Hemolytic disease of the fetus and newborn: Current trends and perspectives

Abstract

The spectrum of hemolytic disease of the newborn has changed over the last few decades. With the implementation of Rhesus D immunoprophylaxis, hemolytic disease due to ABO incompatibility and other alloantibodies has now emerged as major causes of this condition. Though in developing countries, anti D is still a common antibody in pregnant women, many Asian countries have identified alloantibodies other than anti D as a cause of moderate-severe hemolytic disease. The most concerned fact is that, some of these have been described in Rh D positive women. It appears that universal antenatal screening in all pregnant women needs to be initiated, since Rh D positive women are just as likely as D negative women to form alloantibodies. Many developed nations have national screening programs for pregnant women. This is necessary to ensure timely availability of antigen negative blood and reduce effects on the newborn. Although universal screening seems justified, the cost and infrastructure required would be immense. Developing countries and under resourced nations need to consider universal antenatal screening and frame guidelines accordingly.

Impact of Rhesus disease on the global problem of bilirubin-induced neurologic dysfunction

“…India [11] 2180 51 (2.4) India [10] 305 27 (8.9) Czech Republic [8] 6815 181 (2.6) Turkey [12] 743 65 (8.7) Nigeria [13] 280 12 (4.3) Uganda [14] 72 4 (5.6) India [15] 270 35 (13) Thailand [16] 72 7 (10) Nigeria [17] 67 6 (9) Zimbabwe [18] 629 25 (4) Zimbabwe [14] 85 4 (4.7) Mexico [20] 4857 631 (13) Cameroon [21] 225 9 (4) Iraq [22] 142 7 (4.9)…”

From Donor to Recipient: Current Questions Relating to Humoral Alloimmunization

“…Mothers can be also actively immunized by fetal platelets. Contrary to immunization against main RBC Ags, they may develop immunization anti-HPA during the first pregnancy, because HPA Ags are expressed as soon as week 16. An additional factor besides the RH1 or HPA mismatch and HLA restriction may be the ABO phenotype (platelets display few copies of A and B Ags), which seems to affect the outcome and the severity of thrombocytopenia of the newborn [56] while it may reduce RH1 Ag immunization by reducing the fetal RBCs lifespan [57]. Isotypes of anti-HPA or anti-RH1 specific Abs have not been clearly linked with pathogenicity [58].…”

Hemolytic disease of the fetus and newborn caused by anti-D and anti-S alloantibodies: a case report

“…The serological tests for the diagnosis of HDFN includes a positive direct Coombs' test (DCT) on the baby's red blood cells and the presence of an IgG red cell alloantibody in both cord blood eluate and maternal sera. The presence of the corresponding antigen on cord cells confirms the diagnosis of HDFN [4,5]. The most severe HDFN is caused by IgG antibodies directed against D, c or K antigens on the fetal red cells, but any IgG antibodies can cause HDFN [6].…”