Maternal-fetal isoimmunization - a risk for the development of hemolytic disease of the newborn

Abstract

Hemolytic disease of the newborn is a condition caused by maternal alloimmunization against fetal red blood cell antigens. Transplacental hemorrhage, for example, can provoke an immune response in the mother. As a result, IgG-class antibodies directed against fetal erythrocyte antigens are synthesized. The hemolysis that develops in the perinatal period in the fetus is a consequence of the transplacental migration of these anti-erythrocyte antibodies into the fetal circulation. Depending on the perinatal stage in which it occurs, hemolytic disease of the newborn can lead to hemolytic anemia in the infant or hydrops fetalis with subsequent fetal death. Screening for anti-erythrocyte antibodies during pregnancy, as well as the direct Coombs antiglobulin test, are important methods for monitoring alloimmunization and ensuring timely diagnosis of hemolytic disease in the fetus and newborn. This study reflects the prevalence and trends in alloimmunization among pregnant and postpartum women over a three-year period at MHAT “St. Sofia.” The aim was to determine the frequency of alloimmunization and summarize results based on specificity and clinical factors. A retrospective analysis was performed over three years, tracking blood grouping, antibody screening, and antibody identification in pregnant women, mothers, and newborns. Standard diagnostic methods were used, including the enzyme test at 37 °C, the direct and indirect Coombs antiglobulin test, and agglutination testing. The tests were performed both prenatally and postnatally. AB0 blood group incompatibility is the most common and usually occurs in pregnant women with blood group 0, whose fetus has blood group A, B, or AB. This is due to the fact that antibodies produced by individuals with blood group 0 are typically IgG, while those produced by individuals with group A or B are more often IgM. Targeted prenatal care and prophylaxis - pre- and postnatal with anti-D immunoglobulin - have significantly reduced the risk of D-alloimmunization. However, anti-D remains one of the most frequently detected antibodies in pregnant women. To maintain proper use of anti-D prophylaxis, continuous education and awareness are needed among healthcare professionals caring for pregnant women and mothers.