Serological and Immunological Characteristics of Maternal Anti‐Rh(D) Antibodies in Predicting the Severity of Haemolytic Disease of the Newborn

Zupańska, B; Brojer, Ewa; Richards, Y; Lenkiewicz, B; Seyfried, H; Howell, Peter

doi:10.1111/j.1423-0410.1989.tb02037.x

Cited by 54 publications

(18 citation statements)

References 26 publications

(11 reference statements)

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“…We found a strong correlation between the presence of IgG1 and/or IgG3 and severity of HDFN with the presence of both antibodies carrying the highest risk. This suggests that both antibodies contribute to pathogenesis and parallels the findings of Pollock and Zupa nska et al who reported that when IgG3 was present along with IgG1, hydrops developed earlier and there was a greater rate of haemolysis in the foetus [2,13]. Other authors, including Iyer et al, however, have reported IgG1 alone as a major cause of severe HDFN [1,3,14].…”

Section: Discussionsupporting

confidence: 80%

Clinical impact and prevalence of IgG1 and IgG3 subclasses in antenatal alloimmunized women: experience from a tertiary medical centre in South India

Choudhuri

Chacko

Kuruvilla

et al. 2016

ISBT Science Series

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Background Haemolytic disease of the foetus and newborn (HDFN) occurs due to maternal sensitization to paternal antigens. According to literature, IgG1 and IgG3 have a greater impact when compared to IgG2 and IgG4. To date, there is limited literature available from India. The current study was therefore executed using the column agglutination technique (CAT) for subclass identification (IgG1 and IgG3). The findings might be important to facilitate early referral, to centers where appropriate care is possible.Methodology Eighty-five alloimmunized antenatal women were included in the study. IgG subclass (IgG1/IgG3) was determined using the 'DAT IgG1/IgG3 ID' card (Bio-Rad). Pregnancies were followed up and categorized into 'no/mild/moderate' or 'severe' HDFN. Prevalence was calculated and severity of HDFN was correlated with subclass.Result In alloimmunized women (2Á18%), the prevalence of IgG subclass was 20% for IgG1, 3Á53% for IgG3, 24Á71% for IgG1 + IgG3 and 51Á76% had neither IgG1 nor IgG3. There was a highly significant difference between disease severity and the absence/presence of IgG1/IgG3 -either singly or in combination (P < 0Á001) in newborns at risk. The risk of severe HDFN increased a sevenfold: it was lowest in patients with neither IgG1 nor IgG3, when compared to having either one of them or both (P < 0Á05, CI between 1Á5-31Á89).Conclusion The presence of IgG1/IgG3 subclass has a significant impact on the severity of HDFN. Therefore, these mothers require close antenatal monitoring to provide appropriate and timely intervention for newborns. CAT is a feasible option to identify high-risk pregnancies and facilitate early referral.

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Section: Discussionsupporting

confidence: 80%

Clinical impact and prevalence of IgG1 and IgG3 subclasses in antenatal alloimmunized women: experience from a tertiary medical centre in South India

Choudhuri

Chacko

Kuruvilla

et al. 2016

ISBT Science Series

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“…This does not preclude the mechanism suggested by Pollock and Bowman [27] that HDN is more severe when IgG1 alone was detected since the IgG1 will be preferentially transported across the placenta [28]. Overall the predominance of both subclasses in the majority of severely or moderately affected cases confirms the findings of Zupanska et al [29]. But while the number of patients with IgG1+IgG3 is less in group 1 than group 2 or 3 in percentage terms, the presence of IgG1+IgG3 cannot be used as an indicator of clinical significance.…”

Section: Discussionsupporting

confidence: 79%

A Retrospective Study of Red Cell Maternal Antibodies by Chemiluminescence

et al. 1997

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Plasma samples from 109 patients with maternal IgG alloantibodies were investigated using a chemiluminescence (CL) assay, a functional test, to predict which antibodies were clinically significant. The CL assay was able to distinguish between those patients who were unaffected or mildly affected requiring only phototherapy, and those patients with moderate or severe haemolytic disease of the fetus or newborn (HDN) requiring transfusion therapy. The CL result was compared with the anti-D quantification result, the number of IgG molecules bound per red cell and, in 80% of the cases, the monocyte monolayer assay. If mothers carrying Rh-negative fetuses were ignored, then the CL assay correctly predicted the outcome for 93.4% of all cases (including those other than D), while the AutoAnalyzer and monocyte assay predicted correctly 92.7% (of the anti-D patients) and 81.5%, respectively. Greater than 80% of patients with severe or moderate HDN had both IgG1 + IgG3 subclasses in the maternal plasma, while those infants who were unaffected or only mildly affected had a greater chance of having IgG1 only (44%) in the maternal plasma, IgG3 only (27%) or both subclasses (29%).

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“…have recently published a study on the correlation between anti-Rh(D) subclasses and the severity of Rh hemolytic disease of the newborn (HDN) in 98 cases. They agreed with Zupanska et al [2] that the most severe form of HDN (63% of cases) was associated with IgGl+ IgG3 anti-D. Thus it appears that severe forms are most often seen in multiparous women or after transfusion immunization: a consequence of repeated antigenic stimulation.…”

supporting

confidence: 81%

Gm Typing, IgG Subclasses of Anti-Rh(D) and Severity of Hemolytic Disease of the Newborn

Alie-Daran¹,

Dugoujon²,

Fournié³

1992

Vox Sanguinis

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Serological and Immunological Characteristics of Maternal Anti‐Rh(D) Antibodies in Predicting the Severity of Haemolytic Disease of the Newborn

Cited by 54 publications

References 26 publications

Clinical impact and prevalence of IgG1 and IgG3 subclasses in antenatal alloimmunized women: experience from a tertiary medical centre in South India

Clinical impact and prevalence of IgG1 and IgG3 subclasses in antenatal alloimmunized women: experience from a tertiary medical centre in South India

A Retrospective Study of Red Cell Maternal Antibodies by Chemiluminescence

Gm Typing, IgG Subclasses of Anti-Rh(D) and Severity of Hemolytic Disease of the Newborn

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