Importancia de las determinaciones inmunohematológicas en el control prenatal de gestantes con grupo sanguíneo RhD negativo

La guía para la atención prenatal es el marco regulatorio de las normas de obstetricia para el control y cuidado de las gestantes, con énfasis en aquellas que poseen el grupo sanguíneo RhD negativo. La aloinmunización por anti-D es la causa más frecuente y grave de la enfermedad hemolítica del recién nacido. Para un diagnóstico temprano de la embarazada con dicho grupo sanguíneo, resulta necesario determinar los anticuerpos antieritrocitarios involucrados. En la presente comunicación se resalta la función del laboratorio de inmunohematología en el seguimiento de la gestante con grupo de sangre RhD negativo.

The guide for prenatal care is the regulatory mark of obstetrics norms for the control and care of pregnant women, with emphasis on those who have the RhD negative blood group. Alloimmunization by anti-D is the most frequent and serious cause of hemolytic disease of the newborn. For an early diagnosis of the pregnant woman with said blood group, it is necessary to determine the red blood cell antibodies involved. This communication highlights the role of the immunohematology laboratory in the follow-up of pregnant woman with RhD negative blood type.

Non-RhD alloimmunization in pregnancy: an updated review

Abstract RhD alloimmunization in pregnancy is still the main cause of hemolytic disease of the fetus and neonate (HDFN). Nevertheless, there are other antigens that may be associated with the occurrence of this phenomenon and that have been growing in proportion, given that current prevention strategies focus only on anti-RhD antibodies. Although not widespread, the screening and diagnostic management of the disease caused by these antibodies has recommendations in the literature. For this reason, the following review was carried out with the objective of listing the main red blood cell antigen groups described — such as Rh, ABO, Kell, MNS, Duffy, Kidd, among others — addressing the clinical importance of each one, prevalence in different countries, and recommended management when detecting such antibodies during pregnancy.

Isoinmunización Rh en bajas respondedoras: Reporte de caso / Rh Isoimmunization in Low Responders: Case Report / Isoimunização Rh em pacientes com baixa resposta: relato de caso

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.

TO DETERMINE FETOMATERNAL OUTCOME IN RH NEGATIVE PREGNANCY

Background: The present study was conducted to determine the fetomaternal outcome among Rh-negative pregnancies presenting to a secondary care hospital of North India. Methods: A prospective observational design was carried out among Rh negative mothers presenting to the Department of Obstetrics and Gynecology of Swaroop Rani Hospital, Prayagraj, from December 2021 to July 2022. On admission each mother was interviewed using a questionnaire. ABO/Rh grouping of the mothers as well as their husbands/partners were done. Rh antibody titers of the patients were done at first visit and repeated at 28 and 32 weeks respectively. The labor of each of the mothers was monitored carefully, with the mode of delivery and outcome of labor being recorded in the proforma. For the Rh typing of the neonate, cord blood was collected after delivery and sent for ABO/Rh grouping. Both the mother and the neonate were followed up till their discharge/death, and any adverse maternal or neonatal outcome in this period were noted. Results: During the study period, 46 mothers were assessed. The mean age was 23.9±1.4 years. Most of the mothers were multipara. 4.4% of them had a raised Rh antibody titer. Of the mothers, 13% delivered preterm and most required lower segment cesarean section (56.5%). 93.5% of the deliveries resulted in live births. The incidence of Rh incompatibility among the Rh-negative mothers was 83.7%. The mean birth weight was 2.8±0.4 kgs, with most of the babies being male (60.5%). The most common complications developing in the neonates was anemia (21%) and neonatal hyperbilirubinemia (9.3%). Only one (2.3%) of the neonates born to the mothers died due to post-birth complications. Conclusions: Rh incompatibility was observed to be high among the mothers assessed in the study, with 4.4% having raised anti-D titers. Anemia and neonatal hyperbilirubinemia were found to be the most common problems associated with such pregnancies.

Maternal-fetal alloimmunization: perinatal outcomes in a reference hospital in Northeastern Brazil

SUMMARY OBJECTIVE: To assess the prevalence of maternal alloantibodies in pregnant women at a maternity hospital in northeastern Brazil and describe their perinatal outcomes. METHODS: A retrospective cohort study reviewed maternal and newborn medical records between January 2017 and October 2018 to assess for the presence of maternal alloantibodies. RESULTS: The following maternal alloantibodies were found in the 41 cases surveyed: anti-D, 28 cases (45%); anti-C, 7 cases (11%); anti-c, 1 case (1.6%); anti-E, 4 cases (6.4%); anti-Cw, 1 case (1.6%); anti-K, 2 cases (3.2%); anti-Jka, 1 case (1.6%); anti-M, 3 cases (4.8%); anti-Fya, 2 cases (3.2%); anti-Fyb, 1 case (1.6%); anti-Lea, 5 cases (8%); anti-Leb, 3 cases (4.8%); and anti-Dia, 4 cases (6.4%). Anti-D antibodies were the most frequent cause of erythrocyte alloimmunization (80%). Fetal anemia was observed in four pregnancies based on the peak systolic velocity of the middle cerebral artery. In one case, the mother showed anti-M, and anti-Lea alloimmunization, but the direct antiglobulin test results for the newborn were negative, and no unfavorable neonatal outcomes were observed. In one case of a mother with anti-C and anti-D alloimmunization, the neonate showed anti-D antibodies only in the serological panel and required phototherapy. Neonates with plasma antibodies and jaundice requiring phototherapy only had a serological panel with anti-D, anti-C, anti-c, and anti-E antibodies. Intervention was required for 2.5% of pregnant women with positive antibody screens and 81% of newborns with positive direct antiglobulin test results. CONCLUSION: Despite being a rare condition, maternal alloimmunization by irregular antibodies can result in high perinatal morbidity and mortality.

Hidropesía fetal y enfermedad hemolítica del feto y el recién nacido / Hydrops Fetalis and Hemolytic Disease of the fetus and the newborn. Update

Introducción: la enfermedad hemolítica del feto y el recién nacido (EHFRN) consiste en la incompatibilidad presente entre los antígenos eritrocitarios maternos y los fetales, que desencadena en la madre una reacción inmunitaria contra los eritrocitos fetales produciendo su destrucción. La complicación más grave es la hidropesía fetal, la cual consiste en síntomas de origen hemodinámico, derivados de una falla cardíaca por la disminución en el aporte de oxígeno o por la falta de producción de albúmina. Objetivo: realizar una revisión actualizada de la EHFRN, exponiendo principalmente la hidropesía fetal como una de sus grandes complicaciones. Metodología: se realizó una revisión bibliográfica desde 2018 hasta 2021 en bases de datos tales como Science Direct, Pubmed y Medline con base en los siguientes términos MeSH: anemia hemolítica, isoinmunización Rh, eritroblastosis fetal, hidropesía fetal. Conclusión: la EHFRN es una causa frecuente de enfermedad hemolítica grave en estos pacientes, pero gracias a la Inmunoglubulina G anti-D se ha logrado prevenir la mayoría de casos de incompatibilidad Rh. Sin embargo, la hidropesía fetal presenta una alta mortalidad, lo cual hace importante promover un diagnóstico oportuno y el uso de profilaxis

Introduction: Hemolytic disease of the fetus and newborn (EHFRN) consists of the incompatibility present between maternal and fetal erythrocyte antigens, which triggers an immune reaction in the mother against fetal erythrocytes, causing their destruction. The most serious complication is hydrops fetalis, which consists of symptoms of hemodynamic origin, derived from heart failure due to the decrease in oxygen supply or the lack of albumin production. Objective: Make an updated review of the EHFRN, exposing mainly hydrops fetalis as one of its major complications. Methodology: Bibliographic review was carried out from 2018 to 2021 in databases such as Science Direct, Pubmed and Medline based on the following MeSH terms: hemolytic anemia, Rh isoimmunization, erythroblastosis fetalis, hydrops fetalis. Conclusion: EHFRN is a frequent cause of severe hemolytic disease in these patients; but thanks to the anti-D Immunoglobulin G, the majority of cases of Rh incompatibility have been prevented. However, hydrops fetalis has a high mortality rate, which makes it important to promote timely diagnosis and the use of prophylaxis

Hemolytic disease in a neonate caused by anti-c antibody / 中华围产医学杂志

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.

Enfermedad hemolítica del feto y del recién nacido por aloanticuerpos contra el antígeno M / Hemolytic disease in fetuses and newborns due to antibodies against the M-antigen

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.

Research progress in hemolytic disease in fetuses and newborns: a review / 中华围产医学杂志

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.

Research progress in hemolytic disease in fetuses and newborns: a review / 中华围产医学杂志

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.

Frecuencia y procedencia del antígeno Kell en mujeres donantes de sangre durante los años 2016-2017 / Frequency and origin of the Kell antigen in female blood donors during 2016-2017

Resumen Introducción: El sistema Kell está formado por dos antígenos principales: el Kell (K) y el Cellano (k), estos son capaces de causar reacciones graves, tales como reacción hemolítica postransfusional y la enfermedad hemolítica del recién nacido. Los antígenos de este sistema son altamente inmunogénicos lo que les confiere el tercer lugar en importancia clínica. Objetivo: Determinar la frecuencia del antígeno Kell y procedencia de las mujeres donantes de sangre con antígeno Kell positivo en el Hemocentro del Centro Oriente Colombiano (HCOC). Metodología: Estudio descriptivo de corte transversal que incluyó 186 donantes voluntarias de sangre del Hemocentro Centro Oriente Colombiano, se realizó la fenotipificación del antígeno Kell, utilizando la técnica Aglutinación en lámina, la cual se basa en enfrentar glóbulos rojos del donante con anticuerpo monoclonal anti K. Se calculó la frecuencia fenotípica del antígeno Kell, en porcentajes y para el procesamiento de la información se utilizó el paquete estadístico SPSS versión 21.0 en español donde se realizó todo el análisis de los datos de la población. Resultados: Se procesaron 177 muestras obtenidas en 9 campañas de donación de sangre realizadas en diferentes municipios del departamento de Boyacá, obteniéndose una frecuencia fenotípica del 7,5% para el antígeno Kell, en la población de mujeres donantes de sangre del HCOC, siendo esta similar con la frecuencia encontrada en Colombia y Latinoamérica. Conclusión: Se determinó que la frecuencia del antígeno Kell en las mujeres donantes de sangre del HCOC fue del 7,5%, y se logró identificar que no existe una relación estadísticamente entre la procedencia y la presencia del antígeno Kell en las donantes, lo anterior está relacionado con el mestizaje y los procesos de migración.

Abstract Introduction: The Kell system consists of two major antigens: Kell (K) and Cellano (K), which are capable of causing serious reactions, such as posttransfusion hemolytic reaction and hemolytic disease of the newborn. The antigens of this system are highly immunogenic which gives them the third place in clinical importance. Objective: To determine the frequency of Kell antigen and origin of blood donors in the Hemocenter of the Centro Oriente Colombiano (H.C.O.C). Methods: Cross-sectional descriptive study involving 186 blood donors from the Centro Oriente Colombian Hemocenter, phenotyping of the Kell antigen was carried out, using the technique Aglutination in lamina, which is based on facing donor red blood cells with anti-K monoclonal antibody. Calculated the phenotypic frequency of the Kell antigen in percentages and for the processing of the information was used the statistical package SPSS version 21.0 in Spanish where all the analysis of the data of the population was carried out. Results: 177 samples obtained in 9 blood donation campaigns were carried out in different municipalities of the department of Boyacá, obtaining a phenotypic frequency of 7.5% for the Kell antigen in the population of female HCOC blood donors. Similar to the frequency found in Colombia and Latin America. Conclusion: It was determined that the frequency of Kell antigen in the female HCOC donors was 7.5%, and it was possible to identify that there is no statistically relation between the origin and the presence of Kell antigen in the donors, Is related to mestizaje and migration processes.

Multiple intrauterine transfusions for fetal Rh hemolytic disease: a case report / 中华围产医学杂志

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.

Multiple intrauterine transfusions for fetal Rh hemolytic disease: a case report / 中华围产医学杂志

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.

Thymic teratoma presenting as non-immune hydrops fetalis

Teratomas are one of the most frequent tumors in the pediatric population. They occur anywhere along the midline of the body, following the course of the embryonic germ cell ridge. In the mediastinal location, they exert space occupying effects, leading to a myriad of complications, including non-immune hydrops fetalis. We describe a fatal case of an immature thymic teratoma in a neonate presenting with hydrops fetalis. This case emphasizes the importance of early diagnosis and surgical intervention in such cases.

Clinical analysis of seven cases of rare hemolytic disease of the newborn / 中华儿科杂志

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.

Clinical characteristics of neonatal hemolytic disease of anti-M or Rhesus system / 中华围产医学杂志

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.

Incidência de aloimunização eritrocitária em pacientes poli transfundidos / Prevalence of erythrocyte alloimmunization in polytransfused patients

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.

Clinical research on the D-dimer changes in haemolytic disease of newborn / 中国医师进修杂志

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.

Research of coagulation function changes in newborn hemolytic disease / 中国医师进修杂志

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.

Hemolytic Disease of the Newborn Associated with Anti-Jr(a) Alloimmunization in a Twin Pregnancy: The First Case Report in Korea / 대한진단검사의학회지

Jr(a) is a high-frequency antigen found in all ethnic groups. However, the clinical significance of the anti-Jr(a) antibody has remained controversial. Most studies have reported mild hemolytic disease of the newborn and fetus (HDNF) in Jr(a)-positive patients. Recently, fatal cases of HDNF have also been reported. We report the first case of HDNF caused by anti-Jr(a) alloimmunization in twins in Korea. A 33-yr-old nulliparous woman with no history of transfusion or amniocentesis was admitted at the 32nd week of gestation because of vaginal bleeding caused by placenta previa. Anti-Jr(a) antibodies were detected in a routine laboratory examination. An emergency cesarean section was performed at the 34th week of gestation, and 2 premature infant twins were delivered. Laboratory examination showed positive direct antiglobulin test and Jr(a+) phenotype in the red blood cells and the presence of anti-Jr(a) antibodies in the serum in both neonates. The infants underwent phototherapy for neonatal jaundice; this was followed by conservative management. They showed no further complications and were discharged on the 19th postpartum day. Preparative management to ensure the availability of Jr(a-) blood, via autologous donation, and close fetal monitoring must be performed even in cases of first pregnancy in Jr(a-) women.