Anti-M Antibody Induced Prolonged Anemia Following Hemolytic Disease of the Newborn Due to Erythropoietic Suppression in 2 Siblings

Ishida, Atsushi; Ohto, Hitoshi; Yasuda, Hiroyasu; Negishi, Yutaka; Tsuiki, Hideki; Arakawa, Takeshi; Yagi, Yoshihito; Uchimura, Daisuke; Miyazaki, Tôru; Ohashi, Wataru; Takamoto, Shigeru

doi:10.1097/mph.0000000000000341

Cited by 21 publications

(29 citation statements)

References 13 publications

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“…In addition, a characteristic of low‐temperature reactivity was also shown for the IgG component of alloanti‐M. For instance, when the alloanti‐M and the titer were tested in one Japanese newborn's serum, the levels were undetectable by saline‐IAT at 37 °C, 1:16 in saline at room temperature and 1:64 in saline at 4 °C, while the DAT of RBCs was negative . A similar reaction pattern of IgG alloanti‐M was found in our study and reported by another Chinese reference lab .…”

Section: Discussionsupporting

confidence: 89%

“…A series of data showed that abortion occurred more often in the first trimester, anemia occurred much earlier, and hydrops fetalis or stillbirth occurred in MN alloimmunization more than Rh alloimmunization, indicating that anemia caused by alloanti‐M could happen at a very early stage of pregnancy and that hyporegeneration of erythroblast rather than hemolysis should play a critical role for anemia in this stage . Similar to anti‐K being able to suppress erythropoiesis through inhibiting the growth of Kell‐positive erythroid precusor cells, there are also some primary studies to show that alloanti‐M could inhibit the growth of M‐positive colony‐forming units in vitro, as M antigen is expressed on immature erythroid precursors as early as 9 weeks of gestation and fully developed on mature RBCs at birth.…”

Section: Discussionmentioning

confidence: 99%

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Hemolytic disease of the fetus and newborn due to alloanti‐M: three Chinese case reports and a review of the literature

Huang

et al. 2018

Transfusion

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BACKGROUND: Alloanti-M was once regarded as not clinically significant, with a few exceptions in extremely rare cases. However, an increasing number of cases of severe hemolytic disease of the fetus and newborn (HDFN), resulting in fetal hydrops and recurrent abortion caused by alloanti-M, have been reported mainly in the Asian population. STUDY DESIGN AND METHODS: Three pregnantChinese women with a history of abnormal pregnancy with hydrops fetalis were encountered. During this pregnancy, a series of clinical examinations and an alloantibody identification against RBCs and platelets were conducted. Intrauterine transfusion and postnatal transfusion were then performed in the fetuses. In addition, the HDFN cases caused by alloanti-M reported in different ethnic groups as well as their clinical and serologic features are also summarized. RESULTS:Three pregnant women were identified with an M-N+ phenotype and IgM mixed with IgG alloanti-M in serum. Their fetuses were found by ultrasound examination and cord blood testing to have severe anemia. Additionally, an M+N+ phenotype and IgG alloanti-M were detected in the cord blood of the three fetuses with titers ranging from 1:1 to 1:128. Moreover, low reticulocyte counts and negative direct antiglobulin tests were also shown in two of the fetuses. After receiving intrauterine transfusions and postnatal transfusions several times, these three fetuses eventually survived and then healthfully developed in the follow-up tracking. CONCLUSION: Alloanti-M immunization can cause severe HDFN with hyporegenerative anemia, often seen in the Asian population, and suppression of erythropoiesis might account for it. ABBREVIATIONS: DAT = direct agglutination test; HDFN = hemolytic disease of the fetus and newborn; IAT = indirect antiglobulin test; IUT = intrauterine transfusion; MCA-PSV = middle cerebral artery peak systolic velocity; MoM = multiple of median; RPI = reticulocyte production index. From the

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Hemolytic disease of the fetus and newborn due to alloanti‐M: three Chinese case reports and a review of the literature

Huang

et al. 2018

Transfusion

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“…Yasuda et al collated all 33 reported Japanese cases, finding an association with reticulocytopenia and the severity of anemia. This likely represents antibody binding to M+ erythroblasts reducing erythropoiesis and has been described by others . Yasuda et al also found that one‐third of cases occurred with low titer anti‐M.…”

Section: Discussionmentioning

confidence: 53%

Cold reacting anti‐M causing delayed hemolytic disease of the newborn

Crispin

Sliwinski²,

Wilson

et al. 2019

Transfusion

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BACKGROUND: Hemolytic disease of the fetus and newborn (HDFN) is due to passively transferred maternal antibodies directed against fetal red blood cell (RBC) antigens and can lead to severe morbidity and mortality. Anti-M is usually a naturally occurring antibody of low clinical significance, although occasionally severe cases of HDFN are seen. CASE REPORTS: Two M+ sisters are presented, each developing hemolysis during the first 2 weeks of life due to maternal anti-M, resulting in severe anemia and requiring blood transfusion. RBC agglutination was observed in peripheral blood samples of both infants at room temperature with dissociation at 37°C. Maternal anti-M detected by column indirect agglutination technique, was of low titer (1:16) and demonstrated low thermal amplitude, reacting in saline at 4°C but was not detectable in saline at 37°C. ABBREVIATIONS: DAT = direct antiglobulin test; DL = Donath-Landsteiner; HDFN = hemolytic disease of the fetus and newborn; IAT = indirect antiglobulin test; PCH = paroxysmal cold hemoglobinuria; RT = room temperature. From the

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“…Antibodies to this antigen are common but are nonpathogenic because they typically react below body temperature at 4°C . However, due its ability to bind to these select progenitor cells, the anti‐M antibody has been implicated in development of delayed transfusion reactions, hemolytic disease of the newborn, and red cell aplasia through inhibition of red cell precursor growth . Blood transfusions are a known risk factor for blood‐group antibody development .…”

Section: Discussionmentioning

confidence: 99%