Correlation between the Amount of Anti-D Antibodies and IgG Subclasses with Severity of Haemolytic Disease of Foetus and Newborn

Abstract

AIM:The aim of this study was to investigate the influence of subclasses to IgG anti-D on the intensity of hemolytic disease of fetus and newborn (HDFN) at 45 fetuses/newborns with symptoms of mild and severe HDFN in Republic of Macedonia.MATERIAL AND METHODS:In retrospective and prospective studies, in a period of 10 years, from 2004 to 2014, there have been immunohemathology tests performed on 22 009 samples on serums of pregnant women.RESULTS:At 37.78% of the total number of tested patients, IgG1 and IgG3 was the reason for severe HDFN. At 17.77% of the total number of tested patients, which had only IgG1detected, was the reason for serious intensity of HDFN. The correlation of the titer to anti-D antibodies in the mother’s serum and the intensity of HDFN were researched in 48 newborns. The titers between 1:8 and 1:32 resulted in 3 cases of HDFN with symptoms of severe disease and in 4 cases there were no signs of HDFN. At 12 women that had a titre between 1:32 and 1:512, five of the newborns developed severe HDFN, and seven had symptoms of mild and weak intensity form. In 3 cases the titer was higher than 512, and out of them one newborn had weak symptoms of HDFN, one developed severe HDFN and one ended with foetal death. Only in one case the titer reached a value higher than 1000, and it ended with a fetal death.CONCLUSIONS:The titers of the pregnant women serum those are lower than 32 and those higher than 1000 can well predict HDFN. The titers of anti-D antibodies between 64 and 512 have no exact predictive value. IgG1 and IgG3 subclasses of anti-D have no predictive value by themselves, and cannot foresee the outcome of HDFN. The research study results suggest that IgG1 and IgG3 should be included in a multi – parameter protocol for evaluation of the HDFN intensity. They can give a real assessment of the expected HDFN intensity in combination with the titer hight and the significance of the antibodies.

3D visualization and quantitative analysis of human erythrocyte phagocytosis

“…In order to obtain stronger phagocytosis reactions with a greater number of cells involved, we opsonized the erythrocytes with anti‐D antibodies. This model corresponds to the hemolytic transfusion reaction and to hemolytic disease of the fetus and newborn, in which spleen macrophages engulf erythrocytes (Basu et al, ; Velkova, ). The use of monocytes from the peripheral blood is suitable for predicting extravascular immune hemolysis in some recipients with rare alloantibodies, especially when it is difficult to find serologically compatible red blood cells.…”

20 Years of Follow-up Alloimmunization and Hemolytic Disease in Newborn: Has Anything Changed in the Field Over the Years?

“…Thirty years ago, HDN was almost synonymous with RhD sensitization and was a common neonatal problem. Since then, other blood group antigens of the Rh system (C, c, E, e, Cw), and other blood group systems have come to light [3,10,15,19]. The introduction of anti-D prophylaxis and mandatory immuno-hematological screening 3 times during pregnancy [2] has significantly decreased the number of fatalities caused by Rhesus D (RhD) sensitization and its severe impact on infants and pregnant women [17].…”

Retrospective study on prevalence, specificity, sex and age distribution of alloimmunization in two general hospitals in Athens

“…Studies so far have reported various immunization rates among different study groups, ranging from 5% in the general population and a mean percentage of 1.6% in pregnant women worldwide [ 6 , 7 ] to up to 30% in multitransfused patients (myelodysplastic syndromes, thalassemia patients) [ 8 , 9 ]. Genetic heterogeneity between donor and recipient populations, differences in transfusion policies, and differences in the specificity and sensitivity of the test methods may account for the reported variation [ 10 , 11 , 12 , 13 ].…”