease of newborn and its clinical significance. MethodsSixty cases with haemolytic disease of newborn were divided into nonserious group(34 cases) and serious group(26 cases) by the level of bilirubin, 40 cases of normal neonatus (control group) were also selected. The levels of D-dimer and fibrinogen(FIB) were measured and compared.ResultsThe level of D-dimer in serious group and non-serious group[ (9.29 ± 11.34), (0.84 ± 0.77 ) mg/L]was higher than that in control group [ (0.45 ± 0.06) mg/L](P ＜ 0.01 or ＜ 0.05 ),the level of D-dimer in serious group was higher than that in non-serious group (P＜ 0.01 ). There was no significant difference in the level of FIB among the three groups (P ＞ 0.05). ConclusionsThere is hypercoagulability in the serious haemolytic disease of newborn. It is valuable to detect plasma D-dimer density for serious haemolytic disease of judgement and treatment.
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Objective To investigate serological blood typing of the ABO locus which contradict to general law of inheritance in parentage,and the underlying reasons for severe hemolytic disease of newborn(HDN).Methods To research the family whose newborn is AB phenotypes,mother is O phenotypes and father is AB phenotypes.The familiy were genotyped by parentage tests, serological tests,PCR-SSP and direct DNA sequencing at exons 6 and 7 of ABO gene.At the salne time,HDN was detected by micro column gel Coombs (MGCT), and the primary fingerposts of the routine blood tests. Biochemical tests were dynamically observed.Results The results of parentage tests showed that three-generation pedigree have parent-child relationship. The red blood cell(RBC)of this AB phenotypes of this family members strongly agglutinated(4+)with diverse monoelonal anti-A and anti-B antibodies,and their serum did not contain anti-A and anti-B antibodies in blood anti-typing.PCR-SSP can not detect their A and B gene,but DNA sequencing at exons6 and 7 of ABO gene revealed that it had the B(A)803C→G mutation.Conclusions The genetm basis of this parentage are B(A)803G blood gene which harbored both A and B difunctionality of glyeosyhransferases.This was the first report that severe HDN resulting from a large number of A and B antigens in RBC of B(A)phenotype of a newborn,which has clinical significance on ABO locus.
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Objective To discuss the significance of the G6PD-mensuration and the HDN serology verification in the pathogenic diagnosis of the neonates with pathological jaundice.Methods According to the manipulation regulation,the serology of HDN and the G6PD in the neonates those who developed pathological jaundice in a week after birth were examined.Results (1)Of 416 cases with pathological jaundice,108(25.96%) cases whose ABO-blood-type didn't match their mothers' developed HDN.The morbidity of HDN was remarkable higher in the mother-baby blood type combination O/A(B) comparing with the combination A(B)/B(A)(P
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Objective Study on the relations between Rh hemolytic disease of the newborn (HDN) and the influencing factors of producing anti-D. Methods D antigens of 32 RhD-negative pregnant women and their newborns are determined by indirect antiglobulin test (IAT) and absorption/elution test. With polymerase chain reaction (PCR) and direct genomic DNA sequencing, we detect the RHD gene in weak D pregnant women identified serologically, and we analyzed the situation of fetomaternal hemorrhage (FMH) of the D-negative women with more than 2 gestations with flow cytometry. Results Among 32 pregnant women of RhD-negative detected by first test, there are 18 pregnant women with two and more pregnancy. In these 18 pregnant women, 3 cases are identified as D el phenotype, 1 case is designated as D category VI type III, the rest 14 cases are truly D-negative pregnant women. Among the truly D-negative multi-pregnant women, 2 produce anti-D in sera and 13 are detected fetal erythrocytes in their peripheral blood by flow cytometry. However there are no anti-D detected in sera of D-negative first-pregnant women. Conclusion No anti-D allo-immune response were observed in all first-time pregnant women. In multi-pregnant women, however, 14.3% produce anti-D and result in HDN of Rh.
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La enfermedad hemolítica perinatal (EHPN) es una afección inmunológica aloinmune contra antígenos de origen paterno presentes en los hematíes fetales y del recién nacido. Se han reportado numerosos aloanticuerpos dirigidos contra antígenos eritrocitarios como causa de la EHPN, más frecuentemente los del sistema ABO y Rh. La EHPN por el sistema Rh (EHPN-Rh) suele ser severa, en particular por el antígeno D. Es muy común encontrar el anti-D asociado con otros anticuerpos Rh (C, E, de título menor). El anticuerpo anti-c por sí solo puede producir EHPN severa. Los avances en la prevención de la inmunización por el antígeno D han disminuido la incidencia de esta enfermedad. La EHPN por ABO (EHPN-ABO) ha sido siempre más frecuente, pero su relación con muerte fetal o neonatal es menor que la de la EHPN-Rh. En este tipo de EHPN los anticuerpos están preformados. Las subclases de IgG, predominantes en esta enfermedad son las IgG1 y las IgG3. A la luz de los conocimientos actuales, el diagnóstico de esta enfermedad puede efectuarse precozmente, es posible incluso hacerlo antes del nacimiento e indicar la transfusión fetal intrauterina como método de salvamento de los fetos con hematócritos (Hto) menores o iguales al 30 %. En los recién nacidos se emplean la fototerapia y la exanguinotransfusión para disminuir los niveles séricos de bilirrubina producida por la hemólisis y evitar el kerníctero. Siempre que se sospeche la enfermedad deberá actuarse con rapidez y precisar los anticuerpos involucrados, para de esta forma disminuir su incidencia y morbimortalidad.
The perinatal hemolytic disease (PHD) is an alloimmune immunological affection against those antigens of paternal origin that are present in the erythrocytes of the fetus and the newborn infant. Several alloantibodies directed against erythrocytic antigens have been reported as the cause of PHD. The most frequently reported are those of the ABO and Rh systems. The PHD caused by the Rh system is usually severe, particularly that produced by the antigen D. It is very common to find the anti-D associated with other Rh antibodies (C,E, of lower titer).The anti-c antibody may produce severe PHD by itself. The advances in the prevention of immunization by D antigen have reduced the incidende of this disease. The PHD caused by ABO has always been more frequent, but its relationship with fetal or neonatal death is lower than that of PHD-Rh. In this type of PHD the antibodies are preformed. The IgG subclasses predominating in this disease are IgG1 and IgG3. In the light of the present knowledge, the diagnosis of this disease may be made early. It is possible to make it even before birth and to indicate the intrauterine fetal transfusion as a method for saving the fetuses with hematocrites lower or equal to 30%. The phototherapy and the exchange transfusion are used among the newborn infants to reduce the serum levels of bilirubin produced by hemolysis and to prevent kernicterus. As long as the disease is suspected it is necessary to act quickly and to determine the involved antibodies in order to reduce its incidence and morbimortality.
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Objective To study the IgG antibodies on red cell surface in ABO and Rh-incompatible infants and to evaluate its predictive value for hemolysis. Methods From Nov. 2001 to Jul. 2002,50 full term newborn babies with ABO and Rh incompatibility hemolysis were admitted .They were divided into two groups according to the direct Coombs test(DCT): 38 cases with positive result and 12 cases were negative. Another 30 normal newborns were chosen as control group. Erythrocyte associated IgG,A and M were measured by a flow cytometry (FCM). Results the mean level of concentration of IgG antibodies in positive DCT group was (12.64?16.83)%,while (4.54?2.54)% in negative DCT group ( P 427.5 ?mol/L,IgG was elevated with the increased TSB level. There was a close relationship between the concentration of TSB and IgG ( r =0.678). Conclusion Measurement of erythrocyte surface antigen IgG assists the diagnosis of maternal-fetal incompatible hemolysis,especially when with a positive direct Coombs test result.
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Objective To observe the effect of intravenous immune globulin (IVIG) therapy on newborn infants of Rh hemolytic disease. Methods IVIG group (n=14) received conventional treatments including albumin administration and phototherapy with additional IVIG therapy at a daily dose of 400 mg/kg given for 1～5 consecutive days,and control group (n=16) only received conventional treatments. Effects were compared between the two groups. Result There were 25 patients with hyperbilirubinemia caused by Rh hemolytic disease received exchange transfusions. IVIG was infused in 12 cases,100% of them had the total serum bilirubin level dropped down during the treatment before the exchange transfusions, vs 5 (38%) of 13 cases in control group (P