A Detailed Serological Study on the Prediction and Diagnosis of ABO Haemolytic Disease of the Newborn (ABO HD)

Abstract

Summary. An evaluation is given of haemolysin, neutralisation, thermostability, saline titration, anti‐Ap antibody absorption and 2‐mercapto‐ethanol studies on the sera from 178 clinically affected ABO HD cases and 130 control cases. The antiglobulin titre on the 2‐mercapto‐ethanol treated sera which determines the IgG titre was the best procedure used for the demonstration of significant immune anti‐A/B antibodies in the maternal sera. The screen series on 5,704 sera from group 0 mothers for the detection of immune anti‐A/B and the attempted prediction of ABO HD revealed that ABO HD occurs with a frequency of about 0.8%. Exchange transfusion was needed in six cases i.e. about 0.1% of all the infants of group O mothers screened. The minimum criteria for the diagnosis of ABO HD are the serological demonstration of incompatible anti‐A/B antibodies in an eluate prepared from the baby' red cells, accompanied by the clinical observation of jaundice, or more rarely pallor due to anaemia, in the infant during the first few days following birth. In the absence of elution or serum studies on a blood sample from the baby, the presence of an incompatible high titre (>256) IgG antibody in the maternal serum provides good presumptive evidence that the baby may be suffering from ABO HD.

Immunohaematological Profile of Maternal Antibody-Mediated Abo Haemolytic Disease of Foetus and Newborn

“…23 Bowley and Voak had identified that eluate from the infant's red cells with weak positive or negative DAT might give strong indirect antiglobulin reactions with adult A1 red cells, because elution causes increase in antibody concentration. 6,19 In our analysis, concurrent DAT and elution positivity (30.9%) were significantly associated with 4.8 times amplified risk for higher bilirubin levels when compared to those in which antibody was detected only by elution (22.7%). Likewise, Dharmayani et al had observed that those with DAT and elution positivity in concert had a 3.2 times higher risk for higher bilirubin levels when compared to elution alone positive group.…”

“…5 Bowley and Voak suggested that an IgG titre of ≥ 256 in maternal serum had provided a good presumptive evidence of ABO HDFN. 6 In India, Gupte and Bhatia noticed that all cases of ABO HDFN showed a raised incomplete antibody titre ranging from 1:16 -1:32. In our investigation, mothers of two severely affected infants with ABO HDFN had a very high titre of antibodies (1024).…”

“…23 The minimum criteria for the diagnosis of ABO HDFN suggested by Voak et al was serological demonstration of incompatible anti-A/B antibodies in an eluate prepared from the baby red cells accompanied by the clinical observation of jaundice or more rarely pallor due to anaemia in an infant during the first few days of birth. 6 Levine et al had postulated that cord blood bilirubin is not diagnostic of haemolytic disease, but was moderately predictive of peak bilirubin levels in ABO HDFN.…”

Frequency of Antibodies in Haemolytic Disease of Foetus and Newborn

“…Frequency of ABO-HDFN was 0.8% in that study. 29 Murray et al observed that the frequency of HDFN triggered by anti-A was about 1 in 150 births and even lesser for anti-B. 30 The relative frequency of ABO-HDFN varied in different populations.…”

Severe ABO Haemolytic Disease Due to High Titre IgG Anti-B in an A(2) Mother

“…Sephadex separation of IgM anti-A from IgG anti-A: DEAE Sephadex A-50 was used, and the preparation of the gel and the method employed was that of Webb [12]. The techniques used in the estimation of ABH substance in serum, the thermostability test and the use of 2-mercaptoethanol were those of Voak and Bowley [10]. The partial neutralisation test was that described by Dunsford and Bowley [2],…”