A study recently published in Transfusion and Apheresis Science developed a workflow to predict cases of hemolytic disease of the fetus and newborn (HDFN) due to ABO incompatibility using blood testing.
Intrinsic ABO incompatibility, which occurs when a mother whose blood group is type O becomes pregnant with a fetus who is not group O, is observed in 15% to 25% of pregnancies. Of these pregnancies, about 1% lead to cases of HDFN.
In their study, the authors identified 85,176 blood samples received at a hospital blood center between 2016 and 2023. Further genetic analysis of these samples revealed 913 group O mothers who delivered non-group O infants. Of these cases, 20 (2.19%) were diagnosed with HDFN.
All of the newborns with HDFN underwent phototherapy. Additionally, seven patients required an exchange transfusion, which is used to remove excess bilirubin and maternal antibodies from the blood. Intravenous immunoglobulin was administered to four patients who did not respond to phototherapy or exchange transfusion.
Read more about HDFN causes and risk factors
Next, a direct antiglobulin test (DAT) was performed in order to detect the antibodies attached to the surfaces of red blood cells. DAT positivity due to immunoglobulin G1 and G3 was found in 15 of the 20 newborns with HDFN (75%). The authors also found that the strength of newborn DAT results was strongly correlated with maternal antibody titers.
After seven days of treatment, the patients experienced significant improvements in mean hemoglobin, bilirubin and DAT levels.
“The study provides insights into the prevalence and risk of ABO-HDFN by analyzing ABO gene frequency patterns in the population and characterizing the immunohematological aspects of the disease,” the authors wrote. “The findings highlight that ABO blood group distributions and maternal antibody titres play a crucial role in the severity of ABO-HDFN and newborn interventions.”
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