The first example of anti-Diego(b) found in a Polish woman with the Di(a+b-) phenotype and haemolytic disease of the newborn not requiring treatment.

All pregnant women with anti-Diegob (anti-Dib) described so far were non-Caucasians. We present the case of a Polish Di(a+b-) woman with anti-Dib, which did not bind complement, was immunoglobulin G3 (IgG3) alone and had very low functional activity. She delivered a Di(a+b+) infant with a positive direct antiglobulin test and the antibody in his serum but very mild haemolytic disease. Both parents of the pregnant woman were Di(a+b+), so were all her three children. The whole family have been living in a small village in southeastern Poland for a long time. The rare Diego phenotypes, found now and previously in Poland, suggest gene admixture introduced as a result of Poland being invaded by Mongolian-background Tatars during the past centuries.

[Rh feto-maternal incompatibility after the 25 year long immunoprophylaxis]. / Konflikt Rh po 25 latach stosowania immunoprofilaktyki.

Results of antibody investigations during pregnancy in 348,040 women were summared. Immune alloantibody were stated in 3053 women (0.9%): in 2437 anti-D (1.6% of Rh negative) and in 606 other immune antibodies. The reasons of the D antigen immunization were analysed. Anti-D activity by chemiluminescence test (CLT) in 45 women, qualified to cordocentesis, were presented. The results compared to the fetal anaemia indicated that in women with high titer (32 or higher), CLT could diminish invasive diagnostics.

Moderate hemolytic disease of the newborn due to anti-Hr0 in a mother with the D--/D-- phenotype.

Hemolytic disease of the newborn (HDN) due to anti-Hr0 antibody is typically severe and often fatal. We report a case of moderate HDN due to anti-Hr0 in a woman with the D--/D-- phenotype. A 33-year-old woman delivered her second child who was mildly jaundiced. The highest level of bilirubin was 26.1 mg/dL on the third day postpartum and the hemoglobin concentration was 14.0 g/dL. The newborn recovered after phototherapy and no mental retardation was noticed after 1 year of follow up. An exchange transfusion was excluded due to the lack of a compatible donor and the physical condition of the mother precluded blood donation. The maternal RBCs were D+C-c-E-e-; only G and Rh29 of the Rh system were expressed. Thus, her probable phenotype was D--/D--. Her alloantibody was identified as anti-Hr0 (anti-Rh17) as it reacted with all red blood cells (RBCs) but not her own, other D--- RBCs, and Rhnull RBCs. The results of the antibody titer (64) and activity in a chemiluminescense test (CLT; 34%) were consistent with a moderate HDN. Family studies were negative for the D--/D-- phenotype and consanguinity was not proved. This is the first described case of moderate HDN due to anti-Hr0. The result of antibody activity in the CLT might be helpful in predicting the severity of HDN in other rare HDN cases.

[Diagnosis of human parvovirus B19 infection in nonimmune hydrops fetalis]. / Diagnostyka zakazenia ludzkim parwowirusem B19 w nieimmunologicznym obrzeku plodu.

Parvovirus B19 (PV B19) infection was investigated in 29 pregnant women with fetal hydrops, after exclusion of feto-maternal incompatibility within red blood cell antigens, TORCH infections, feto-maternal hemorrhage and genetics reasons. The active viral infection was detected in 9 women (31%) by PCR amplification of DNA B19; in 2 of them IgM and IgG, in 1 IgM and in 4 IgG antibodies were also present. In 6 women (20%) IgG antibodies were only found, but not IgM and DNA B19, which confirmed infection in the past. In addition in 9 cases DNA B19 was evaluated in the fetal blood. The results in the mothers and their fetuses were concordant (4 positive, 5 negative). Our conclusion is that in nonimmune hydrops fetalis, PV B19 infection should be based on the viral DNA evaluation in the blood of mother (or fetus). IgM antibodies, in time of fetal disorders, might not be detected.

[Intrauterine blood transfusions in the treatment of severe serologic conflict]. / Transfuzje wewnatrzmaciczne w leczeniu ciezkich postaci konfliktu serologicznego.

Efficacy of the intraperitoneal and intravenous blood transfusions guided ultrasonographically was evaluated in severe cases of fetal hemolytic disease due to Rh conflict. It was shown, that survival rate of fetuses without generalized edema is two-fold higher in the group treated with intraperitoneal blood transfusions in comparison with the control group. It was found, that the proportion of erythrocytes containing HbA in umbilical blood of newborn is related to the number of intraperitoneal transfusions. One has to underline the failure of such a treatment in features with generalized edema. In such case intravenous blood transfusion is a method of choice.

[Evaluation of the test using polybrene for the detection of anti-erythrocyte antibodies]. / Ocena testu z uzyciem polibrenu w wykrywaniu przeciwcial przeciw krwinkom czerwonym.

The polybren test (P) was used parallelly with the antiglobulin test (PTA-LISS) and enzymatic test (LEN) for detection of HIV-1 antibodies. The analysis of the results of testing of 646 sera showed that the P test is a simple method making possible detection of most antibodies of the IgG class without using antiglobulin serum within up to 3 minutes. The sensitivity of the P test was high. The sera with antibodies to the antigens of the systems Rh, Kidd, Duffy, MNSs and other less frequent antibodies such as anti-Vel, anti-Coa anti-Co(b), anti-Dia and anti-Ge showed the highest activity in the P test. In one serum anti-D antibodies, in three sera anti-C and in one serum anti-Ge antibodies were detected only in the P test, while no reactions were obtained in the PTA-LISS and LEN tests. Among the immune antibodies the exception was the antibody to Kell antigens which weakly reacted in the P test and in most cases an additional phase of testing with antiglobulin PTA-P was necessary for its demonstration. The P test was of low usefulness in the detection of cold IgM antibodies such as anti-Le, anti-Fe1, anti-I and anti-HI.

[Remarks on routine use of the enzyme test LEN (LISS Enzyme) in immunohematological studies]. / Spostrzezenia nad rutynowym stosowaniem testu enzymatycznego LEN (LISS-Enzym) w badaniach immunohematologicznych.

The authors report one-year experience with the enzymatic test LEN (LISS-Enzym) replacing the one-step papain test in the compatibility testing, and in place of the two-step papain test in the detection and identification of red cells allo-antibodies. A wide range of investigations confirmed the usefulness of this test in the detection and antibodies specificity, mainly from the Rh system which are often undetectable by means of the indirect antiglobulin tests. It is concluded that in compatibility tests the LEN test should replace the low-sensitivity one-step papain test used as yet. It is stressed that in case of positive reactions only in the LEN test suggesting presence of autoantibodies the test should be repeated bringing to 37 degrees C the reacting components before their mixing. This makes possible elimination of clinically not significant cold autoantibodies.

[Prediction of the severity of fetal erythroblastosis using the erythrocyte phagocytosis test and evaluating anti-Rh antibody titers and their levels by autoanalysis]. / Przewidywanie ciezkosci choroby hemolitycznej noworodków za pomoca testu erytrofagocytozy, miana przeciwcial anty-Rh i ich stezenia ocenianego w autoanalizatorze.

Erythrophagocytosis++ test was performed in 45 pregnant Rh-negative women together with routine anti-Rh antibodies assay with indirect antiglobulin test and their concentration determined in an autoanalyser. It was found that the degree of ++phagocytosis of the standard erythrocytes immunized with maternal anti-Rh antibodies by the monocytes from healthy subjects is an important predictive factor enabling to foresee a severity of hemolytic disease in newborn babies. ++Phagocytosis over 50% predicts a severe course of the disease whereas under 20%--a mild form of the serologic conflict.

First example of By phenotype.

In ABO blood grouping red cells of a young healthy woman behaved like O, but in her serum anti-B was lacking. By absorption-elution technique the very weak B activity was revealed. The saliva contained B and H substances, although the B to H ratio was significantly reduced, when compared to the normal B and Bm secretors. In the serum B transferase activity was not demonstrated. The presented results were comparable to those described in persons with Ay phenotype. Therefore, this weak B variant can be classified into By category.

[Anti-M antibodies in the pathogenesis of hemolytic disease of the newborn]. / Przeciwciala anty-M w patogenezie choroby hemolitycznej noworodków.

Two cases are presented of serological fetomaternal incompatibility in the MNSs group system diagnosed for the first time in Poland. Anti-M antibodies of the mother caused in one newborn haemolytic disease with acute anaemia requiring blood transfusions. In the other newborn clinical signs of the disease failed to appear despite a positive direct antiglobulin test. The results are presented of immunohematological studies calling attention to difficulties connected the diagnosis of haemolytic disease of the newborn caused by anti-M antibodies. This problem is discussed more extensively in the light of available literature.

Serological and immunological characteristics of maternal anti-Rh(D) antibodies in predicting the severity of haemolytic disease of the newborn.

A number of factors were analyzed for their predictive value in indicating the severity of haemolytic disease of the newborn (HDN) in 72 infants. The factors investigated were: maternal antibody titre in the indirect antiglobulin test, the number of antibody molecules on sensitized standard red cells evaluated by a radiometric antiglobulin test, the IgG subclass specificity and the reactivity in monocyte-monolayer assay (MMA) and in the rosette assays with lymphocytes and granulocytes from healthy individuals. The results of the MMA correlate much better with the severity of HDN than the antibody titre. In clinically unaffected infants the reactivity in the MMA never exceeded 20%, while in the severe/very severe group it was always greater than 20% (in 95% of very severe cases even above 50%). The number of IgG-bound molecules was also shown to closely correlate with the clinical severity and there was a much greater proportion of severe/very severe cases exhibiting combined IgG1 and IgG3 specificity. Of all the evaluations performed the rosette assays with lymphocytes and granulocytes were found to be less useful in predicting the severity of HDN.

Weak A phenotypes possibly caused by mutation.

A family is described in which an apparent Ay phenotype was transmitted through 2 generations. We favor a mutation of the A allele as the most likely cause of the phenotype. Activities of the serum A-gene-specified transferase were not detected in any of the 3 family members with the Ay phenotypes.