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Prefumo F, Fichera A, Fratelli N, Sartori E. Fetal anemia: Diagnosis and management. Best Pract Res Clin Obstet Gynaecol 2019; 58:2-14. [PMID: 30718211 DOI: 10.1016/j.bpobgyn.2019.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
Fetal anemia has been known for many years as a dangerous complication of pregnancy. Its most common causes are maternal alloimmunization and parvovirus B19 infection, although it can be associated with many different pathological conditions including fetal aneuploidies, vascular tumors, and arteriovenous malformations of the fetus or placenta and inherited conditions such as alpha-thalassemia or genetic metabolic disorders. Doppler ultrasonographic assessment of the peak velocity of systolic blood flow in the middle cerebral artery for the diagnosis of fetal anemia and intravascular intrauterine transfusion for its treatment are the current practice standards. Live birth rates as high as 95% have been reported in recent years. The additional role of intravenous immunoglobulin therapy and the long-term consequences of the condition are the subjects of active ongoing research.
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Affiliation(s)
- Federico Prefumo
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy.
| | - Anna Fichera
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - Nicola Fratelli
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - Enrico Sartori
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
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52
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Mener A, Patel SR, Arthur CM, Stowell SR. Antibody-mediated immunosuppression can result from RBC antigen loss independent of Fcγ receptors in mice. Transfusion 2018; 59:371-384. [PMID: 30474857 DOI: 10.1111/trf.14939] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/17/2018] [Accepted: 05/23/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anti-RhD administration can prevent de novo anti-RhD formation following RhD+ red blood cell (RBC) exposure, termed antibody-mediated immunosuppression (AMIS). Recent studies suggest that AMIS may occur through target antigen alterations, known as antigen modulation. However, studies suggest that AMIS may occur independent of antigen modulation. In particular, AMIS to RBCs that transgenically express the fusion hen egg lysozyme-ovalbumin-Duffy (HOD) antigen have been shown to occur independent of activating Fcγ receptors (FcγRs) thought to be required for antigen modulation. Therefore, we sought to determine the mechanism behind AMIS following HOD RBC exposure. STUDY DESIGN AND METHODS Following transfer of HOD RBCs into wild-type or FcγR-chain knockout recipients in the presence or absence of monoclonal anti-hen egg lysozyme (HEL) antibody, individually or in combination, HOD antigen levels and anti-HOD antibody formation were examined. RESULTS Our results demonstrate that anti-HEL antibodies individually or in combination suppressed anti-HOD IgM, which correlated with the rate of detectable decrease in HEL on HOD RBCs. Furthermore, exposure to anti-HEL antibodies alone or in combination equally suppressed anti-HOD IgG formation. Unexpectedly, combination or individual anti-HEL antibodies induced AMIS and antigen modulation in an FcγR-independent manner. Pre-exposure of HOD RBCs to anti-HEL antibodies reduced antigen levels and suppressed anti-HOD antibody formation following HOD RBC exposure. CONCLUSION These results suggest that antibody-mediated antigen modulation may reflect a mechanism of AMIS that can occur independent of activating FcγRs and may provide a surrogate to identify antibodies capable of inducing AMIS against different RBC antigens.
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Affiliation(s)
- Amanda Mener
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, Georgia
| | - Seema R Patel
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, Georgia
| | - Connie M Arthur
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, Georgia
| | - Sean R Stowell
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, Georgia
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53
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Patel SR, Gibb DR, Girard-Pierce K, Zhou X, Rodrigues LC, Arthur CM, Bennett AL, Jajosky RP, Fuller M, Maier CL, Zerra PE, Chonat S, Smith NH, Tormey CA, Hendrickson JE, Stowell SR. Marginal Zone B Cells Induce Alloantibody Formation Following RBC Transfusion. Front Immunol 2018; 9:2516. [PMID: 30505302 PMCID: PMC6250814 DOI: 10.3389/fimmu.2018.02516] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 10/12/2018] [Indexed: 12/12/2022] Open
Abstract
Red blood cell (RBC) alloimmunization represents a significant immunological challenge for some patients. While a variety of immune constituents likely contribute to the initiation and orchestration of alloantibodies to RBC antigens, identification of key immune factors that initiate alloantibody formation may aid in the development of a therapeutic modality to minimize or prevent this process. To define the immune factors that may be important in driving alloimmunization to an RBC antigen, we determined the specific immune compartment and distinct cells that may initially engage transfused RBCs and facilitate subsequent alloimmunization. Our findings demonstrate that the splenic compartment is essential for formation of anti-KEL antibodies following KEL RBC transfusion. Within the spleen, transfused KEL RBCs are found within the marginal sinus, where they appear to specifically co-localize with marginal zone (MZ) B cells. Consistent with this, removal of MZ B cells completely prevented alloantibody formation following KEL RBC transfusion. While MZ B cells can mediate a variety of key downstream immune pathways, depletion of follicular B cells or CD4 T cells failed to similarly impact the anti-KEL antibody response, suggesting that MZ B cells may play a key role in the development of anti-KEL IgM and IgG following KEL RBC transfusion. These findings highlight a key contributor to KEL RBC-induced antibody formation, wherein MZ B cells facilitate antibody formation following RBC transfusion.
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Affiliation(s)
- Seema R Patel
- Department of Laboratory Medicine and Pathology, Center for Transfusion Medicine and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, United States
| | - David R Gibb
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Kathryn Girard-Pierce
- Department of Laboratory Medicine and Pathology, Center for Transfusion Medicine and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, United States
| | - Xiaoxi Zhou
- Department of Laboratory Medicine and Pathology, Center for Transfusion Medicine and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, United States
| | - Lilian Cataldi Rodrigues
- Department of Laboratory Medicine and Pathology, Center for Transfusion Medicine and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, United States
| | - Connie M Arthur
- Department of Laboratory Medicine and Pathology, Center for Transfusion Medicine and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, United States
| | - Ashley L Bennett
- Department of Laboratory Medicine and Pathology, Center for Transfusion Medicine and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, United States
| | - Ryan P Jajosky
- Department of Laboratory Medicine and Pathology, Center for Transfusion Medicine and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, United States
| | - Megan Fuller
- Department of Laboratory Medicine and Pathology, Center for Transfusion Medicine and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, United States
| | - Cheryl L Maier
- Department of Laboratory Medicine and Pathology, Center for Transfusion Medicine and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, United States
| | - Patricia E Zerra
- Department of Laboratory Medicine and Pathology, Center for Transfusion Medicine and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, United States
| | - Satheesh Chonat
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, GA, United States
| | - Nicole H Smith
- Department of Laboratory Medicine and Pathology, Center for Transfusion Medicine and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, United States
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Sean R Stowell
- Department of Laboratory Medicine and Pathology, Center for Transfusion Medicine and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, United States
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54
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Mener A, Patel SR, Arthur CM, Chonat S, Wieland A, Santhanakrishnan M, Liu J, Maier CL, Jajosky RP, Girard-Pierce K, Bennett A, Zerra PE, Smith NH, Hendrickson JE, Stowell SR. Complement serves as a switch between CD4+ T cell-independent and -dependent RBC antibody responses. JCI Insight 2018; 3:121631. [PMID: 30429364 DOI: 10.1172/jci.insight.121631] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/10/2018] [Indexed: 01/11/2023] Open
Abstract
RBC alloimmunization represents a significant immunological challenge for patients requiring lifelong transfusion support. The majority of clinically relevant non-ABO(H) blood group antigens have been thought to drive antibody formation through T cell-dependent immune pathways. Thus, we initially sought to define the role of CD4+ T cells in formation of alloantibodies to KEL, one of the leading causes of hemolytic transfusion reactions. Unexpectedly, our findings demonstrated that KEL RBCs actually possess the ability to induce antibody formation independent of CD4+ T cells or complement component 3 (C3), two common regulators of antibody formation. However, despite the ability of KEL RBCs to induce anti-KEL antibodies in the absence of complement, removal of C3 or complement receptors 1 and 2 (CR1/2) rendered recipients completely reliant on CD4+ T cells for IgG anti-KEL antibody formation. Together, these findings suggest that C3 may serve as a novel molecular switch that regulates the type of immunological pathway engaged following RBC transfusion.
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Affiliation(s)
- Amanda Mener
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology
| | - Seema R Patel
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology
| | - Connie M Arthur
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology
| | - Satheesh Chonat
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, and
| | - Andreas Wieland
- Department of Microbiology & Immunology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Jingchun Liu
- Yale School of Medicine, Department of Laboratory Medicine, New Haven, Connecticut, USA
| | - Cheryl L Maier
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology
| | - Ryan P Jajosky
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology
| | - Kathryn Girard-Pierce
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology
| | - Ashley Bennett
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology
| | - Patricia E Zerra
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology
| | - Nicole H Smith
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology
| | - Jeanne E Hendrickson
- Yale School of Medicine, Department of Laboratory Medicine, New Haven, Connecticut, USA
| | - Sean R Stowell
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology
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55
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Richards AL, Sheldon K, Wu X, Gruber DR, Hudson KE. The Role of the Immunological Synapse in Differential Effects of APC Subsets in Alloimmunization to Fresh, Non-stored RBCs. Front Immunol 2018; 9:2200. [PMID: 30344520 PMCID: PMC6182098 DOI: 10.3389/fimmu.2018.02200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/05/2018] [Indexed: 01/19/2023] Open
Abstract
Background: Each year, over 5 million red blood cell (RBC) transfusions are administered to patients in the USA. Despite the therapeutic benefits of RBC transfusions, there are associated risks. RBC-specific alloantibodies may form in response to antigenic differences between RBC donors and recipients; these alloantibodies can be a problem as they may mediate hemolysis or pose barriers to future transfusion support. While there is currently no reliable way to predict which RBC recipients will make an alloantibody response, risk factors such as inflammation have been shown to correlate with increased rates of RBC alloimmunization. The underlying mechanisms behind how inflammation mediates alloantibody production are incompletely defined. Methods: To assess erythrophagocytosis, mice were treated with PBS or inflammatory stimuli followed by a transfusion of allogeneic RBCs labeled with a lipophilic dye. At multiple time points, RBC consumption and expression of activation makers by leukocytes was evaluated. To determine which antigen presenting cell (APC) subset(s) were capable of promoting allogeneic T cell activation, sorted leukocyte populations (which had participated in erythrophagocytosis) were co-cultured in vitro with allogeneic CD4+ T cells; T cell proliferation and ability to form immunological synapses with APCs were determined. Results: Upon transfusion of fresh allogeneic RBCs, multiple APCs consumed transfused RBCs. However, only CD8+ and CD11b+ dendritic cells formed productive immunological synapses with allogeneic T cells and stimulated proliferation. Importantly, allogeneic T cell activation and RBC alloantibody production occurred in response to RBC transfusion alone, and transfusion in the context of inflammation enhanced RBC consumption, the number of immune synapses, allogeneic T cell proliferation, and the rate and magnitude of alloantibody production. Conclusions: These data demonstrate that regardless of the ability to participate in RBC consumption, only a subset of APCs are capable of forming an immune synapse with T cells thereby initiating an alloantibody response. Additionally, these data provide mechanistic insight into RBC alloantibody generation.
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Affiliation(s)
| | - Kathryn Sheldon
- Bloodworks Northwest Research Institute, Seattle, WA, United States
| | - Xiaoping Wu
- Bloodworks Northwest Research Institute, Seattle, WA, United States
| | - David R Gruber
- Bloodworks Northwest Research Institute, Seattle, WA, United States
| | - Krystalyn E Hudson
- Bloodworks Northwest Research Institute, Seattle, WA, United States.,Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, WA, United States
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56
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Slootweg YM, Lindenburg IT, Koelewijn JM, Van Kamp IL, Oepkes D, De Haas M. Predicting anti-Kell-mediated hemolytic disease of the fetus and newborn: diagnostic accuracy of laboratory management. Am J Obstet Gynecol 2018; 219:393.e1-393.e8. [PMID: 30063902 DOI: 10.1016/j.ajog.2018.07.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/21/2018] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is controversy on critical cut-off values of laboratory testing to select pregnancies at increased risk for anti-Kell-mediated hemolytic disease of the fetus and newborn. Without early detection and treatment, anti-Kell-mediated hemolytic disease of the fetus and newborn may result in progressive fetal anemia, fetal hydrops, asphyxia, and perinatal death. OBJECTIVE We aimed to determine the value of repeated anti-Kell titer determination and biological activity measurement using the antibody-dependent cellular cytotoxicity test determination in the management of pregnancies at risk for anti-Kell-mediated hemolytic disease of the fetus and newborn. STUDY DESIGN This was a retrospective cohort study of pregnancies with anti-Kell and a Kell-positive fetus, identified from January 1999 through April 2015. Laboratory test results and clinical outcome were collected from the Dutch nationwide screening program and the national reference center for fetal therapy in The Netherlands, the Leiden University Medical Center. Diagnostic accuracy was measured (receiver operating characteristic curves, sensitivity, specificity, positive and negative predictive values) for anti-Kell titers and antibody-dependent cellular cytotoxicity test. The relationship between the titer and antibody-dependent cellular cytotoxicity measurements and the 2 foregoing measurements were computed with a Pearson product-moment correlation coefficient. RESULTS In a 16-year unselected cohort, representing screening results of 3.2 million pregnancies resulting in live births in The Netherlands, we identified 1026 Kell-immunized pregnancies. In all, 93 pregnant women had anti-Kell and a Kell-positive child, without other red cell alloantibodies. In all, 49 children (53%) needed intrauterine or postnatal transfusion therapy. The first anti-Kell titer showed already a high diagnostic accuracy with an area under the curve of 91%. The optimal cut-off point for the titer was 4 (sensitivity 100%; 95% confidence interval, 91-100), specificity 27% (95% confidence interval, 15-43), and positive predictive value 60% (49-71%). The antibody-dependent cellular cytotoxicity test was not informative to select high-risk pregnancies. Linear regression showed no significant change during pregnancy, when antibody titer and antibody-dependent cellular cytotoxicity test results were compared with every 2 foregoing measurements (P < .0001). CONCLUSION Early determination of the anti-Kell titer is sufficient to select pregnancies at increased risk for hemolytic disease of the fetus and newborn with need for transfusion therapy. If the Kell status of the fetus is known to be positive, a titer of ≥4 can be used to target intensive clinical monitoring.
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Affiliation(s)
- Yolentha M Slootweg
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Irene T Lindenburg
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Joke M Koelewijn
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands; Department of Clinical Transfusion Research, Sanquin Research, Amsterdam, The Netherlands
| | - Inge L Van Kamp
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Masja De Haas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands; Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands; Department of Clinical Transfusion Research, Sanquin Research, Amsterdam, The Netherlands
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57
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Zwiers C, Koelewijn JM, Vermij L, van Sambeeck J, Oepkes D, de Haas M, van der Schoot CE. ABO incompatibility and RhIG immunoprophylaxis protect against non-D alloimmunization by pregnancy. Transfusion 2018; 58:1611-1617. [PMID: 29624682 DOI: 10.1111/trf.14606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/19/2018] [Accepted: 02/21/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal antibodies against fetal red blood cell antigens, most often anti-D, -K, or -c. ABO incompatibility between mother and child and anti-D immunoprophylaxis (RhIG) are known to reduce the risk of D immunization and subsequent HDFN. However, no immunoprophylaxis has been developed to prevent non-D immunizations. STUDY DESIGN AND METHODS We evaluated whether ABO incompatibility has a preventive effect on formation of non-D alloantibodies, by performing a case-control study including pregnant women with newly detected non-D antibodies, identified within a nationwide data set, immunized during their first pregnancy and/or delivery. Subsequently, we assessed a possible protective effect of RhIG in a subgroup with non-Rh antibodies only. The proportions of previous ABO incompatibility and of RhIG administrations of these women were compared to the known rate of 19.4% ABO incompatibility and 9.9% RhIG administrations (D- women carrying a D+ child) in the general population of pregnant women. RESULTS A total of 11.9% of the 232 included immunized women had a possible ABO incompatibility in their first pregnancy (vs. expected 19.4%; 95% confidence interval [CI], 7.3-18.8; p = 0.036). Furthermore, 1.0% women with non-Rh antibodies were D-, delivered a D+ child, and had therefore received RhIG, whereas 9.9% was expected (95% CI, 0.18-5.50; p = 0.003). CONCLUSION We found that ABO incompatibility and RhIG reduce the risks not only for D, but also for non-Rh immunizations, suggesting that antibody-mediated immune suppression in this condition is not antigen specific.
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Affiliation(s)
- Carolien Zwiers
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Joke M Koelewijn
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam.,Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - Lisa Vermij
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Joost van Sambeeck
- Department of Transfusion Technology Assessment, Sanquin Research, Amsterdam.,Centre for Healthcare Operations Improvement & Research, University of Twente, Enschede, the Netherlands
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Masja de Haas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands.,Sanquin Diagnostic Services, Amsterdam, the Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam
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58
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Deleers M, Guizani M, Jani J, Hulot M, El Kenz H. A case of severe foetal anaemia due to anti-Kell that could not be detected by the weekly assessment of middle cerebral artery peak systolic velocity. Transfus Apher Sci 2018; 57:111-113. [PMID: 29449170 DOI: 10.1016/j.transci.2018.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Marie Deleers
- Department of Transfusion, CHU-Brugmann, LHUB-ULB, Brussels, Belgium.
| | - Meriem Guizani
- Department of Obstetrics and Gynaecology, CHU-Brugmann, Brussels, Belgium
| | - Jacques Jani
- Department of Obstetrics and Gynaecology, CHU-Brugmann, Brussels, Belgium
| | - Martine Hulot
- Department of Transfusion, CHU Saint-Pierre, LHUB-ULB, Brussels, Belgium
| | - Hanane El Kenz
- Department of Transfusion, CHU-Brugmann, LHUB-ULB, Brussels, Belgium
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59
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Sonneveld ME, Koeleman CAM, Plomp HR, Wuhrer M, van der Schoot CE, Vidarsson G. Fc-Glycosylation in Human IgG1 and IgG3 Is Similar for Both Total and Anti-Red-Blood Cell Anti-K Antibodies. Front Immunol 2018; 9:129. [PMID: 29445378 PMCID: PMC5797742 DOI: 10.3389/fimmu.2018.00129] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/16/2018] [Indexed: 11/17/2022] Open
Abstract
After albumin, immunoglobulin G (IgG) are the most abundant proteins in human serum, with IgG1 and IgG3 being the most abundant subclasses directed against protein antigens. The quality of the IgG-Fc-glycosylation has important functional consequences, which have been found to be skewed toward low fucosylation in some antigen-specific immune responses. This increases the affinity to IgG1-Fc-receptor (FcγR)IIIa/b and thereby directly affects downstream effector functions and disease severity. To date, antigen-specific IgG-glycosylation have not been analyzed for IgG3. Here, we analyzed 30 pregnant women with anti-K alloantibodies from a prospective screening cohort and compared the type of Fc-tail glycosylation of total serum- and antigen-specific IgG1 and IgG3 using mass spectrometry. Total serum IgG1 and IgG3 Fc-glycoprofiles were highly similar. Fc glycosylation of antigen-specific IgG varied greatly between individuals, but correlated significantly with each other for IgG1 and IgG3, except for bisection. However, although the magnitude of changes in fucosylation and galactosylation were similar for both subclasses, this was not the case for sialylation levels, which were significantly higher for both total and anti-K IgG3. We found that the combination of relative IgG1 and IgG3 Fc-glycosylation levels did not improve the prediction of anti-K mediated disease over IgG1 alone. In conclusion, Fc-glycosylation profiles of serum- and antigen-specific IgG1 and IgG3 are highly similar.
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Affiliation(s)
- Myrthe E Sonneveld
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands.,Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Carolien A M Koeleman
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - H Rosina Plomp
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands.,Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Gestur Vidarsson
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands.,Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
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60
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Nwogu LC, Moise KJ, Klein KL, Tint H, Castillo B, Bai Y. Successful management of severe red blood cell alloimmunization in pregnancy with a combination of therapeutic plasma exchange, intravenous immune globulin, and intrauterine transfusion. Transfusion 2017; 58:677-684. [DOI: 10.1111/trf.14453] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Laura C. Nwogu
- Department of Pathology and Laboratory Medicine; University of Texas McGovern Medical School at Houston; Houston Texas
| | - Kenneth J. Moise
- Department of Obstetrics, Gynecology and Reproductive Sciences; University of Texas McGovern Medical School at Houston; Houston Texas
| | - Kimberly L. Klein
- Department of Pathology and Laboratory Medicine; University of Texas McGovern Medical School at Houston; Houston Texas
| | - Hlaing Tint
- Department of Pathology and Laboratory Medicine; University of Texas McGovern Medical School at Houston; Houston Texas
| | - Brian Castillo
- Department of Pathology and Laboratory Medicine; University of Texas McGovern Medical School at Houston; Houston Texas
| | - Yu Bai
- Department of Pathology and Laboratory Medicine; University of Texas McGovern Medical School at Houston; Houston Texas
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61
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Andersson L, Szabo F. The incidence and outcome of clinically significant antibodies detected in Rhesus-D positive pregnant women of the Northern Territory. Aust N Z J Obstet Gynaecol 2017; 58:514-517. [PMID: 29192961 DOI: 10.1111/ajo.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Haemolytic disease of the fetus/newborn secondary to clinically significant non-Rhesus-D antibodies has risen in importance since the advent of immunoprophylactic anti-D administration to Rhesus-D negative women. Of interest is the incidence of these antibodies in Rhesus-D positive women, who receive less frequent antenatal alloantibody screening. This is of particular concern if the antibodies arise late in pregnancy and may go undetected. AIMS To assess the proportion of Rhesus-D positive pregnant women with late developing clinically significant antibodies for haemolytic disease of the fetus/newborn, and whether these resulted in adverse fetal outcomes. MATERIALS AND METHODS A retrospective analysis over a 12-month period at a tertiary hospital in the Northern Territory. Group and antibody screen results in addition to clinical data regarding pregnancy/newborn were collected. RESULTS Sixty-four of 2612 women (2.5%) had red blood cell antibodies detected during their pregnancy. Of these, 21 clinically significant antibodies were detected in 19 women (0.7% of initial cohort). The most common antibody detected was anti-c (28.5%). In six of these women (0.23% of initial cohort), the antibodies were late developing. Mild jaundice was noted in three newborns with phototherapy required in one. CONCLUSIONS Although clinically significant antibodies were detected during pregnancy, and in a small proportion of cases as a late developing antibody undetected in the first trimester screening, clinical outcomes for the newborn were mild. As such, the cost of retesting all Rhesus-D positive pregnant women in the third trimester would be considerable and unlikely to result in any meaningful clinical benefit.
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Affiliation(s)
- Lauren Andersson
- Department of Haematology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Ferenc Szabo
- Department of Haematology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Raheja A, Agarwal K. Unusual Rhesus Antibodies as a Cause for Fetal Isoimmunisation. JOURNAL OF FETAL MEDICINE 2017. [DOI: 10.1007/s40556-017-0141-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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63
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64
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Rodrigues C, Sell AM, Guelsin GAS, Higa TT, Pagliarini e Silva S, Macedo LC, Sippert EÂ, de Alencar JB, Zanette Â, Acorsi CRL, Castilho L, Visentainer JEL. HLA polymorphisms and risk of red blood cell alloimmunisation in polytransfused patients with sickle cell anaemia. Transfus Med 2017; 27:437-443. [DOI: 10.1111/tme.12459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 07/05/2017] [Accepted: 08/09/2017] [Indexed: 02/06/2023]
Affiliation(s)
- C. Rodrigues
- Immunogenetics Laboratory, Basic Health Sciences Department; State University of Maringa; Maringa PR Brazil
| | - A. M. Sell
- Immunogenetics Laboratory, Basic Health Sciences Department; State University of Maringa; Maringa PR Brazil
| | - G. A. S. Guelsin
- Research Laboratory of Molecular Blood Group, Hematology and HemotherapyCenter; State University of Campinas; Campinas SP Brazil
| | - T. T. Higa
- Maringa Regional Blood Center; Maringa PR Brazil
| | | | - L. C. Macedo
- Immunogenetics Laboratory, Basic Health Sciences Department; State University of Maringa; Maringa PR Brazil
| | - E. Â. Sippert
- Research Laboratory of Molecular Blood Group, Hematology and HemotherapyCenter; State University of Campinas; Campinas SP Brazil
| | - J. B. de Alencar
- Immunogenetics Laboratory, Basic Health Sciences Department; State University of Maringa; Maringa PR Brazil
| | - Â. Zanette
- Bahia Hematology and HemotherapyCenter; Salvador BA Brazil
| | - C. R. L. Acorsi
- Department of Statistics; State University of Maringa; Maringa PR Brazil
| | - L. Castilho
- Research Laboratory of Molecular Blood Group, Hematology and HemotherapyCenter; State University of Campinas; Campinas SP Brazil
| | - J. E. L. Visentainer
- Immunogenetics Laboratory, Basic Health Sciences Department; State University of Maringa; Maringa PR Brazil
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Bollason G, Hjartardottir H, Jonsson T, Gudmundsson S, Kjartansson S, Halldorsdottir AM. Red blood cell alloimmunization in pregnancy during the years 1996-2015 in Iceland: a nation-wide population study. Transfusion 2017; 57:2578-2585. [DOI: 10.1111/trf.14262] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/09/2017] [Accepted: 06/21/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Gunnar Bollason
- University of Iceland, Faculty of Medicine; Reykjavik Iceland
| | - Hulda Hjartardottir
- Department of Obstetrics and Gynecology; Landspitali University Hospital; Reykjavik Iceland
| | - Thorbjorn Jonsson
- University of Iceland, Faculty of Medicine; Reykjavik Iceland
- Blood Bank, Landspitali University Hospital; Reykjavik Iceland
| | | | - Sveinn Kjartansson
- Department of Pediatrics; Landspitali University Hospital; Reykjavik Iceland
| | - Anna Margret Halldorsdottir
- University of Iceland, Faculty of Medicine; Reykjavik Iceland
- Blood Bank, Landspitali University Hospital; Reykjavik Iceland
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66
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Abbasi N, Johnson JA, Ryan G. Fetal anemia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:145-153. [PMID: 28782230 DOI: 10.1002/uog.17555] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/13/2017] [Accepted: 06/16/2017] [Indexed: 06/07/2023]
Affiliation(s)
- N Abbasi
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - J-A Johnson
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada
| | - G Ryan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada
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67
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Gormley M, Ona K, Kapidzic M, Garrido-Gomez T, Zdravkovic T, Fisher SJ. Preeclampsia: novel insights from global RNA profiling of trophoblast subpopulations. Am J Obstet Gynecol 2017; 217:200.e1-200.e17. [PMID: 28347715 DOI: 10.1016/j.ajog.2017.03.017] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/15/2017] [Accepted: 03/17/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND The maternal signs of preeclampsia, which include the new onset of high blood pressure, can occur because of faulty placentation. We theorized that transcriptomic analyses of trophoblast subpopulations in situ would lend new insights into the role of these cells in preeclampsia pathogenesis. OBJECTIVE Our goal was to enrich syncytiotrophoblasts, invasive cytotrophoblasts, or endovascular cytotrophoblasts from the placentas of severe preeclampsia cases. Total RNA was subjected to global transcriptional profiling to identify RNAs that were misexpressed compared with controls. STUDY DESIGN This was a cross-sectional analysis of placentas from women who had been diagnosed with severe preeclampsia. Gestational age-matched controls were placentas from women who had a preterm birth with no signs of infection. Laser microdissection enabled enrichment of syncytiotrophoblasts, invasive cytotrophoblasts, or endovascular cytotrophoblasts. After RNA isolation, a microarray approach was used for global transcriptional profiling. Immunolocalization identified changes in messenger RNA expression that carried over to the protein level. Differential expression of non-protein-coding RNAs was confirmed by in situ hybridization. A 2-way analysis of variance of non-coding RNA expression identified particular classes that distinguished trophoblasts in cases vs controls. Cajal body foci were visualized by coilin immunolocalization. RESULTS Comparison of the trophoblast subtype data within each group (severe preeclampsia or noninfected preterm birth) identified many highly differentially expressed genes. They included molecules that are known to be expressed by each subpopulation, which is evidence that the method worked. Genes that were expressed differentially between the 2 groups, in a cell-type-specific manner, encoded a combination of molecules that previous studies associated with severe preeclampsia and those that were not known to be dysregulated in this pregnancy complication. Gene ontology analysis of the syncytiotrophoblast data highlighted the dysregulation of immune functions, morphogenesis, transport, and responses to vascular endothelial growth factor and progesterone. The invasive cytotrophoblast data provided evidence of alterations in cellular movement, which is consistent with the shallow invasion often associated with severe preeclampsia. Other dysregulated pathways included immune, lipid, oxygen, and transforming growth factor-beta responses. The data for endovascular cytotrophoblasts showed disordered metabolism, signaling, and vascular development. Additionally, the transcriptional data revealed the differential expression in severe preeclampsia of 2 classes of non-coding RNAs: long non-coding RNAs and small nucleolar RNAs. The long non-coding RNA, urothelial cancer associated 1, was the most highly up-regulated in this class. In situ hybridization confirmed severe preeclampsia-associated expression in syncytiotrophoblasts. The small nucleolar RNAs, which chemically modify RNA structure, also correlated with severe preeclampsia. Thus, we enumerated Cajal body foci, sites of small nucleolar RNA activity, in primary cytotrophoblasts that were isolated from control and severe preeclampsia placentas. In severe preeclampsia, cytotrophoblasts had approximately double the number of these foci as the control samples. CONCLUSION A laser microdissection approach enabled the identification of novel messenger RNAs and non-coding RNAs that were misexpressed by various trophoblast subpopulations in severe preeclampsia. The results suggested new avenues of investigation, in particular, the roles of PRG2, Kell blood group determinants, and urothelial cancer associated 1 in syncytiotrophoblast diseases. Additionally, many of the newly identified dysregulated molecules might have clinical utility as biomarkers of severe preeclampsia.
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Affiliation(s)
- Matthew Gormley
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology, and Reproductive Sciences; The Eli & Edythe Broad Center for Regeneration Medicine and Stem Cell Research; and the Department of Anatomy, University of California San Francisco, San Francisco, CA
| | - Katherine Ona
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology, and Reproductive Sciences; The Eli & Edythe Broad Center for Regeneration Medicine and Stem Cell Research; and the Department of Anatomy, University of California San Francisco, San Francisco, CA
| | - Mirhan Kapidzic
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology, and Reproductive Sciences; The Eli & Edythe Broad Center for Regeneration Medicine and Stem Cell Research; and the Department of Anatomy, University of California San Francisco, San Francisco, CA
| | - Tamara Garrido-Gomez
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology, and Reproductive Sciences; The Eli & Edythe Broad Center for Regeneration Medicine and Stem Cell Research; and the Department of Anatomy, University of California San Francisco, San Francisco, CA
| | - Tamara Zdravkovic
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology, and Reproductive Sciences; The Eli & Edythe Broad Center for Regeneration Medicine and Stem Cell Research; and the Department of Anatomy, University of California San Francisco, San Francisco, CA
| | - Susan J Fisher
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology, and Reproductive Sciences; The Eli & Edythe Broad Center for Regeneration Medicine and Stem Cell Research; and the Department of Anatomy, University of California San Francisco, San Francisco, CA.
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68
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Jerković Raguž M, Šumanovic Glamuzina D, Brzica J, Gruica T. The Incidence and Effects of Alloimmunization in Pregnancy During the Period 2000 - 2013. Geburtshilfe Frauenheilkd 2017; 77:780-785. [PMID: 28729746 DOI: 10.1055/s-0043-109867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/20/2017] [Accepted: 04/26/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION The 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 METHODS The 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. RESULTS The 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.
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Affiliation(s)
- Marjana Jerković Raguž
- Department of Neonatology and Intensive Care Unit, Clinic for Children's Diseases, University Clinical Hospital Mostar, Bosnian and Herzegovina
| | - Darinka Šumanovic Glamuzina
- Department of Neonatology and Intensive Care Unit, Clinic for Children's Diseases, University Clinical Hospital Mostar, Bosnian and Herzegovina
| | - Jerko Brzica
- Department of Neonatology and Intensive Care Unit, Clinic for Children's Diseases, University Clinical Hospital Mostar, Bosnian and Herzegovina
| | - Tonći Gruica
- Department of Gynecology and Obstetrics General Hospital Šibenik, Croatia
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69
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Ree IMC, Smits-Wintjens VEHJ, van der Bom JG, van Klink JMM, Oepkes D, Lopriore E. Neonatal management and outcome in alloimmune hemolytic disease. Expert Rev Hematol 2017; 10:607-616. [DOI: 10.1080/17474086.2017.1331124] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Isabelle M. C. Ree
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
- Sanquin Blood Supply, Clinical Transfusion Research, Leiden, Zuid-Holland, The Netherlands
| | | | - Johanna G. van der Bom
- Sanquin Blood Supply, Clinical Transfusion Research, Leiden, Zuid-Holland, The Netherlands
| | | | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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70
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Zwiers C, van Kamp I, Oepkes D, Lopriore E. Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn – review on current management and outcome. Expert Rev Hematol 2017; 10:337-344. [DOI: 10.1080/17474086.2017.1305265] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Carolien Zwiers
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Inge van Kamp
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Enrico Lopriore
- Divison of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
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71
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Lee BK, Le Ray I, Sun JY, Wikman A, Reilly M, Johansson S. Haemolytic and nonhaemolytic neonatal jaundice have different risk factor profiles. Acta Paediatr 2016; 105:1444-1450. [PMID: 27173507 DOI: 10.1111/apa.13470] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/19/2016] [Accepted: 05/10/2016] [Indexed: 12/23/2022]
Abstract
AIM This study examined maternal and pregnancy risk factors for haemolytic and nonhaemolytic neonatal jaundice in a large population-based cohort study. METHODS We conducted a cohort study of 1 019 220 singleton live births from the Swedish medical birth register from 1987 to 2002, using information on neonatal jaundice and maternal and pregnancy characteristics. Diagnoses of gestational hypertensive disorders were obtained by linkage to the national inpatient register. Multivariate logistic regression analysis provided odds ratios for the risk factors of both forms of jaundice. RESULTS A total of 6057 (0.6%) births were affected by haemolytic jaundice and 36 869 (3.6%) by nonhaemolytic jaundice. The strongest risk factors for haemolytic jaundice were maternal alloimmunisation, blood group O and neonatal jaundice in older siblings. For nonhaemolytic jaundice, the strongest risk factors were preterm birth, neonatal jaundice in older siblings, maternal origin from East or South-East Asia and maternal obesity. We estimated that 13% of haemolytic jaundice was attributable to alloimmunisation and 39% of nonhaemolytic jaundice was attributable to preterm birth. CONCLUSION Haemolytic and nonhaemolytic neonatal jaundice had different risk factor profiles. Interventions to reduce maternal alloimmunisation, preterm birth and maternal obesity may lower the prevalence of neonatal jaundice and the risk of consequent neurological complications.
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Affiliation(s)
- Brian K. Lee
- Department of Epidemiology and Biostatistics; Drexel University School of Public Health; Philadelphia PA USA
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Isabelle Le Ray
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Ji Yu Sun
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Agneta Wikman
- Department of Laboratory Medicine; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
| | - Marie Reilly
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Stefan Johansson
- Clinical Epidemiology Unit; Department of Medicine; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Science and Education; Sachs' Children and Youth Hospital; Karolinska Institutet; Stockholm Sweden
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72
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Sonneveld ME, Koelewijn J, de Haas M, Admiraal J, Plomp R, Koeleman CAM, Hipgrave Ederveen AL, Ligthart P, Wuhrer M, van der Schoot CE, Vidarsson G. Antigen specificity determines anti-red blood cell IgG-Fc alloantibody glycosylation and thereby severity of haemolytic disease of the fetus and newborn. Br J Haematol 2016; 176:651-660. [PMID: 27891581 DOI: 10.1111/bjh.14438] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/02/2016] [Indexed: 01/08/2023]
Abstract
Haemolytic disease of the fetus and newborn (HDFN) is a severe disease in which fetal red blood cells (RBC) are destroyed by maternal anti-RBC IgG alloantibodies. HDFN is most often caused by anti-D but may also occur due to anti-K, -c- or -E. We recently found N-linked glycosylation of anti-D to be skewed towards low fucosylation, thereby increasing the affinity to IgG-Fc receptor IIIa and IIIb, which correlated with HDFN disease severity. Here, we analysed 230 pregnant women with anti-c, -E or -K alloantibodies from a prospective screening cohort and investigated the type of Fc-tail glycosylation of these antibodies in relation to the trigger of immunisation and pregnancy outcome. Anti-c, -E and -K show - independent of the event that had led to immunisation - a different kind of Fc-glycosylation compared to that of the total IgG fraction, but with less pronounced differences compared to anti-D. High Fc-galactosylation and sialylation of anti-c correlated with HDFN disease severity, while low anti-K Fc-fucosylation correlated with severe fetal anaemia. IgG-Fc glycosylation of anti-RBC antibodies is shaped depending on the antigen. These features influence their clinical potency and may therefore be used to predict severity and identify those needing treatment.
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Affiliation(s)
- Myrthe E Sonneveld
- Department of Experimental Immunohaematology, Sanquin Research, Amsterdam, and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Joke Koelewijn
- Department of Immunohaematotology Diagnostics, Sanquin, Amsterdam, the Netherlands
| | - Masja de Haas
- Department of Immunohaematotology Diagnostics, Sanquin, Amsterdam, the Netherlands.,Centre for Clinical Transfusion Research, Sanquin Research and Dept of Immunohaematology and Blood Transfusion of Leiden University Medical Centre, Leiden, the Netherlands
| | - Jon Admiraal
- Department of Experimental Immunohaematology, Sanquin Research, Amsterdam, and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Rosina Plomp
- Centre for Proteomics and Metabolomics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Carolien A M Koeleman
- Centre for Proteomics and Metabolomics, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Peter Ligthart
- Department of Immunohaematotology Diagnostics, Sanquin, Amsterdam, the Netherlands
| | - Manfred Wuhrer
- Centre for Proteomics and Metabolomics, Leiden University Medical Centre, Leiden, the Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohaematology, Sanquin Research, Amsterdam, and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Gestur Vidarsson
- Department of Experimental Immunohaematology, Sanquin Research, Amsterdam, and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Natarajan P, Liu J, Santhanakrishnan M, Gibb DR, Slater LM, Hendrickson JE. Bortezomib decreases the magnitude of a primary humoral immune response to transfused red blood cells in a murine model. Transfusion 2016; 57:82-92. [PMID: 27734515 DOI: 10.1111/trf.13864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/11/2016] [Accepted: 08/19/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Few therapeutic options currently exist to prevent or to mitigate transfusion-associated red blood cell (RBC) alloimmunization. We hypothesized that bortezomib, a proteasome inhibitor currently being utilized for HLA alloantibody and ADAMTS13 autoantibody reduction, may be beneficial in a transfusion setting. Herein, we utilized a reductionist murine model to test our hypothesis that bortezomib would decrease RBC alloimmune responses. STUDY DESIGN AND METHODS Wild-type mice were treated with bortezomib or saline and transfused with murine RBCs expressing the human KEL glycoprotein. Levels of anti-KEL immunoglobulins in transfusion recipients were measured by flow cytometry. The impact of bortezomib treatment on recipient plasma cells (PCs) and other immune cells was also assessed by flow cytometry and immunofluorescence. RESULTS After bortezomib treatment, mice had a 50% reduction in splenic white blood cells and a targeted reduction in marrow PCs. Mice treated with bortezomib before the transfusion of KEL RBCs became alloimmunized in three of three experiments, although their serum anti-KEL IgG levels were 2.6-fold lower than those in untreated mice. Once a primary antibody response was established, bortezomib treatment did not prevent an anamnestic response from occurring. CONCLUSION To the extent that these findings are generalizable to other RBC antigens and to humans, bortezomib monotherapy is unlikely to be of significant clinical benefit in a transfusion setting where complete prevention of alloimmunization is desirable. Given the impact on PCs, however, it remains plausible that bortezomib therapy may be beneficial for RBC alloimmunization prevention or mitigation if used in combination with other immunomodulatory therapies.
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Affiliation(s)
- Prabitha Natarajan
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jingchun Liu
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - David R Gibb
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Lewis M Slater
- Hematology-Oncology Section, Medicine Health Care Group Long Beach Veterans Affairs, and Division of Hematology-Oncology and Department of Medicine, University of California, Irvine, California
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
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74
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Perrone G, Brunelli R, Marcoccia E, Zannini I, Candelieri M, Gozzer M, Stefanutti C. Therapeutic Apheresis in Pregnancy: Three Differential Indications With Positive Maternal and Fetal Outcome. Ther Apher Dial 2016; 20:677-685. [DOI: 10.1111/1744-9987.12422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/14/2016] [Accepted: 03/01/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Giuseppina Perrone
- Department of Obstetrical and Gynecological Sciences and Urological Sciences
| | - Roberto Brunelli
- Department of Obstetrical and Gynecological Sciences and Urological Sciences
| | - Eleonora Marcoccia
- Department of Obstetrical and Gynecological Sciences and Urological Sciences
| | - Ilaria Zannini
- Department of Obstetrical and Gynecological Sciences and Urological Sciences
| | - Miriam Candelieri
- Department of Obstetrical and Gynecological Sciences and Urological Sciences
| | | | - Claudia Stefanutti
- Extracorporeal Therapeutic Techniques Unit, Immunohematology and Transfusion Medicine, Lipid Clinic and Atherosclerosis Prevention Centre, Department of Molecular Medicine; ‘Umberto I’ Hospital, ‘Sapienza’ University of Rome; Rome Italy
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75
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Sankaralingam P, Jain A, Bagga R, Kumar P, Marwaha N. Red cell alloimmunization in RhD positive pregnant women and neonatal outcome. Transfus Apher Sci 2016; 55:153-8. [PMID: 27324408 DOI: 10.1016/j.transci.2016.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/31/2016] [Accepted: 06/08/2016] [Indexed: 11/25/2022]
Abstract
The frequency of red blood cell (RBC) alloimmunization in RhD positive pregnant women is not known in our population. We planned to determine its frequency and correlation with neonatal outcome. We included 1000 RhD positive pregnant women: 500 had 'normal pregnancy' (Group I) and another 500 had 'high risk pregnancy' (Group II). ABO and extended Rh phenotyping were done by tube technique, antibody screening and identification by gel technique. For alloimmunized women, the paternal and neonatal ABO and extended Rh typing were done. Neonatal direct antiglobulin test (DAT) was also done and their clinical outcome observed. The frequency of RBC alloimmunization was 0.7% (7/1000) and all these women were from group II (p = 0.015). The alloantibodies were anti-E (85.7%), anti-c (71.4%), anti-Cw (14.3%) and anti-S (14.3%). Also, 6 women had history of transfusion (p < 0.01). Of the 7 neonates born to alloimmunized mothers, 4 (57.14%) had a positive DAT. The mean duration of phototherapy was higher in the DAT positive neonates (p < 0.01) and 2 (50%) required exchange transfusion. Thus, the frequency of alloimmunization was 0.7% in RhD positive pregnant women. High risk pregnancies and antenatal patients having a history of blood transfusion should be considered for regular antibody screening.
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Affiliation(s)
- Prabakaran Sankaralingam
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Ashish Jain
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
| | - Rashmi Bagga
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Praveen Kumar
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Neelam Marwaha
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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76
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Ngoma AM, Mutombo PB, Ikeda K, Nollet KE, Natukunda B, Ohto H. A systematic review of red blood cell alloimmunization in pregnant women in Africa: time to do better. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/voxs.12270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- A. M. Ngoma
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal Quebec Canada
| | - P. B. Mutombo
- School of Public Health; University of Kinshasa; Kinshasa Democratic Republic of Congo
| | - K. Ikeda
- Department of Blood Transfusion and Transplantation Immunology; Fukushima Medical University; Fukushima Japan
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - K. E. Nollet
- Department of Blood Transfusion and Transplantation Immunology; Fukushima Medical University; Fukushima Japan
- Radiation Medical Science Center; Fukushima Medical University; Fukushima Japan
| | - B. Natukunda
- Department of Hematology and Transfusion Medicine; Faculty of Medicine; Mbarara University of Science and Technology; Mbarara Uganda
| | - H. Ohto
- Department of Blood Transfusion and Transplantation Immunology; Fukushima Medical University; Fukushima Japan
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77
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Richards AL, Hendrickson JE, Zimring JC, Hudson KE. Erythrophagocytosis by plasmacytoid dendritic cells and monocytes is enhanced during inflammation. Transfusion 2016; 56:905-16. [PMID: 26843479 DOI: 10.1111/trf.13497] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/05/2015] [Accepted: 11/13/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Generation of antibodies against red blood cell (RBC) antigens can be a clinically significant problem. The underlying mechanisms that regulate the production of RBC antibodies are only partially understood; however, factors such as inflammation significantly increase the rates of RBC antibody generation. Humoral alloimmunization begins with consumption of transfused RBCs by antigen-presenting cells (APCs). Recently, it has become appreciated that there are multiple different types of APCs. The relative contribution of APC subsets to RBC antibodies has not been described in either the quiescent or the inflamed states. STUDY DESIGN AND METHODS To evaluate the types of APCs that consume RBCs, and how inflammation affects this process, C56Bl/6 mice were treated with polyinosinic-polycytidylic acid (poly(I:C)) to induce an inflammatory response and/or were transfused with 3,3'-dihexadecyloxacarbocyanine perchlorate-labeled syngeneic RBCs. Erythrophagocytosis (both at baseline and during inflammation) was analyzed for different subsets of macrophages (MΦ), dendritic cells (DCs), B cells, and monocytes, by a combined approach using flow cytometry and fluorescent microscopy technology. RESULTS In four independent experiments, erythrophagocytosis at baseline was predominately performed by red pulp MΦ; however, during inflammation both plasmacytoid DCs (pDCs) and monocytes increased RBC consumption. Furthermore, pDCs up regulated MHC-II and activation markers CD80 and CD86. In addition to changing patterns of erythrophagocytosis, inflammation also led to a significant decrease in CD11c+ conventional DC populations and an increase in granulocytes. CONCLUSIONS The nature of APCs that consume transfused RBCs is changed by inflammation. Given that APCs initiate humoral immune responses, these findings provide potential mechanistic insight into how inflammation regulates RBC alloimmunization.
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Affiliation(s)
| | - Jeanne E Hendrickson
- Departments of Laboratory Medicine and Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - James C Zimring
- Bloodworks NW Research Institute, Seattle, Washington.,Departments of Laboratory Medicine and Hematology Division, University of Washington, Seattle, Washington
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78
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Park MS, Choi MS, Lee JH, Park SK. A case of Severe Hydrops Fetalis due to Anti-E Alloimmunization. NEONATAL MEDICINE 2016. [DOI: 10.5385/nm.2016.23.4.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Mi Seon Park
- Department of Pediatrics, Chosun University College of Medicine, Gwangju, Korea
| | - Min Seon Choi
- Department of Pediatrics, Chosun University College of Medicine, Gwangju, Korea
| | - Jae Hee Lee
- Department of Pediatrics, Chosun University College of Medicine, Gwangju, Korea
| | - Sang Kee Park
- Department of Pediatrics, Chosun University College of Medicine, Gwangju, Korea
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79
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Abstract
AbstractHemolytic disease of the fetus and newborn (HDFN) affects 3/100 000 to 80/100 000 patients per year. It is due to maternal blood group antibodies that cause fetal red cell destruction and in some cases, marrow suppression. This process leads to fetal anemia, and in severe cases can progress to edema, ascites, heart failure, and death. Infants affected with HDFN can have hyperbilirubinemia in the acute phase and hyporegenerative anemia for weeks to months after birth. The diagnosis and management of pregnant women with HDFN is based on laboratory and radiographic monitoring. Fetuses with marked anemia may require intervention with intrauterine transfusion. HDFN due to RhD can be prevented by RhIg administration. Prevention for other causal blood group specificities is less studied.
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80
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Recommendations for the prevention and treatment of haemolytic disease of the foetus and newborn. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:109-34. [PMID: 25633877 DOI: 10.2450/2014.0119-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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81
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Rieneck K, Clausen FB, Dziegiel MH. Noninvasive Antenatal Determination of Fetal Blood Group Using Next-Generation Sequencing. Cold Spring Harb Perspect Med 2015; 6:a023093. [PMID: 26511760 DOI: 10.1101/cshperspect.a023093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Hemolytic disease of the fetus and newborn (HDFN) is a condition characterized by a decreased lifespan of fetal red blood cells caused by maternally produced allospecific antibodies transferred to the fetus during pregnancy. The antibodies bind to the corresponding blood group antigens on fetal red blood cells and induce hemolysis. Cell-free DNA derived from the conceptus circulates in maternal blood. Using next-generation sequencing (NGS), it can be determined if this cell-free fetal DNA encodes the corresponding blood group antigen that is the target of the maternal allospecific antibodies. This determination carries no risk to the fetus. It is important to determine if the fetus is at risk of hemolysis to enable timely intervention. Many tests for blood groups are based solely on the presence or absence of a single nucleotide polymorphism (SNP). Antenatal determination of fetal blood group by NGS analysis holds advantages over polymerase chain reaction (PCR) determination based on allele specific amplification.
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Affiliation(s)
- Klaus Rieneck
- Department of Clinical Immunology, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Frederik Banch Clausen
- Department of Clinical Immunology, Copenhagen University Hospital, 2100 Copenhagen, Denmark
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82
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Sürücü G, Mayer B, Märzacker A, Yürek S, Salama A. Harmless Pregnancy-Induced Warm Autoantibodies to Red Blood Cells. Transfus Med Hemother 2015; 42:325-7. [PMID: 26696801 PMCID: PMC4678310 DOI: 10.1159/000440672] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/25/2015] [Indexed: 11/19/2022] Open
Abstract
Background There is little information concerning the development and significance of autoantibodies (aab) to red blood cells (RBCs) during pregnancy. Methods Unselected pregnant women were routinely screened for the presence of unexpected antibodies to RBCs using standard techniques. Results Between 2009 and 2013, 153,612 pregnant women were tested. The antibody screening test was positive in 1,721 women (1.12%). In 1,602 (1.04%) cases, immune and/or non-immune alloantibodies and cold-reactive aab were detected, whereas warm-reactive aab were found in 119 women (0.08%). In almost all cases, warm-reactive aab belonged to the IgG class. No evidence of the presence of significant haemolysis in affected women was observed. Conclusion Pregnant women may rarely develop aab to RBCs, which do not appear to cause haemolytic anaemia. Further clarification is required on the reasons behind the development of these aab and their clinical insignificance.
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Affiliation(s)
- Gülüstan Sürücü
- Institute for Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Beate Mayer
- Institute for Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Salih Yürek
- Institute for Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Abdulgabar Salama
- Institute for Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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83
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Zwingerman R, Jain V, Hannon J, Zwingerman N, Clarke G. Alloimmune Red Blood Cell Antibodies: Prevalence and Pathogenicity in a Canadian Prenatal Population. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:784-790. [DOI: 10.1016/s1701-2163(15)30148-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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84
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Le Vaillant C, Jacopin-Bruneau L, Nowak C, Riteau AS. [Two cases of unusual allo-immunization caused by atypical antibodies]. Presse Med 2015; 44:1078-82. [PMID: 26319768 DOI: 10.1016/j.lpm.2015.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 06/23/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Claudine Le Vaillant
- CHU de Nantes, hôpital Mère-Enfant, service de gynécologie-obstétrique, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France.
| | - Lucie Jacopin-Bruneau
- Centre hospitalier de Saint-Nazaire, service de gynécologie-obstétrique, 11, boulevard Georges-Charpak, BP 414, 44606 Saint-Nazaire, France
| | - Christel Nowak
- CHU de Nantes, hôpital Mère-Enfant, service de gynécologie-obstétrique, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - Anne-Sophie Riteau
- CHU de Nantes, hôpital Mère-Enfant, service de gynécologie-obstétrique, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
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85
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Mari G, Norton ME, Stone J, Berghella V, Sciscione AC, Tate D, Schenone MH. Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: the fetus at risk for anemia--diagnosis and management. Am J Obstet Gynecol 2015; 212:697-710. [PMID: 25824811 DOI: 10.1016/j.ajog.2015.01.059] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We sought to provide evidence-based guidelines for the diagnosis and management of fetal anemia. METHODS A systematic literature review was performed using MEDLINE, PubMed, EMBASE, and the Cochrane Library. The search was restricted to English-language articles published from 1966 through May 2014. Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion. Evidence reports and published guidelines were also reviewed, and additional studies were located by reviewing bibliographies of identified articles. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology was used for defining the strength of recommendations and rating the quality of evidence. Consistent with US Preventive Task Force guidelines, references were evaluated for quality based on the highest level of evidence. RESULTS AND RECOMMENDATIONS We recommend the following: (1) middle cerebral artery peak systolic velocity (MCA-PSV) measured by ultrasound Doppler interrogation be used as the primary technique to detect fetal anemia; (2) amniotic fluid delta OD450 not be used to diagnosis fetal anemia; (3) MCA-PSV assessment be reserved for those patients who are at risk of having an anemic fetus (proper technique for MCA-PSV evaluation includes assessment of the middle cerebral artery close to its origin, ideally at a zero degree angle without angle correction); (4) if a fetus is deemed at significant risk for severe fetal anemia (MCA greater than 1.5 multiples of the median or hydropic), fetal blood sampling be performed with preparation for an intrauterine transfusion, unless the pregnancy is at a gestational age when the risks associated with delivery are considered to be less than those associated with the procedure; (5) if a fetus is deemed at significant risk for severe fetal anemia, the patient be referred to a center with expertise in invasive fetal therapy; (6) MCA-PSV be considered to determine the timing of a second transfusion in fetuses with anemia, and, alternatively, a predicted decline in fetal hemoglobin may be used for timing the second procedure; and (7) pregnancies with a fetus at significant risk for fetal anemia be delivered at 37-38 weeks of gestation unless indications develop prior to this time.
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86
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Goldman M, Lane D, Webert K, Fallis R. The prevalence of anti-K in Canadian prenatal patients. Transfusion 2015; 55:1486-91. [DOI: 10.1111/trf.13151] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/11/2015] [Accepted: 04/05/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Mindy Goldman
- Medical Services and Innovation; Canadian Blood Services; Ottawa Ontario Canada
| | - Debra Lane
- Medical Services and Innovation; Canadian Blood Services; Winnipeg Manitoba Canada
| | - Kathryn Webert
- Medical Services and Innovation; Canadian Blood Services; Hamilton Ontario Canada
| | - Robert Fallis
- Diagnostic Services; Canadian Blood Services; Winnipeg Manitoba Canada
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87
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de Haas M, Thurik FF, Koelewijn JM, van der Schoot CE. Haemolytic disease of the fetus and newborn. Vox Sang 2015; 109:99-113. [PMID: 25899660 DOI: 10.1111/vox.12265] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 01/11/2015] [Accepted: 02/02/2015] [Indexed: 12/12/2022]
Abstract
Haemolytic Disease of the Fetus and Newborn (HDFN) is caused by maternal alloimmunization against red blood cell antigens. In severe cases, HDFN may lead to fetal anaemia with a risk for fetal death and to severe forms of neonatal hyperbilirubinaemia with a risk for kernicterus. Most severe cases are caused by anti-D, despite the introduction of antental and postnatal anti-D immunoglobulin prophylaxis. In general, red blood cell antibody screening programmes are aimed to detect maternal alloimmunization early in pregnancy to facilitate the identification of high-risk cases to timely start antenatal and postnatal treatment. In this review, an overview of the clinical relevance of red cell alloantibodies in relation to occurrence of HDFN and recent views on prevention, screening and treatment options of HDFN are provided.
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Affiliation(s)
- M de Haas
- Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands.,Department of Experimental Immunohaematology, Sanquin Research Amsterdam and Landsteiner laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - F F Thurik
- Department of Experimental Immunohaematology, Sanquin Research Amsterdam and Landsteiner laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - J M Koelewijn
- Department of Experimental Immunohaematology, Sanquin Research Amsterdam and Landsteiner laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.,Department of General Practice, University Medical Centre, Groningen, the Netherlands
| | - C E van der Schoot
- Department of Experimental Immunohaematology, Sanquin Research Amsterdam and Landsteiner laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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88
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Risk of maternal alloimmunization in Southern Pakistan – A study in a cohort of 1000 pregnant women. Transfus Apher Sci 2015; 52:99-102. [DOI: 10.1016/j.transci.2014.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/08/2014] [Indexed: 11/24/2022]
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89
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Jojić D, Predojević-Samardžić J, Guzijan G, Petrović-Tepić S. Immune hydrops fetalis. SCRIPTA MEDICA 2015. [DOI: 10.5937/scrimed1501080j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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90
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Molecular immunohaematology round table discussions at the AABB Annual Meeting, Denver 2013. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 13:514-20. [PMID: 25545874 DOI: 10.2450/2014.0213-14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 10/20/2014] [Indexed: 11/21/2022]
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91
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Velkova E. The Significance of Imunohematology Research in Relation to Menagement of Hemolitical Diseases of the Newborn in Republic of Macedonia. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: Prompt discovery of allosensibilisation to RBC’s antigens during pregnancy and successful management of HDFN in Republic of Macedonia, in order to decrease morbidity and mortality of the fetus and the newborn.MATERIALS AND METHODS: The study comprises in total 23,800 patients, 14,858 pregnant women and 8,842 newborn babies.RESULTS: The screening and identification of anti RBC’s antibodies detected in total 216 alloantibodies, out of which 81% (175) had a clinical significance. Out of the above mentioned 164 alloantibodies (65.9%) belong to the Rh system. The most often reason for a severe hemolytic disease is the anti-D antibody. The HDFN symptoms of mild and moderate degree demonstrated 32.5%, and 18.9% had symptoms of severe fetal suffering, and almost half of them (48%) were with or with mild HDFN and had no need of therapy. In 15% it was about alloantibodies of other Rg antigens: anti-C, anti-E and anti-c, at which in most cases there were no signs of HDFN, or it showed weak symptoms (89%), just one case of anti-c ended with intrauterine death.CONCLUSIONS: Anti D antibody represents the most often reason for severe HDFN and displays a need of intrauterine transfusion and exsangvino transfusion. Anti-c is the only antibody that demonstrated the same potential for severe HBN as the anti-D. The most often reason for alloimmunisation of the mother is the lack of RhIG prophylaxis (97.8): postnatal, antenatal and in case of possible sensible conditions during pregnancy. Thus, there is a need and an outmost importance of elaboration and adoption of the National programe for RhIG prophylaxis in Republic of Macedonia.
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92
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Hassan MN, Mohd Noor NH, Johan Noor SR, Sukri SA, Mustafa R, Luc Aster HVR. Hemolytic disease of fetus and newborn due to maternal red blood cell alloantibodies in the Malay population. Asian J Transfus Sci 2014; 8:113-7. [PMID: 25161351 PMCID: PMC4140053 DOI: 10.4103/0973-6247.137449] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Maternal red blood cell (RBC) alloimmunization may lead to production of harmful antibodies that result in hemolytic disease of fetus and newborn (HDFN). There is insufficient data on the prevalence of HDFN due to RBC alloantibodies in the Malay neonatal population. Aim: The aim of this study was to determine the incidence of HDFN in the Malay neonatal population due to clinically significant RBC alloantibodies. Subjects and Methods: A cross sectional study was conducted in Transfusion Medicine Unit, Hospital Universitiy Sains Malaysia over one year period from January to December 2009. A total of 5163 Malay pregnant women who attended labor room for delivery were collected and analyzed prospectively. The blood samples were subjected to the standard immunohematological procedure for RBC antibody screening and identification using reagents of Diamed-ID Gel microtyping system. All the newborns with RBC alloantibody were investigated for the evidence of HDFN. Results: Thirty (0.58%) women were found to have clinically significant RBC alloantibodies. Most of the alloantibodies belonged to Rhesus (Rh) system (56.7%) where anti-E (33.3%) was the most common followed by anti-D (10.0%). Rh antibodies were the main cause of HDFN in fourteen (0.27%) neonates. Anti-D and anti-c were identified to cause moderate to very severe HDFN. Conclusions: With the low prevalence of clinically significant RBC alloantibodies and HDFN, routine antenatal antibody screening practice may not be advised as a routine practice at present, preferably reserved for those women of RhD negative or with history of HDFN, significantly of those attributed to anti-c.
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Affiliation(s)
- Mohd Nazri Hassan
- Department of Haematology, School of Medical Sciences, Health Campus, Universiti Sains, Kubang Kerian, Kelantan, Malaysia
| | - Noor Haslina Mohd Noor
- Department of Haematology, School of Medical Sciences, Health Campus, Universiti Sains, Kubang Kerian, Kelantan, Malaysia
| | - Shah Reza Johan Noor
- Department of Obstetrics and Gynaecology, School of Medical Sciences, Health Campus, Universiti Sains, Kubang Kerian, Kelantan, Malaysia
| | - Salamah Ahmad Sukri
- Department of Haematology, School of Medical Sciences, Health Campus, Universiti Sains, Kubang Kerian, Kelantan, Malaysia
| | - Rapiaah Mustafa
- Department of Haematology, School of Medical Sciences, Health Campus, Universiti Sains, Kubang Kerian, Kelantan, Malaysia
| | - Hans Van Rostenberghe Luc Aster
- Department of Paediatric, School of Medical Sciences, Health Campus, Universiti Sains, Kubang Kerian, Kelantan, Malaysia, Malaysia
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93
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Abstract
Birth defects are an urgent global health priority. They affect millions of births worldwide. But their prevalence and impact are largely under-ascertained, particularly in middle- and low-income countries. Fortunately, a large proportion of birth defects can be prevented. This review examines the global prevalence and primary prevention methods for major preventable birth defects: congenital rubella syndrome, folic acid-preventable spina bifida and anencephaly, fetal alcohol syndrome, Down syndrome, rhesus hemolytic disease of the fetus and the newborn; and those associated with maternal diabetes, and maternal exposure to valproic acid or iodine deficiency during pregnancy. Challenges to prevention efforts are reviewed. The aim of this review is to bring to the forefront the urgency of birth defects prevention, surveillance, and prenatal screening and counseling; and to help public health practitioners develop population-based birth defects surveillance and prevention programs, and policy-makers to develop and implement science-based public health policies.
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94
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Fan J, Lee BK, Wikman AT, Johansson S, Reilly M. Associations of Rhesus and non-Rhesus maternal red blood cell alloimmunization with stillbirth and preterm birth. Int J Epidemiol 2014; 43:1123-31. [PMID: 24801308 DOI: 10.1093/ije/dyu079] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although the risks of adverse pregnancy outcomes associated with anti-D antibodies are well-recognized, much less is known concerning alloimmunization with other red blood cell antibodies detected during routine maternal screening. To date, most reports of adverse pregnancy outcomes associated with non-anti-D antibodies have been from small case studies. The aim of this study was to examine the associations of maternal alloimmunization with specific red blood cell antibodies and the risks of preterm birth and stillbirth in the Swedish population. METHODS All antibody screening, outcome and covariate data were obtained through linkages of Swedish national health and data registers. Follow-up in these population-based registers was available up to 31 December 2002. The final study sample consisted of 1,022,569 singleton births from 668,952 mothers during 1987-2002. RESULTS In total, 1.3% of the 1,022,569 study pregnancies were alloimmunized. In adjusted logistic regression models, compared with having no antibodies, alloimmunization with anti-D, anti-E, anti-C and anti-c was associated with increased risk of both stillbirth and preterm birth. In addition, anti-Kell was associated with increased risk of preterm birth and anti-Lea with increased risk of stillbirth. Compared with firstborn children, risk of preterm birth associated with alloimmunization was greater in subsequent births CONCLUSIONS In the largest study to date, alloimmunization with Rhesus, K- and -Lea red blood cell antibodies increased the risk of preterm birth and/or stillbirth. The association of anti-Lea with stillbirth was an unexpected finding. Further study of the consequences of non-anti-D alloimmunization is warranted.
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Affiliation(s)
- Jing Fan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden, Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19102, USA, Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, S-14183 Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet and Department of Neonatology, Sachs' Children and Youth Hospital, 118 83 Stockholm, Sweden
| | - Brian K Lee
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden, Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19102, USA, Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, S-14183 Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet and Department of Neonatology, Sachs' Children and Youth Hospital, 118 83 Stockholm, Sweden
| | - Agneta T Wikman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden, Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19102, USA, Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, S-14183 Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet and Department of Neonatology, Sachs' Children and Youth Hospital, 118 83 Stockholm, Sweden
| | - Stefan Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden, Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19102, USA, Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, S-14183 Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet and Department of Neonatology, Sachs' Children and Youth Hospital, 118 83 Stockholm, Sweden
| | - Marie Reilly
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden, Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19102, USA, Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, S-14183 Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet and Department of Neonatology, Sachs' Children and Youth Hospital, 118 83 Stockholm, Sweden
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95
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Clausen FB. Integration of noninvasive prenatal prediction of fetal blood group into clinical prenatal care. Prenat Diagn 2014; 34:409-15. [PMID: 24431264 DOI: 10.1002/pd.4326] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/08/2014] [Accepted: 01/12/2014] [Indexed: 12/21/2022]
Abstract
Incompatibility of red blood cell blood group antigens between a pregnant woman and her fetus can cause maternal immunization and, consequently, hemolytic disease of the fetus and newborn. Noninvasive prenatal testing of cell-free fetal DNA can be used to assess the risk of hemolytic disease of the fetus and newborn to fetuses of immunized women. Prediction of the fetal RhD type has been very successful and is now integrated into clinical practice to assist in the management of the pregnancies of RhD immunized women. In addition, noninvasive prediction of the fetal RhD type can be applied to guide targeted prenatal prophylaxis, thus avoiding unnecessary exposure to anti-D in pregnant women. The analytical aspect of noninvasive fetal RHD typing is very robust and accurate, and its routine utilization has demonstrated high sensitivities for fetal RHD detection. A high compliance with administering anti-D is essential for obtaining a clinical effect. Noninvasive fetal typing of RHC/c, RHE/e, and KEL may become more widely used in the future.
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Affiliation(s)
- Frederik Banch Clausen
- Laboratory of Blood Genetics, Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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96
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Kaur P, Kaur G, Basu S, Kaur R. Anti S enigma in a pregnant patient. Transfus Apher Sci 2014; 50:281-2. [PMID: 24485071 DOI: 10.1016/j.transci.2014.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
Abstract
Among the antibodies of the MNS blood group system, anti S antibody is generally IgG antibody reacting at 37 °C. It is rarely implicated in hemolytic transfusion reaction; however, it can lead to potentially severe transfusion reactions. Anti S is also capable of causing mild to severe fatal hemolytic disease of newborn. We report a case of anti S antibody in a pregnant patient with complicated falciparum malaria.
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Affiliation(s)
- Paramjit Kaur
- Department of Transfusion Medicine, Government Medical College, Sector 32, Chandigarh 160030, India.
| | - Gagandeep Kaur
- Department of Transfusion Medicine, Government Medical College, Sector 32, Chandigarh 160030, India
| | - Sabita Basu
- Department of Transfusion Medicine, Government Medical College, Sector 32, Chandigarh 160030, India
| | - Ravneet Kaur
- Department of Transfusion Medicine, Government Medical College, Sector 32, Chandigarh 160030, India
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97
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Walsh CA, Russell N, McAuliffe FM, Higgins S, Mahony R, Carroll S, McParland P. Relationship between maternal antibody type and antenatal course following intrauterine transfusion for red cell alloimmunisation. Eur J Obstet Gynecol Reprod Biol 2013; 171:235-9. [DOI: 10.1016/j.ejogrb.2013.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/31/2013] [Accepted: 09/02/2013] [Indexed: 11/25/2022]
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98
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A mouse model of hemolytic disease of the newborn. Blood 2013; 122:1334-5. [PMID: 23970354 DOI: 10.1182/blood-2013-07-512715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this issue of Blood, Stowell et al describe a novel mouse model of hemolytic disease of the fetus and newborn (HDFN) that recapitulates many of the key features of human disease.1 Recently, this same group of researchers described a transgenic mouse that expresses the human KEL2 (Chellano) red cell surface protein from the Kell system on red cells, and subsequently demonstrated that Kell differences on transfused blood induce antibody responses and hemolytic transfusion reactions similar to those seen in patients. In this latest report, Stowell et al demonstrate that similar to some patients, Kell differences between mother and father can lead to maternal antibody generation and hemolytic disease in utero. In so doing, they provide experimental confirmation of a long sought after animal model of HDFN.
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99
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Wagner MM, van Dunné FM, Kuipers I, Thornton N, Folman CC, Ponjee GA, Oepkes D. Anti-Emm in a pregnant patient--case report. Vox Sang 2013; 106:385-6. [PMID: 24164348 DOI: 10.1111/vox.12104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 09/25/2013] [Accepted: 09/25/2013] [Indexed: 12/01/2022]
Abstract
A 23-year-old primigravida of North African origin presented with a positive antibody screen at booking at 15 weeks of gestation. An antibody to a high-frequency antigen (HFA) of unknown identity was detected, which was reactive with the red blood cells of the father. This led to several challenges including antibody identification, clinical monitoring to detect signs of haemolytic disease of the foetus and newborn (HDFN) and compatible blood in case perinatal transfusion was needed. Anti-Emm was identified 2 months post-partum. This is the first published case which describes a pregnant patient with anti-Emm.
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Affiliation(s)
- M M Wagner
- Department of Gynaecology, Medical Center Haaglanden, The Hague, the Netherlands; Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
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100
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A case of severe foetal anaemia due to anti-M isoimmunisation salvaged by intrauterine transfusions. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12 Suppl 1:s302-4. [PMID: 23867188 DOI: 10.2450/2013.0016-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 04/04/2013] [Indexed: 11/21/2022]
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