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

Marjana Jerkovic Raguz; Zeljka Prce; Vedran Bjelanovic; Ivana Bjelanovic; Sanja Dzida; Mirela Mabic

doi:10.1055/a-1248-2329

Klin Padiatr 2020; 232(06): 314-320
DOI: 10.1055/a-1248-2329

Original Article

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

20 Jahre mütterliche Alloimmunisierung und die Auswirkungen auf Neugeborene: Hat sich etwas auf diesem Gebiet im Laufe der Jahre geändert?

Autor*innen

Marjana Jerkovic Raguz

¹NICU Deparment, Clinic for Children’s Diseases, Sveucilisna Klinicka Bolnica Mostar, Mostar
Zeljka Prce

²Faculty of Medicine, University of Mostar Faculty of Medicine, Mostar
Vedran Bjelanovic

³Clinic of Gynecology and Obstetrics, University Clinical Hospital Mostar, Mostar
Ivana Bjelanovic

⁴Faculty of Medicine, University of Mostar Faculty of Medicine, Mostar
Sanja Dzida

⁵Department of Neonatology and Intensive Care Unit, Clinic for Children’s Diseases, University Clinical Hospital Mostar, Mostar
Mirela Mabic

⁶Faculty of Economics, University of Mostar, Mostar

Abstract

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

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

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

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

Zusammenfassung

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

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

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

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

Key words

Pregnancy - newborn - hemolytic disease - sensitization

Schlüsselwörter

Schwangerschaft - Neugeborene - hämolytischen Erkrankung des Neugeborenen - Immunisierung

Volltext

Referenzen

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