The Incidence and Effects of Alloimmunization in Pregnancy During the Period 2000 – 2013

Abstract

ABSTR AC T IntroductionThe objective of the analysis was to examine the epidemiological aspects of maternal alloimmunization and to determine the most common antibody specificities resulting in hemolytic disease of the newborn (HDN). Materials and MethodsThe retrospective epidemiological study encompasses all pregnant women who underwent immunohematological screening and the newborn treated for HDN in the period from 2000 to 2013 in the Herzegovina region. ResultsThe indirect Coombs test (ICT) detected antibodies against antigens in 384 (2.4 %) pregnant women of the 18 800 who were tested at the Department of Transfusion Medicine. The direct Coombs test (DCT) detected antibodies against antigens in 160 (0.8 %) newborn treated for HDN. The results of our 13-year study, in which 60 % of the pregnant women had non-RhD antibodies, confirms this finding.Conclusion However, we have reached the 21st century and the burden of alloimmunisation in pregnancy is still on our backs. The problem of immunization and HDN is still present in our region, which is a neonatal and public health problem.

Live birth prevalence of hemolytic disease of the fetus and newborn in the United States from 1996 to 2010

“…7 Lower rates in the Bosnian study may be explained by the exclusion of newborns not admitted to the neonatal intensive care unit. 8 These results may not be translatable to the United States because of differences in demographic and clinical characteristics between European and US-based patients.…”

“…The results of this study estimate that the live birth prevalence of all-cause HDFN is 1695 per 100,000 births, which is slightly higher than the recent Italian (817 per 100,000) 7 and Bosnian (840 per 100,000) estimates. 8 However, in the Italian study, rates were obtained through physician surveys with variable response rates; only 55% of physicians responded to the question regarding the rate of hemolytic disease of the newborn. In addition, data were provided by blood transfusion centers, which may represent only more clinically significant cases.…”

“… 6 Although there have been more recent ex–US-based studies reporting live birth prevalence rates of all cases of HDFN among newborns and HDFN caused by specific antigens in newborns and maternal alloimmunization during pregnancy, these studies may not be generalizable to the US-based population because of varying sociodemographic factors and standards of medical care. 7 , 8 Several single-center studies have estimated that the live birth prevalence of maternal alloimmunization ranged from 400 to 1200 per 100,000 births. 9 , 10 , 11 , 12 Variability in these estimates may be reflective of inconsistent inclusion criteria and small sample sizes; moreover, studies of alloimmunized pregnancies do not include cases of HDFN that were only recognized at birth.…”

An Unusual Case of Hemolytic Disease of Newborn Due to ABO and Rh Isoimmunization

“…Around 3.77% of pregnant mothers with bad obstetric history have a risk of developing alloimmunization [8]. Red cell alloimmunization among expectant mothers is widely studied around different parts of the world, ranging from 0.4% to 2.7% and anti-E, anti-c, anti-kell are the most common alloantibodies among Rh D positive pregnant women [9][10][11][12][13]. Anti-c was identified to cause severe HDN in about 10% of pregnancies with c+ foetus in Netherland [11].…”

Perfil clínico y epidemiológico de los pacientes con enfermedad hemolítica del recién nacido atendidos en un hospital universitario, Medellín, Colombia, 2014-2018

“…En el estudio de Vallejo et al, 25 la media de estancia hospitalaria fue de 5,2 días, mientras que en este estudio fue de 8,2 días respecto al ingreso a UCIN, este estudio lo reportó en un 19,9% de los neonatos; en contraste, Jerkovic et al, lo reportó en un 0.8% de los neonatos y Raguz et al 26 en un 1,04%. 20 Esto puede ser explicado por los diferentes niveles de atención hospitalaria donde fueron recibidos los neonatos, así mismo como por diferentes criterios de inclusión entre ambas poblaciones de este estudio y del anteriormente mencionado.…”