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

Abstract

Objective of the study is to research the epidemiological aspects of maternal alloimmunization against erythrocyte antigens of fetuses (AB0, Rhesus, Lewis, Kell, Duffy and others) and to identify the most common types of hemolytic disease of the newborn (HDN) in the West Herzegovina region.

Study Design The 20-year retrospective epidemiological study includes all pregnant women who had been immunologically tested and newborn treated for HDN.

Results The indirect antiglobulin (IAT) detected antibodies against antigens in 545 (1.8%) pregnant women of the 29 663 who were tested at the Department of Transfusion Medicine. During the 20-year-long study 310 (1.0%) newborn with HDN were treated. Our results indicate that 42% (230/545) of the pregnant women had AB0 immunization. The most common form of HDN is AB0 HDN 64% (199/310), whereas RhD HDN was treated in 19% (59/310) of the newborn infants. ETR was performed on 29 (19%) infants, 21 (72.4%) with AB0 HDN, and 7 (26%) with RhD HDN.

Conclusion This 20-year-long study concludes that, even though there has been significant progress in the prevention of immunization and proactive treatment of HDN, precautionary measures are still required as is the need for gynecologists and obstetricians to be active. The reasons for this are the non-existence of preventive measures for non-RhD immunization, the irregular immunological screening of RhD positive women in pregnancy in the region encompassed by the study in the past few years. The above raises new questions and recommends further research and monitoring of immunization and HDN treatment worldwide.

Zusammenfassung

Ziel dieser Studie war die Untersuchung von epidemiologischen Aspekten mütterlicher Immunisierung gegen fetale Erythrozytenantigene(AB0, Rhesus, Lewis, Kell, Duffy und andere) und die Feststellung von häufigsten Ursachen der hämolytischen Erkrankung des Neugeborenen (MHN) in der Region der West-Herzegowina.

Methoden und Probanden 20-jährige retrospektive epidemiologische Studie umfasste alle Schwangeren, die immunologische getestet sowie Neugeborene, die wegen MHN behandelt wurden.

Ergebnisse Durch den indirekten antiglobulin Test (IAT) wurden bei 545 (1,8%) Schwangeren Antikörper gegen Antigene nachgewiesen, von 29 663 Probanden, die an der Transfusionsanstalt UHC Mostar getestet wurden. Während der zwanzigjährigen Studie hatten 310 (1,0%) Neugeborene MHN. Unsere Ergebnisse zeigten, dass 42% (230/545) der Schwangeren die AB0-Immunisierung hatten. Die häufigste MHN bei dieser Forschung war die AB0 MHN 64% (199/310), während RhD MHN bei 19% (59/310) der Neugeborenen behandelt wurde.Die Blutaustauschtransfusion (ETR) erfolgte bei 29 (19%) Neugeborenen, 21 (72,4%) bei Neugeborenen mit AB0 MHNund 7 (26%) mit Rh D MHN.

Schlussfolgerung Obwohl es zu während dieser 20-jährigen Studie zu einem bedeutenden Fortschritt bei der Vorbeugung der Immunisierung und der proaktiven MHN-Behandlung kam, erfordert es weiterhin Vorsichtsmaßnahmen und die Aktivitäten der Gynäkologen und Neonatologen. Grund dafür ist das Nichtbestehen von Vorbeugungsmaßnahmen zur nicht-RhD Immunisierung (67% der Schwangeren hatten Nicht-RhD Antikörper), unregelmäßiges immunologisches Testen von RhD-positiven Schwangeren in den letzten Jahren im Untersuchungsgebiet. All dies eröffnet neue Fragen und Empfehlungen zur Erforschung und Beobachtung der Immunisierung sowie MHN-Behandlung auf der globalen immunologischen Szene.

Key words

Pregnancy - newborn - hemolytic disease - sensitization

Schlüsselwörter

Schwangerschaft - Neugeborene - hämolytischen Erkrankung des Neugeborenen - Immunisierung

Publication History

Article published online:
15 October 2020

• References

• 1 American Academy of Pediatrics. Management of hiperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114: 1138
• 2 Bennardello F. Coluzzi. et al. Recommendations for the prevention and treatment of haemolytic disease of the fetus and newborn. Blood Transfus 2015; 13: 109-134
• 3 Chandrasekar A. Morris. et al. The clinical outcome of non-Rh D antibody affected pregnancies in Northern Ireland. Ulster Med J 2001; 70: 89-94
• 4 Dajak S. Erceg-Maglić. et al. Hemolytic Disease of the Fetus and Newborn in Split-Dalmatia: Contry fifteen years long study. Paediatr Croat 2017; 61: 6-12
• 5 Dajak S, Stefanovic V, Capkun V. Severe hemolytic disease of fetus and newborn caused by red blood cell antibodies undetected at first-trimester screening. Transfusion 2011; 51: 1380-1388
• 6 Gottvall T, Filbey D. Allosensitization in pregnancy during the years 1992–2005 in the central west region of Sweden. Acta Obstetricia et Gynecologica Scandinavica 2008; 87: 843-848
• 7 Gudlaugsson B. Hjartardottir. et al. Rhesus D allosensitization in pregnancy from 1996 to 2015 in Iceland: a nation-wide population study prior to routine antenatal anti-D prophylaxis. Transfusion 2020; 60: 175-183
• 8 Haas M. Thurik. et al. Haemolytic disease of the fetus and newborn. Vox Sanguinis 2015; 2: 99-113
• 9 Hendrickson JE, Delaney M. Hemolytic Disease of the Fetus and Newborn: Modern Practice and Future Investigations. Transfusion Medicine Reviews 2016; 16: 3011-3016
• 10 Joy SD. Rossy. et al. Management of Pregnancies Complicated by Anti-E allosensitization, American Journal of Obstetrics and Gynecology 2005; 105: 24-28
• 11 Koelewijn JM. Vrijkotte. et al. Women's attitude towards prenatal screening for red blood cell antibodies, other than Rhesus D. BMC pregnancy Childbirth 2008; 8: 49
• 12 Kristinsdottir T. Kjartansson. et al. Positive Coomb’s test in newborns; causes and clinical consequences Summary of cases diagnosed in the Blood Bank in the years 2005 to 2012. Laeknabladid 2016; 102: 326-331
• 13 Matijević R. Grgić. et al. Diagnosis and management of RhD allosensitization. Fetal Diagn Ther 2005; 20: 393-401
• 14 Murray NA, Roberts I. Haemolytic disease of the newborn. Arch Dis Child Fetal Neonatal Ed 2007; 92: 83-88
• 15 Pahuja S. Gupta. et al. The prevalence of irregular erythrocyte antibodies among antenatal women in Delhi. Blood Transfusion 2011; 4: 388-393
• 16 Sánchez-Durán MA. Higueras. et al. Management and outcome of pregnancies in women with red cell isosensitization: a 15-year observational study from a tertiary care university hospital. BMC Pregnancy Childbirth 2019; 19: 356
• 17 Smith HM. Shirey. et al. Prevalence of clinically significant red blood cell alloantibodies in pregnant women at a large tertiary-care facility. Immunohematology 2013; 4: 127-130
• 18 Smits-Wintjens VE, Walther FJ, Lopriore E. Rhesus haemolytic disease of the newborn: Postnatal management, associated morbidity and long-term outcome. Semin Fetal Neonatal Med 2008; 13: 265-271
• 19 Velkova E. Correlation between the Amount of Anti-D Antibodies and IgG Subclasses with Severity of Haemolytic Disease of Foetus and Newborn. Open Access Macedonian Journal of Medical Sciences 2015; 2: 293-297