Hemolytic disease of the fetus and newborn caused by anti-Hr0 in a 27-year-old female with Dc- phenotype: A case report.

Anti-Hr0 (Anti-Rh17) is a rare immune Immunoglobulin G (IgG) to high-frequency Rh antigens that may cause severe and often fatal Hemolytic disease of the fetus and newborn (HDFN) in D--, Dc- and DCw- mothers who have been exposed to red cells of the common Rh phenotype by transfusion or pregnancy. Several pregnant women have been affected by this antibody leading to perinatal death. Therefore, immediate and effective management of these cases is of great importance. We report a case of HDFN in a 27-year-old (G5, P3, L1), woman with Rh Dc- phenotype managed successfully using intravenous immunoglobulin (IVIg) and simple transfusions.

Determinants of Neonatal Jaundice among Neonates Admitted to Neonatal Intensive Care Unit in Public General Hospitals of Central Zone, Tigray, Northern Ethiopia, 2019: a Case-Control Study.

BACKGROUND: Neonatal jaundice is common a clinical problem worldwide. Globally, every year, about 1.1 million babies develop severe hyperbilirubinemia with or without bilirubin encephalopathy and the vast majority reside in sub-Saharan Africa and South Asia. Strategies and information on determinants of neonatal jaundice in sub-Saharan Africa are limited. So, investigating determinant factors of neonatal jaundice has paramount importance in mitigating jaundice-related neonatal morbidity and mortality. Methodology. Hospital-based unmatched case-control study was conducted by reviewing medical charts of 272 neonates in public general hospitals of the central zone of Tigray, northern Ethiopia. The sample size was calculated using Epi Info version 7.2.2.12, and participants were selected using a simple random sampling technique. One year medical record documents were included in the study. Data were collected through a data extraction format looking on the cards. Data were entered to the EpiData Manager version 4.4.2.1 and exported to SPSS version 20 for analysis. Descriptive and multivariate analysis was performed. Binary logistic regression was used to test the association between independent and dependent variables. Variables at p value less than 0.25 in bivariate analysis were entered to a multivariable analysis to identify the determinant factors of jaundice. The level of significance was declared at p value <0.05. RESULTS: A total of 272 neonatal medical charts were included. Obstetric complication (AOR: 5.77; 95% CI: 1.85-17.98), low birth weight (AOR: 4.27; 95% CI:1.58-11.56), birth asphyxia (AOR: 4.83; 95% CI: 1.617-14.4), RH-incompatibility (AOR: 5.45; 95% CI: 1.58-18.74), breastfeeding (AOR: 6.11; 95% CI: 1.71-21.90) and polycythemia (AOR: 7.32; 95% CI: 2.51-21.311) were the determinants of neonatal jaundice. CONCLUSION: Obstetric complication, low birth weight, birth asphyxia, RH-incompatibility, breastfeeding, and polycythemia were among the determinants of neonatal jaundice. Hence, early prevention and timely treatment of neonatal jaundice are important since it was a cause of long-term complication and death in neonates.

ABO and Rh blood groups in relation to ovarian, endometrial and cervical cancer risk among the population of South-East Siberia.

BACKGROUND: There is a large amount of evidence that the ABO blood group system may play a role in disease etiology. A relationship between ABO and Rhesus blood groups and cancer risk has been demonstrated in a number of studies. However, in relation to gynecological malignancies, these findings are inconsistent and contradictory. AIM: To perform a case-control study for analysis of the distribution of ABO and Rh blood antigens among women from South-East Siberia who suffered from ovarian, endometrial and cervical cancer, and to assess the potential role of these antigens in carcinogenesis. DESIGN, SUBJECTS AND METHODS: A total of 1,163 cases with ovarian cancer (n=551), endometrial cancer (n=440) and cervical cancer (n=172) were involved in the study. The control group was formed from 22,581 female blood donors. Blood groups were determined through patients medical records and blood donor records. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. The blood group O was defined as the referent group, as it has the greatest frequency in the populations of Southern Siberia. P values less than 0.05 were regarded as statistically significant. RESULTS: We found that carriage of non-O blood types increased the risk of ovarian cancer by 40-60%, and the magnitude of this relationship was strongest in women with the AB (IV) blood group. Carriage of the A (II) blood group strongly correlated with an increased risk of ovarian cancer in premenopausal, but not in postmenopausal women. No statistically significant correlations were obtained for endometrial cancer and cervical cancer. Additionally, we did not observe a relationship between Rhesus factor and cancer risk. CONCLUSION: We suggest that carriage of non-O blood groups may elevate risk of ovarian cancer and can play a role in its development.

Maternal-fetal blood incompatibility and neuromorphologic anomalies in schizophrenia: Preliminary findings.

Prior research has shown that maternal-fetal Rhesus (Rh) and ABO blood incompatibility increase the risk for schizophrenia. In the present study, the relationship between blood incompatibility and volumes of brain structures previously implicated in schizophrenia was assessed in schizophrenia cases and controls from a large birth cohort. Rh/ABO incompatible cases had significantly reduced cortical gray matter volume compared to compatible cases, a finding which appears to be driven by significant volume reductions in the dorsolateral prefrontal cortex and inferior frontal cortex. Larger hippocampal and putamen volumes were also observed in exposed controls compared to unexposed controls. Although the sample size is small and replications are required, these data suggest that maternal-fetal blood incompatibility may increase the risk for altered brain morphology in both schizophrenia and in controls. The findings also suggest that the larger hippocampal volume in exposed controls may indicate a mechanism of adaptive resilience which diminishes the risk that controls will develop schizophrenia.

A strategic approach to the problems of providing rhesus D-negative blood transfusion in geographic areas with low RhD negativity: a Nigerian perspective.

In contrast to the white prevalence, the frequency of rhesus D (RhD) negativity in the Nigerian population ranges from less than 1% to about 6% in the different ethnic population groups across the country. Consequently, there is often a severe scarcity of RhD-negative blood in Nigeria, leading to undue delay in transfusing RhD-negative patients. This situation has led to the prolongation of hospital stays as well as increased morbidity and mortality in affected patients. The problem is compounded by the general unavailability of donor RhD-negative blood, which is partially related to a suboptimal national blood transfusion service. This situation has thus relegated the responsibilities of donor recruitment and blood collection to individual hospital blood banks. This has led to the necessity of finding a variety of ways to mitigate the daunting problem of the provision of RhD-negative donor blood in Nigeria. In this article, we review the roles, advantages, and disadvantages of various methods including the use of autologous donations, D(u) testing, inter-blood bank transfers, voluntary RhD-negative donor recall, family donations, and cryopreservation to ameliorate the problem. The real need is nonetheless to optimize the functional capacity of the Nigerian National Blood Transfusion Service.

Prevención de las infecciones del torrente sanguíneo asociadas a cateter venoso central (CVC) en las unidades de cuidados intensivos de 07 establecimientos de salud de Lima y Callao / Prevention of bloodstream infections associated with central venous catheter (CVC) in intensive care units of 07 health facilities in Lima and Callao

El presente documento brinda información de las experiencias realizadas en el estudio, el cual contribuye en el mejoramiento continuo de la calidad y la reducción del impacto de las infecciones intrahospitalarias en servicios críticos priorizados de siete hospitales públicos y privados a través de la vigilancia, la gestión de riesgos y la promoción de buenas prácticas, en el marco de las iniciativas para la seguridad de los pacientes impulsados por el MINSA y la OMS

Prevención de las infecciones del torrente sanguíneo asociadas a cateter venoso central (CVC) en las unidades de cuidados intensivos de 07 establecimientos de salud de Lima y Callao / Prevention of bloodstream infections associated with central venous catheter (CVC) in intensive care units of 07 health facilities in Lima and Callao

El presente documento brinda información de las experiencias realizadas en el estudio, el cual contribuye en el mejoramiento continuo de la calidad y la reducción del impacto de las infecciones intrahospitalarias en servicios críticos priorizados de siete hospitales públicos y privados a través de la vigilancia, la gestión de riesgos y la promoción de buenas prácticas, en el marco de las iniciativas para la seguridad de los pacientes impulsados por el MINSA y la OMS(AU)

A curious case of anti-D antibody titer.

RhD alloimmunization remains a threat to 1% of the 10% of RhD-negative women in the United States who are giving birth to RhD-positive fetuses despite routine antenatal and postpartum administration of Rh(o)D immune globulin (RhIG). This report examines the clinical course of an RhD-negative woman who developed a high anti-D antibody titer during her pregnancy while carrying an RhD-positive female fetus yet had a negative antibody screen at the time she gave birth. Although she delivered a healthy newborn unaffected by hemolytic disease, subsequent pregnancies will be treated as though she is RhD alloimmunized. The discussion below includes possible causes for the abrupt rise in this woman's anti-D antibody titer, a review of the complex Rh system and cellular anamnestic response, and current fetal surveillance for hemolytic disease of the fetus and newborn.

RBC alloimmunization is an important complication of FFP transfusion: A case report of immune anti-D induced by apheresis fresh frozen plasma.

UK, Germany as well as the Council of Europe recommendation guide have set limits of RBC in clinical fresh frozen plasma (FFP), but current transfusion guidelines do not get the consensus opinion at recommending the D status of FFP to be considered before transfusion. We report a female group A, D- patient with cerebrovascular disease who was induced to develop IgG immune anti-D which can be detected on the 15th day of hospitalization after the relatively regular time interval of transfusion of 1800ml apheresis FFP. Therefore, in making clinical decisions to transfuse FFP or apheresis FFP, the best choice is considered as the same or compatibility with RhD group, in case Rh immunization can be induced and trigger some potential serious problems in future emergent transfusion or pregnancy, especially in high incidence of D antigen countries.

An increased risk for non allo-immunization related intrauterine fetal death in RhD-negative patients.

OBJECTIVE: To investigate immediate perinatal outcome of RhD-negative patients carrying RhD-positive fetuses who received antenatal Rh immunoglobulin for the prevention of RhD-mediated hemolytic disease of the fetus and newborn. METHODS: A retrospective population-based analysis was conducted comparing pregnancies of all RhD-negative women who received antenatal Rh immunoglobulin prophylaxis (anti-D), to RhD-positive parturients, during the years 1988-2003. All women were RhD-negative without evidence of RhD sensitization. Patients received anti-D during the 28-30th week of pregnancy, and an additional dosage within 72 hours following delivery after confirmation of the newborn's RhD status. RESULTS: Of 145,437 deliveries during the study period, 6.8% were of RhD-negative women (n = 9961). Perinatal mortality rate was significantly higher among the RhD-negative women who received antenatal prophylaxis rhesus immunoglobulin as compared with the controls (17/1000 vs. 12/1000, OR = 1.3, 95%CI 1.2-1.6; p < 0.001). This higher mortality rate was related to a higher rate of intrauterine fetal demise (IUFD) (10/1000 vs. 6/1000, OR = 1.5, 95%CI 1.2-1.9; p < 0.001). The association remained significant after controlling for RhD isoimmunization leading to hydrops fetalis, using the Mantel-Haenszel technique (weighted OR = 1.3; 95% CI 1.1-1.5; p = 0.001). The rate of RhD isoimmunization was 0.6% (n = 58). Using a multivariable analysis with IUFD as the outcome variable, controlling for known confounders for fetal demise, RhD-negative status was an independent risk factor for IUFD. CONCLUSION: RhD-negative women carrying RhD-positive newborns are at an increased risk for IUFD despite Rh immunoprophylaxis.

Successful perinatal management of hydrops fetalis due to hemolytic disease associated with D-- maternal phenotype.

We report the successful management of a case of hemolytic disease and hydrops fetalis secondary to anti Rh 17 antibodies in a woman with the rare D-- phenotype. We discuss the efficacy of intravenous immunoglobulins in treating hemolytic disease of the newborn infant.

Enfermedad hemolítica fetoneonatal por anticuerpo anti-Diª / Haemolytic anemia in neonatal period produced by anti-Diª antibody

El sistema Diego está compuesto por dos pares independientes de antígenos: Diª/Dib, Wrª/Wrb, ubicados en una proteína de la membrana eritrocitaria, la banda 3. Este sistema tiene mucho valor en antropología porque informa del origen mongoloide de los japoneses, chinos e indios americanos. El 36 por ciento de las poblaciones indígenas de América Central y del Sur y un 3-15 por ciento de orientales presentan el antígenos Diª. pero en América y Europa casi todas las personas son Di(a-,b+). el objetivo de este trabajo es informar el caso de una mujer con 3 hijos, uno de los cuales desarrolló enfermedad hemolítica fetoneonatal (EHFN) debida a anticuerpos anti-Diª. El estudio de anticuerpos irregulares en el suero de la mujer usando panel celular comercial fue negativo; pero la prueba antiglobulínica indirecta enfrentando los globulos rojos del marido con el suero de la esposa fue fuertemente positiva. El anticuerpo se identificó como anti-Diª. De los tres hijos, el primero fue normal, pero el segundo presentó ictericia y prueba antiglobulínica directa positiva, por lo que fue necesario realizar una exanguinotransfusión, transfusiones de hematíes y luminoterapia. La ictericia fue causada por el anti-Diª materno inducido por el primer embarazo. El tercer neonato fue antígeno Diª negativo.

Enfermedad hemolítica fetoneonatal por anticuerpo anti-Di¬ / Haemolytic anemia in neonatal period produced by anti-Di¬ antibody

El sistema Diego está compuesto por dos pares independientes de antígenos: Di¬/Dib, Wr¬/Wrb, ubicados en una proteína de la membrana eritrocitaria, la banda 3. Este sistema tiene mucho valor en antropología porque informa del origen mongoloide de los japoneses, chinos e indios americanos. El 36 por ciento de las poblaciones indígenas de América Central y del Sur y un 3-15 por ciento de orientales presentan el antígenos Di¬. pero en América y Europa casi todas las personas son Di(a-,b+). el objetivo de este trabajo es informar el caso de una mujer con 3 hijos, uno de los cuales desarrolló enfermedad hemolítica fetoneonatal (EHFN) debida a anticuerpos anti-Di¬. El estudio de anticuerpos irregulares en el suero de la mujer usando panel celular comercial fue negativo; pero la prueba antiglobulínica indirecta enfrentando los globulos rojos del marido con el suero de la esposa fue fuertemente positiva. El anticuerpo se identificó como anti-Di¬. De los tres hijos, el primero fue normal, pero el segundo presentó ictericia y prueba antiglobulínica directa positiva, por lo que fue necesario realizar una exanguinotransfusión, transfusiones de hematíes y luminoterapia. La ictericia fue causada por el anti-Di¬ materno inducido por el primer embarazo. El tercer neonato fue antígeno Di¬ negativo. (AU)

Haemolytic disease of the newborn due to anti-Ce.

A baby was readmitted to the hospital 3 days after delivery when she developed jaundice. At admission, the direct antiglobulin test was also found to be positive. The baby required emergency exchange transfusion. A strongly reacting IgG anti-Ce (Rh7) was found in the serum of the mother. Severe haemolytic disease of the newborn due to anti-Ce is very rare. The mother's serum had been screened and found negative for red cell antibodies at 16 weeks gestation but the test was not repeated later in pregnancy when this antibody might have been detected.

Neurodesarrollo al año de vida en infantes con antecedentes de enfermedad hemolítica por factor Rh / Neurodevelopment at one year of age in infants of Rhesus hemolytic disease

Introducción. Los reportes de seguimiento en infantes con antecedente de enfermedad hemolítica del recién nacido (EHRN) por factor Rh informan coeficientes intelectuales menores en estos pacientes. El objetivo del presente estudio fue analizar el estado neurológico al año de vida de infantes con EHRN y su relación con algunas variables neonatales.Material y métodos. Los pacientes se analizaron en función de las tres zonas de Liley-Sentíes, de la presencia de anemia (hematócrito menor de 40 por ciento), número de transfusiones intrauterinas, calificación de Apgar, edad gestacional, peso, bilirrubinas, número de exanguinotransfusiones, días de fototerapia, hospitalización y del resultado de la valoración neurológica y audiológica al año de vida.Resultados. Se estudiaron 56 pacientes; solamente el peso y la edad gestacional fueron significativamente menores para los de la zona III de la clasificación de Liley-Sentíes. No se encontraron diferencias neurológicas entre los pacientes de las 3 zonas. El grupo de infantes anémicos tuvo un número significativamente mayor de alteraciones neurológicas severas, así como menor edad gestacional y mayor número de días en fototerapia. La transfusión intrauterina no tuvo relación con la anemia ni sobre el estado neurológico al año de vida. El porcentaje de infantes con alteración neurológica fue de 30 por ciento, de los cuales 76 por ciento estuvieron asociados a anemia. Conclusión. Los resultados están de acuerdo a lo reportado en la literatura, donde se describe una relación significativa entre anormalidad neurológica y menor nivel de hemoglobina. Se observó que la gravedad de la hemólisis por factor Rh evaluada por el esquema de Liley-Sentíes no se relaciona con el estado neurológico al año de vida.