Red blood cell alloimmunization among Saudi pregnent women in the central province of Saudi Arabia

To determine the incidence of alloimmunization among pregnant women in Saudi Arabia Prospective study King Khaled University, Hospital, Riyadh, Saudi Arabia One thousand one hundred and ninty five pregnant women The rates of alloimmunization among pregnant women subjects by analyzing the blood type of both mother and neonate The largest fraction of alloimmunization involved Rh antigens [52.38%], while other groups such as Kell and Duffy play a less common role. Alloantibodies identified fivety pesofalloantibodiesin addition to nonspecific-autoantibodies. The most frequent [52.38%] were against Rhesus 2.38%; Kell 2.38%; Duffy 2.38%; 4.76% were non-specificantibodiesand33.3%were autoantibodies. Alloimmunization are: anti-D 28.57%, anti-C 4.76% anti-E 14.28% and anti-e 4.76%; only one 2.38% developed anti-K; anti-Jk, one 2.38%; one had anti-Le 2.38%; there was one 2.38% with anti-Fy. 1.84% of the total number of study subjects were alloimmunized by antigens of Rh while 0.08% were alloimmunized to antigens either from Kell, Kidd, Lewis or Dufffy. The relative importance of antigens other than Rh D have increased since the introduction of Rh D prophylactic treatment. Alloimmunization to E, c and Kell antigens can reach significantproportionsofstudied populations and can result in deleterious effects on fetus. The actual risk of alloantibody production during pregnancy is unknown but stimuli for antibody production are feto-maternal bleeds that occur throughout pregnancy

Evaluación de la enfermedad hemolítica por anti-D: resultados en el recién nacido / evaluationEvaluation of hemolytic disease by anti-D. Results in the newborn

Introducción. Objetivo: describir la condición al nacimiento y evolución intrahospitalaria del neonato con enfermedad hemolítica por anti-D.Material y métodos. Se estudiaron a embarazadas Rh negativo, con isoinmunización al antígeno RhD y sometidas a espectrofotometría de bilirrubina (Br) en líquido amniótico (EBLA). Se compararon los datos clínicos y demográficos de neonatos con enfermedad hemolítica (EH), comparándose el último estudio de EBLA con el esquema de Liley-Sentíes. Se formaron los grupos 1, 2 y 3, para estratificar la EH fetal como leve, moderada y grave.Resultados. Se incluyeron 67 casos, con 31, 17 y 19 neonatos, para cada grupo. Los casos del grupo 3 fueron de menor edad gestacional, 34.4 semanas (P< 0.001), peso 2 223 g (P <0.001) y hematócrito 36 por ciento (P <0.01). Los valores máximos de Br y días de estancia en fototerapia fueron similares. La transfusión eritrocitaria fue en proporción de 0.09, 0.23 y 0.52, para cada grupo (P <0.003). La exsanguinotransfusión fue de 0.16, 0.29 y 0.68 (P< 0.001). Los días de estancia fueron de 5, 9 y 23 días, respectivamente (P< 0.001).Conclusión. La estancia hospitalaria prolongada depende de la edad gestacional, la severidad de la EH y de la morbilidad hospitalaria asociada. El esquema de Liley-Sentíes, es un criterio vigente para la estratificación de la EH con utilidad pronóstica y terapéutica.

Role of C1q in Rhesus haemolytic disease of the newborn.

Present study attempts to find out if maternal anti-D can bind the first complement component C1q and its impact on phagocytosis and severity of Rh haemolytic disease of the newborn (HDN). One hundred Rh immunised women were enrolled, however six having Rh(D) negative infants were excluded. Immunometric assay revealed that of 94 sera, 18 (19.1%) were able to bind C1q but failed to bind C3. Six mothers had anti-C (two bound C1q) and one had anti-E (C1q nonbinding) in addition to anti-D. Various characteristics of anti-D like titre, concentration, IgG subtypes and phagocytic activity showed comparable results (P > 0.3) in C1q binding and nonbinding groups. No significant difference in the severity of Rhesus haemolytic disease of the newborn (Rh HDN), judged by the outcome of pregnancy, cord blood haemoglobin, peak and pre exchange transfusion (ET), indirect serum bilirubin and requirement of ET, was observed in these two groups. Hence this study suggests that though some anti-D sera can bind C1q, there is no further activation of complement pathway and the severity of Rh HDN is not influenced by this phenomenon.

Antibody dependent cell mediated cytotoxicity and erythrophagocytosis assays in Rh haemolytic disease of the newborn.

OBJECTIVE: To evaluate the role of antibody dependent cell mediated cytotoxicity (ADCC) and erythrophagocytosis in comparison to IgG subtypes and concentration of anti-D in haemolytic disease of the newborn (HDN). DESIGN, SETTING AND PATIENTS: One hundred Rh (D) immunised women attending an antenatal clinic of Nowrosjee Wadia Maternity Hospital at 32 to 34 weeks of gestation. Results of 90 women having Rh (D) positive infants were correlated with severity based on outcome of pregnancy, cord blood Hb and treatment given to infant. MEASUREMENTS: Immunoradiometric assay (IRMA) was used for anti-D quantitation. In ADCC assay 51Cr release in the culture supernatant was measured, and in the phagocytosis assay lytic activity was measured on spectrophotometer. Cord blood monocytes were used as effector cells in both the assays. RESULTS: Good correlation (P < 0.01) was observed between ADCC vs IRMA and ADCC vs phagocytosis. ADCC% specific lysis was significantly higher and still-birth rate was increased when mothers had IgG1 + IgG3 type of anti-D. Though all variables showed significant correlation (P < 0.01) with severity, ADCC assay was the most predictive. Cord blood haemoglobin showed a significant inverse correlation with ADCC and phagocytosis assays. CONCLUSION: In the absence of a cordocentesis facility severity of Rh HDN could be reliably judged by ADCC assay. If an isotope laboratory is not available, then instead of ADCC, phagocytosis assay may be employed.

Análise clínica laboratorial na sensibilizaçäo eritrocitária perinatal com a realizaçäo de estudo imuno-hematológico pela gel-centrifugaçäo / Clinico-laboratorial analysis in perinatal erythrocytic sensitivity with the immuno-hematologic study by gel centrifugation

O estudo da rotina imuno-hematológica materno-fetal de 4.340 partos, objetiva correlacionar os resultados positivos dos testes de Coombs Indireto com uma possível icterícia na clínica evolutiva dos recém-nascidos. A rotina consiste na análise do sangue materno (tipagem ABO/Rh-fenotipagem Rh e Kell-Teste de Coombs indireto) e do sangue do recém-nascido (tipagem ABO/Rh-fenotipagem Rh e Kell - Teste de Coombs Direto) obtidos pela metodologia em gel-centrifugaçäo. Em 4340 partos, foram identificados 135 (3,1 por cento) testes de Coombs positivos. As especialidades fos anticorpos encontrados fcoram as seguintes: 94 (69,6 por cento) no sistema ABO; 16 (11,8 por cento) nos vários sistemas, tais como Kell, Duffy, MNSs e HI; 14 (10,4 por cento) no sistema Rh (CcDEe); e 11 (8,2 por cento) no sistema Lewis. Dos 135 testes de Coombs positivo, 104 apresentaram Teste de Coombs direto positivo, onde 87 (83,7 por cento) dos recém-nascidos desenvolveram ictericia. Do total de 135 casos apenas 9 (6,7 por cento) apresentaram positividade para ambos os testes de Coombs, com 100 por cento dos recém-nascidos apresentando icterícia. Os resultados obtidos foram de grande valia, pois com o diagnóstico da hemólise eritrocitária pela causa imunohematológica, obtidos pela utilizaçäo de uma técnica mais sensível, observamos a predominância na positividade do Coombs direto (104 casos - 72,2 por cento), independente do sistema sangüineo materno, mostrando que é aconselhável manter o recém-nascido sob observaçäo por um período mínimo de 72 horas para melhor avaliaçäo da evoluçäo clínica laboratorial da doença hemolítica perinatal

Assessment of severity of haemolytic disease of newborn by monocyte monolayer assay.

The present study was undertaken to estimate the predictive value of antibody titration, antibody quantitation and monocyte monolayer assay (MMA) in assessment of severity of haemolytic disease of the newborn (HDN). Serum samples from 45 alloimmunized mothers, with anti-D(23), anti-c(10), anti-K(6), anti-E(5) and anti-e(1) were taken for the study. The results obtained were compared and the efficiency of each technique in predicting the severity of HDN was assessed. Antibody quantitation and MMA (phagocytic index) correlated well with severity of HDN in mothers with anti-D antibodies. Antibody quantitation (anti-D) had a positive predictive value of 54.5 per cent and negative predictive value of 85.7 per cent while MMA had a positive predictive value of 75 per cent and a negative predictive value of 100 per cent. These findings suggest MMA to be a good negative predictor of HDN but not a good positive predictor of haemolytic disease of the newborn.

Doença hemolítica perinatal leve causada por anti-Diª em mulato / Light perinatal hemolytic disease induced by anti-Diª in mulatto

Um anticorpo anti-Diª. foi causador de doença hemolítica leve em recém-nascido, filho de um casal de mulatos brasileiros. A presença do antígeno Diª. em populaçöes neo-brasileiras é discutido e enfatiza a necessidade dos painéis usados no país incluírem células portadores deste antígeno

Levantamento estatistico de parturientes na Maternidade-Escola Assis Chateaubriand (MEAC) expostas a isoimunizaçao RHo (D) / Statistic survey of parturient woman in Maternity-School Assis Chateaubriand (MEAC) exposed the isoimunization Rho (D)

Foi feito o estudo imunohematologico em 367 mulheres na MEAC por ocasiao do atendimento obstetrico. Obteve-se 61,5% de mulheres Rh negativo, D u negativo nao sensibilizadas, que tiveram filhos Rh positivo ou aborto, onde a profilaxia da isoimunizaçao Rho (D) se impunha. Estes resultados extrapolados para uma media de atendimento mensal de l080 casos, nos levou a um calculo da necessidade de 95 doses de imunoglobulina G anti-D, por mes