Occurrence of ABO And RhD Incompatibility with Rh Negative Mothers

Abstract

Introduction:Hemolytic disease of the newborn was first described in the medical literature 1609, when it was diagnosed in one French housewife. In 1932 Diamond and colleagues described the mutual relationship of fetal hydrops, jaundice, anemia and erythoblastosis, which was later called fetal erytroblastosis. Hemolytic disease of the newborn (HDN) in the strict sense is considered disease whose basis is accelerated immune destruction of fetal/child erythrocytes that are bound to IgG antibodies of maternal origin. These antibodies are directed against antigens of father’s origin, which are present in the fetal/children’s erythrocytes and that the mother’s immune system recognizes them as foreign antigens.Goal:The goal is that in the period from January 1st 2011 to October 23st 2013 determine the frequency of ABO and Rh D incompatibilities in our sample of pregnant women/mothers, and to underscore the importance of regular check of ABO Rh D negative pregnant women and application specific Rh D protection.Material and methods:In the General Hospital “Prim. Dr. Abdulah Nakas” in Sarajevo by retrospective study are followed several relevant variables. Immune alloantibodies were detected in vivo by indirect Coombs test (ICT) with serum mother and O test erythrocytes, by direct Coombs test (DCT) with erythrocytes of a newborn.Results:The total number of births ABO Rh D negative was 596 (14%) and ABO Rh D positive mothers 4261 (86%). Of the total number of Rh D negative mothers there was A Rh D: negative mothers 42%; O Rh D negative 33%; B Rh D: negative 17% and AB Rh D: negative 8%. Most of immune antibodies appear in mothers with O Rh D: negative blood type. The emergence of immune antibodies in the Rh D negative mothers was 1%, the appearance of ABO incompatibilities amounted to 2.3% of our sample.Conclusion:In order to reduce the occurrence of alloimmunization of the mother to erythrocyte antigens of the newborn that can lead to major complications in subsequent pregnancies of Rh D: negative mothers and HDN constant monitoring in order to prevent them is necessary. Prevention is essential because once immunized mother will remain immunized for life.

Neonatal Jaundice in Low- and Middle-Income Countries: Lessons and Future Directions from the 2015 Don Ostrow Trieste Yellow Retreat

“…The importance of Rh disease varies widely with the prevalence of Rh-negative maternal status, but the issue of affordable prophylaxis is clearly a priority for many LMICs. The lack of routine maternal and neonatal blood testing in many LMICs is also a barrier, and also impacts the management of ABO incompatibility as a risk factor for serious NNJ [7,32,53,56,57,58,59]. …”

Prevalence of rhesus negativity among pregnant women

“…Prevention of HDN is successful when hyperimmune Rh D gammaglobulin is used in 28/29 and 32/34 week of pregnancy. 5,9,23 Financial inability to purchase the anti-D immunoglobulin had been identified to be a major reason why women don't receive immune prophylaxis, in the condition when the women are unaware about the free supply of anti-D in Government maternity institutions in India. A vial of anti-D immunoglobulin of 1,500 IU or 250μg costs between 2500-7000 INR (75-94 USD).…”

“…Those who survive may suffer from jaundice, which leads to the deafmuteness, speech disturbances, cerebral palsy and mental retardation. 4,5 The frequency of Rh D iso-immunization in the general population continues to be a point of significance for the clinician, as this significantly contributes to morbidity and mortality in obstetric practice. 6 There is a need for further studies in Rh D negative pregnant women because several factors affect the development of allo-immunization and its prognosis.…”

“…Therefore, the second and other pregnancy can have complications related to maternal Rh antibodies to Rh positive fetal red blood cells. 4,5,[8][9][10] Their appearance in the circulation is also possible after amniocentesis, spontaneous or induced abortion, cardiocentesis, chorionic villus sampling, ruptured ectopic pregnancy and a blunt trauma to the abdomen.…”

“…The frequency of Rh negative women is more common for Caucasian women (15%) than African American (5%) and is less common in Asian women. 5,[8][9][10] Antibodies from Rh system are almost always immune, predominantly in the IgG class, passing due to its size through the umbilical cord and cause hemolytic disease of the new born. Under Hemolytic disease of the new born (HDN) in the strict sense is considered disease whose basis is accelerated immune destruction of fetal/child erythrocytes that are bound to IgG antibodies of maternal origin.…”