Maternal IgG anti‐A and anti‐B titres predict outcome in ABO‐incompatibility in the neonate

Abstract

Aim: To evaluate predictors for risk of severe hyperbilirubinaemia and kernicterus in ABO‐incompatible neonates with emphasize on maternal IgG anti‐A/‐B titres. Methods: Blood group O women in labour at Oslo University Hospital, Ullevål, were included in the years 2004–2006. Offspring with blood group A or B had direct antiglobulin test performed and IgG anti‐A/‐B levels measured in maternal plasma. Blood group A or B infants developing severe hyperbilirubinaemia, received in addition to phototherapy, immunoglobulin treatment and/or exchange transfusion (EXT). Results: Of 253 neonates, 61.3% had blood group O, 29.6% blood group A and 9.1% blood group B. Twenty neonates with blood group A or B received at least one immunoglobulin treatment. In multivariate analysis, maternal antibody‐titres were the only significant predictors for immunoglobulin treatment (p < 0.0001), EXTs (p < 0.05) and duration of phototherapy (p < 0.0001). The need for invasive treatment increased sharply for antibody titres ≥512. Receiver operating characteristic analyses demonstrated that titres ≥512 had a sensitivity of 90% and a specificity of 72% for predicting immunoglobulin treatment and thus severe hyperbilirubinaemia. Conclusion: Maternal IgG anti‐A/‐B titres contribute to the prediction of risk of severe hyperbilirubinaemia in ABO‐incompatible neonates, in addition to blood‐grouping and direct antiglobulin‐testing, especially following early discharge after delivery.

Retrospective analysis of HDFN due to ABO incompatibility in a single institution over 6 years

“…Several conditions may lead to the immune formation of anti‐A or anti‐B antibodies during the pregnancy of mothers of the O blood group, and their occurrence seems to be related to antigen immaturity of newborns' red cells and/or adsorption of natural agglutinins by alternative antigens with loss of their protective effect against immunisation toward A/B antigens. The occurrence of ABO‐based HDFN is reported in 10% of Caucasian mothers experiencing a major ABO incompatibility with their newborns, 1% of whom require invasive treatments in addition to phototherapy (Ziprin et al, ; Murray & Roberts, ; Bakkeheim et al, ; Ree et al, ).…”

“…The severity of the consequent disease depends on A/B expression on newborn cells, on antigen maturity, mothers' natural agglutinin adsorption by alternative antigens and, most likely, the immune antibody titre and avidity. In Caucasians, 15–20% of newborns have a major ABO incompatibility with mothers, and in 10% of them, a serological HDFN occurs, where only 1·5–2% require treatment by exchange transfusion (ET) or intravenous immunoglobulins (IVIG) (Ziprin et al, ; Murray & Roberts, ; Bakkeheim et al, ; Ree et al, ). Racial differences in ABO HDFN associated with a higher incidence of jaundice have been recognised; in the African population, it was attributed to higher O/B frequency and severe HDFN in O/B mismatch (Bhat & Pavan Kumar, ).…”

Next Generation Sequencing-Based Fetal ABO Blood Group Prediction by Analysis of Cell-Free DNA from Maternal Plasma

“…HDFN can be especially severe in pregnant women with blood group O with a high titer of anti-A or anti-B [3,[6][7][8]. A pregnant woman with high anti-A or anti-B titers [3,10] who has a previous record of having an icteric baby is at increased risk of subsequently having another baby with serious ABO HDFN.…”

A standardized kodecyte method to quantify ABO antibodies in undiluted plasma of patients before ABO‐incompatible kidney transplantation

“…It is not known which assay (kodecyte or A 1 cell assay) has the best correlation with clinical outcome, and this requires clinical trials. The kodecyte method proposed here is also potentially applicable for determining ABO antibody levels in ABO‐incompatible pediatric heart transplantation, production of intravenous immunoglobulin, detecting blood donors with high‐titer ABO antibodies, production of platelet preparations, monitoring ABO‐mismatch bone marrow transplantation, and predicting and monitoring hemolytic disease of the newborn . By eliminating the step of sample dilution and using a standardized reagent RBC, the kodecyte assay has the potential to eliminate the compounding errors of plasma dilution, simplify methodology, make it more suitable for automation, improve standardization between laboratories, and potentially produce a more clinically relevant result.…”