Anti-M Alloimmunization in Pregnancy: An Unusual Cause of Bad Obstetric History

Rai, Rakhi; Saha, Subhas Chandra; Jain, Ashish; Bagga, Rashmi; Prabhash, Kumar; Marwaha, Neelam

doi:10.1007/s13224-015-0822-6

Cited by 5 publications

(5 citation statements)

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“…This patient also had BOH, thus exhibiting severe alloimmunization. Anti-M is a naturally occurring immunoglobulin M antibody that reacts in cold and is clinically insignificant [ 1 , 19 ]. Its conversion to IgG is rare and can cause HDFN.…”

Section: Discussionmentioning

confidence: 99%

“…Its conversion to IgG is rare and can cause HDFN. The prevalence of anti-M can be 10–15% in the pregnant population, but the incidence of HDFN associated with anti-M is very low [ 1 , 2 ]. Rai et al [ 1 ] reported a case of severe alloimmunization with anti-M antibody.…”

Section: Discussionmentioning

confidence: 99%

“…Even more than half a century after the advent of RhD prophylaxis, red cell alloimmunization still poses challenges to obstetricians [ 1 ]. This alloimmunization can lead to hemolytic disease of the fetus and newborn (HDFN).…”

Section: Introductionmentioning

confidence: 99%

“…This alloimmunization can lead to hemolytic disease of the fetus and newborn (HDFN). Other red cell antigens, namely C, c, E, and e, have also emerged as important causes of alloimmunization [ 1 ]. There are approximately 270 antibodies against red blood cell antigens [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…The American College of Obstetricians and Gynecologists recommends routine antenatal testing at the blood bank for maternal blood type (ABO), RhD, and indirect antiglobulin test (IAT) for all pregnant mothers at the first antenatal visit, and additional antibody test at around 28 weeks in RhD negative mothers, whereas the United Kingdom recommends routine antenatal screening test at the blood bank for maternal blood type (ABO), RhD, and IAT for all pregnant mothers at the first antenatal visit, and at around 28 weeks for all mothers [ 7 , 8 ]. In India, according to the guidelines of the Directorate General of Health Sciences Technical Manual, Government of India, alloantibody screening is reserved for Rh-negative women or those with adverse obstetric history [ 1 ]. The studies from New Delhi, Tamil Nadu, Karnataka, and Andhra Pradesh have reported the frequency of these unexpected antibodies as 1.25%, 1.5%, 2.27%, and 1.1%, respectively [ 3 , 6 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Red cell alloimmunization in pregnancy: a study from a premier tertiary care centre of Western India

Gothwal¹,

Singh²,

Bajpai³

et al. 2022

Obstet Gynecol Sci

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The study was conducted to determine the frequency of alloimmunization to various blood group antibodies in pregnant women, and the risk of hemolytic disease in the fetus and newborn. MethodsAll antenatal women, irrespective of the period of gestation or obstetric history, were included, whereas those taking anti-D immune-prophylaxis or with a history of blood transfusion were excluded. Antibody screening and identification were performed using a Bio-Rad ID microtyping system. ResultsOf 2,084 antenatal females, 1,765 were D-antigen positive and 319 D-antigen negative. Sixty-five (3.119%) women alloimmunized. Out of 54 (2.591%) who had sensitized to D-antigen, 11 (0.527%) also sensitized to other antibodies. These 11 alloantibodies identified included: anti-M (n=6; 9.23%), anti-c (n=1; 3.076%), anti-E (n=1; 1.538%), anti-e (n=1; 1.538%), anti-Lewis (a) (n=1; 1.538%), and unspecified antibodies (n=1; 1.538%). Multiple antibodies were seen in four patients that combined: anti-D and anti-C (n=2; 3.076%), anti-e and anti-c (n=1; 1.538%), and anti-D and anti-G (n=1; 1.538%). ConclusionThe rate of alloimmunization in D-antigen-negative women was high. Apart from this, the alloimmunization rate in women with bad obstetric history was very high, at 8.1%. In developing countries such as India, universal antenatal antibody screening, though desirable, may not be justified at present, as the cost and infrastructure required would be immense because of the lower alloimmunization rates in RhD antigen-positive women. However, it is necessary to impose properly formulated protocols to screen pregnant women with bad obstetric history.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Red cell alloimmunization in pregnancy: a study from a premier tertiary care centre of Western India

Gothwal¹,

Singh²,

Bajpai³

et al. 2022

Obstet Gynecol Sci

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Immunohaematological conundrums in obstetrics from transfusion services viewpoint in Armed Forces setup

Jagani¹,

Kumar²,

Pawar

et al. 2023

Medical Journal Armed Forces India

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Hemolytic disease of the fetus and newborn due to alloanti‐M: three Chinese case reports and a review of the literature

Huang

et al. 2018

Transfusion

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BACKGROUND: Alloanti-M was once regarded as not clinically significant, with a few exceptions in extremely rare cases. However, an increasing number of cases of severe hemolytic disease of the fetus and newborn (HDFN), resulting in fetal hydrops and recurrent abortion caused by alloanti-M, have been reported mainly in the Asian population. STUDY DESIGN AND METHODS: Three pregnantChinese women with a history of abnormal pregnancy with hydrops fetalis were encountered. During this pregnancy, a series of clinical examinations and an alloantibody identification against RBCs and platelets were conducted. Intrauterine transfusion and postnatal transfusion were then performed in the fetuses. In addition, the HDFN cases caused by alloanti-M reported in different ethnic groups as well as their clinical and serologic features are also summarized. RESULTS:Three pregnant women were identified with an M-N+ phenotype and IgM mixed with IgG alloanti-M in serum. Their fetuses were found by ultrasound examination and cord blood testing to have severe anemia. Additionally, an M+N+ phenotype and IgG alloanti-M were detected in the cord blood of the three fetuses with titers ranging from 1:1 to 1:128. Moreover, low reticulocyte counts and negative direct antiglobulin tests were also shown in two of the fetuses. After receiving intrauterine transfusions and postnatal transfusions several times, these three fetuses eventually survived and then healthfully developed in the follow-up tracking. CONCLUSION: Alloanti-M immunization can cause severe HDFN with hyporegenerative anemia, often seen in the Asian population, and suppression of erythropoiesis might account for it. ABBREVIATIONS: DAT = direct agglutination test; HDFN = hemolytic disease of the fetus and newborn; IAT = indirect antiglobulin test; IUT = intrauterine transfusion; MCA-PSV = middle cerebral artery peak systolic velocity; MoM = multiple of median; RPI = reticulocyte production index. From the

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Anti-M Alloimmunization in Pregnancy: An Unusual Cause of Bad Obstetric History

Cited by 5 publications

References 4 publications

Red cell alloimmunization in pregnancy: a study from a premier tertiary care centre of Western India

Red cell alloimmunization in pregnancy: a study from a premier tertiary care centre of Western India

Immunohaematological conundrums in obstetrics from transfusion services viewpoint in Armed Forces setup

Hemolytic disease of the fetus and newborn due to alloanti‐M: three Chinese case reports and a review of the literature

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