[Sickle cell anemia and pregnancy: considerations on systematic prophylactic transfusion]. / Drépanocytose et grossesse: à propos de la transfusion prophylatique systématique.

Sickle cell anemia, a congenital hemolytic type of anemia due to a genetic defect in the beta chain of the globin molecule can cause severe disease. During pregnancy, the risk for preeclampsia and deep venous thrombosis is increased in patients with sickle cell anemia. Occlusion of placenta blood vessels with rigid deformed erythrocytes can cause repeated miscarriages and intra-uterine fetal death. Repeated blood transfusions can prevent these complications by reducing the concentration of abnormal hemoglobin S. We report on the evolution of five pregnancies in three patients with sickle cell anemia who received multiple blood transfusions during gestation, and discuss advantages and risks involved in the care of such cases.

Gel test assay for IgG subclass detection by GM typing: application to hemolytic disease of the newborn.

The gel test assay was evaluated for IgG subclass detection by GM typing of antibodies and compared to the classical inhibition agglutination method on slides or microtiter plates. We used a panel of 5 murine monoclonal antibodies directed against G1M(1), G1M(3), G1M(17), G2M(23), and G3M(21) and 1 human polyclonal anti-G3M(5) antibody. Eleven polyclonal antisera (of immunized women) directed against red blood cells were tested for the GM allotypes carried by their alloantibodies. We controlled the specificity of the gel test reaction using a panel of anti-RH(D) monoclonal antibodies. All reagents exhibited a good reactivity and specificity. They can be used for routine typing. The gel test assay for IgG subclass detection is a specific, simple, and low-cost technique for the detection and management of severe forms of diseases in alloimmunized pregnancies.

[Prevention of fetal hemolytic disease: it is time to take action]. / Prévention de la maladie hémolytique du foetus et du nouveau-né: il faut agir!

In spite of the progress made since 1970 in specific prevention by anti-rhesus immunoglobulins, and improved management of at-risk pregnancies, allo-immunization due to the erythrocytic Rh 1 antigen (formerly known as Rhesus D or Rh D) remains widespread. In fact, anti-Rh 1 antibodies currently constitute over one-third of the immune antibodies detected after pregnancy. The prevention of allo-immunization against the Rh 1 antigen is therefore still problematical, and concerns approximately one pregnant woman in seven. The etiology and pathology of fetal hemolytic disease have been recalled, and the treatment approach during pregnancy and delivery has been carefully examined. Tests for quantifying the risk of fetomaternal hemorrhage have also been described. This approach aims at improving the methods of preventing allo-immunization (e.g., during pregnancy and delivery) and the efficacy of treatment. It is also stated that if the necessary preventive action is not taken in cases of allo-immunization due to to the Rh 1 antigen, this should be considered a grave medical fault.

Characterization of human anti-hrB-like monoclonal antibody.

To develop a blood typing reagent with Rh specificity, peripheral blood lymphocytes were isolated from a multiparous woman with apparent alloanti-Ce and fused with FIS heteromyeloma cells. One hybridoma cell line, FOR-2E3, secreted human IgG, which agglutinated all human red blood cells except R2R2, RZRZ, Dc-, D--, Rhnull, and e+ hrB-. The supernatant is useful as a reagent to screen for hrB- blood donors and to differentiate haplotypes with C and e in cis from haplotypes with C and e in trans.

New antibody in severe rhesus incompatible pregnancies: IgG-kappa antiplacental alkaline phosphatase.

As already found in other various diseases, a macromolecular alkaline phosphatase complex (HMW-AP) was also found in sera of two severe Rhesus-incompatible pregnancies complicated by ascites and fetal hydrops at delivery. This atypical complex was detected and isolated by agarose gel electrophoresis. Immunoelectrophoresis and heat inactivation of this HMW-AP complex revealed that it consisted of IgG of the kappa type and placental AP isoenzyme. The transitory presence of this immuncomplex is discussed. However, in all women with Rh-immunized complicated pregnancies, significant variations of neutrophil and serum AP activities were observed. A fall in AP activity and the presence of an antiplacental AP antibody in serum of women with complicated Rh immunization should be of value in assessing the prognosis of the disease.

Characterization of an IgG2, G2m(23) anti-Rh-D antibody.

IgG2, G2m(23) anti-Rh-D antibodies were detected in the serum of a donor. It has been characterized by Gm typing and the use of polyclonal and mouse monoclonal anti-IgG subclasses (which had proved to be satisfactory for agglutination of sensitized red blood cells). This anti-D constitutes a good reagent for G2m(23) typing.

IgG/placental alkaline phosphatase complexes in Rh-incompatible pregnancy with fetal hydrops.

In 11 cases with anti-Rh-complicated pregnancies, i.e. ascites at 21/25 weeks and fetal hydrops at delivery, we detected the presence of IgG/placental alkaline phosphatase complexes in the maternal serum.