Pregnancies in which multiple types of antibodiesAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. against the fetal red blood cells are present can be challenging and require cooperation between different medical specialties to treat complications associated with hemolytic disease of the fetus and newborn (HDFN), as illustrated by a recently published case study in the Journal of Obstetrics and Gynecology of India.
Human blood cells have several proteins on their surface known as antigensAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens.. However, not all persons have the same antigens. In pregnancies where the fetus is positive for a specific antigen but the mother is negative for the same antigen, contact with fetal blood during birth will cause the mother’s immune system to recognize the fetal blood cells as foreign and produce antibodies against them. These antibodies can cross the placenta and bind to fetal red blood cells, causing HDFN.
Most cases of HDFN are caused by the incompatibility of antigens that belong to the RhRh factor A protein or antigen found on red blood cells. When an Rh-negative mother carries an Rh-positive fetus, her immune system may make antibodies that attack the fetus' red blood cells. family, which include the G antigen, the D antigen, and the D antigen. The presence of multiple antibodies targeting each of these antigens is rare and represents a challenge for physicians, and advanced testing techniques are required for making an accurate diagnosis.
Rho(D) immune globulinRho(D) immune globulin A preventive treatment that helps prevent Rh-negative mothers from developing antibodies that may harm the fetus. (RhIGRho(D) immune globulin A preventive treatment that helps prevent Rh-negative mothers from developing antibodies that may harm the fetus.) is a treatment that involves introducing synthetic antibodies that bind to the D-positive red blood cells that could have crossed the bloodstream, preventing the formation of maternal antibodies that can cause HDFN in a subsequent pregnancy.
Learn more about health care providers who treat HDFN
Women with positive anti-G and anti-C antibodies are candidates for receiving RhIg. However, the administration of RhIg is not recommended for women with anti-D antibodies.
The authors reported a case involving a 34-year-old D-negative woman with a D-positive husband with five previous pregnancies, including one miscarriage and one medically terminated pregnancy. Although Rh immunoglobulinIntravenous immunoglobulin A therapy made from donated antibodies that may help reduce the mother’s immune response and protect the fetus. was administered during the first two pregnancies to prevent HDFN, it was not administered during the miscarriage or the medically terminated pregnancy. Further testing revealed the presence of anti-G, anti-D, and anti-C antibodies in maternal blood.
A multidisciplinary team, including fetal medicine, transfusion medicine and neonatology specialists worked together to treat the patient. They monitored the baby’s health and performed intrauterine transfusions when necessary. The baby was born prematurely and needed specialized care, including an exchange transfusion. Both mother and baby eventually recovered.
“The present case report highlights the coordination between the fetal medicine, transfusion medicine and neonatologists for successful management and outcome of pregnancy complicated with hemolytic disease on fetus and newborn (HDFN) due to multiple alloantibodies (anti-D, anti-C and anti-G),” the authors concluded.
