Castillo-Macías A, Díaz-Chuc EA, Sotelo-Coronado JI, Llaca-Díaz JM, Avilés-Rodríguez LE, Pérez-Chávez F, Cázares-Tamez R, Mercado-Del Ángel F

Language: Spanish
References: 18
Page: 158-163
PDF size: 282.17 Kb.

ABSTRACT

Background: Hemolytic disease of the fetus and newborn occurs after alloimmunization with red blood cells antigens by blood transfusion, maternal-fetal hemorrhage during pregnancy or at delivery. Currently, the incidence of alloimmunization by anti-D antibody has been reduced from 14% to 0.1% of D-negative mothers, however, there is no immunoglobulin that prevents or decreases alloimmunization by other red blood cells antigens during pregnancy. The incompatibilities of the Duffy blood group are a common cause of hemolytic disease of the fetus and newborn.
Objective: To present the case of a neonate with perinatal hemolytic disease secondary to anti-Fy^a and anti-D antibodies managed with intrauterine transfusion.
Clinic case: A 22-year-old patient with a history of multiple blood transfusions and clinical data of anemic syndrome. In the 28th week of pregnancy it was evaluated for the application of anti-D immunoglobulin. The blood bank was asked for two units of Rh negative erythrocyte concentrate. Incompatibility (++) in the human antiglobulin phase (Coombs) was observed, so the irregular antibody gel was screened, which was positive in cells I and II (+++). An identification protocol for irregular antibodies was initiated with a panel of 11 cells, which reported agglutination in cells 1, 2, 3, 5, 6, 7, 8 and 11, without specificity. The adsorption study of the anti-D antibody showed D + antigen cells. The diagnosis of anti-Fy^a and anti-D antibodies was established. The pregnant woman was terminated by caesarean section, from which a male with a group was born and Rh O positive, of 30.1 weeks of gestation (size of 40 cm and weight of 2000 g) with fetal hydrops. He underwent resuscitation cycles, entered the neonatal intensive care unit, without pharmacotherapy and died after one hour of extrauterine life. The mother withdrew 36 hours after the puerperium, without additional complications.
Conclusion: The antibodies anti-Fy^a alone or next to other alloantibodies produce severe hemolytic disease of the fetus and newborn. The laboratory of immunohematology in the blood bank is an essential tool in the diagnosis, monitoring and treatment of hemolytic disease of the fetus and newborn.

REFERENCES

1. Howes RE, Patil AP, Piel FB, et al. The global distribution of the Duffy blood group. Nat Commun. 2011;2:266-280.

2. Dávila AA, Cruz DV, Del Rosario López De Roux M, Menéndez RD, Rosales LC. Enfermedad hemolítica del recién nacido por incompatibilidad Duffy: Reporte de un caso. Rev Cubana Pediatr. 2008;80(2):1-3.

3. Basu S, Kaur R, Kaur G, et al. Hemolytic disease of the fetus and newborn: Current trends and perspectives. Asian J Transfus Sci. 2011;5(1):3-7.

4. Obukhova P, Korchagina E, Henry S, Bovin N. Natural anti-A and anti-B of the ABO system: Allo- and autoantibodies have different epitope specificity. Transfusion. 2012;52(4):860-869.

5. Evers D, Middelburg RA, de Haas M, et al. Red-blood-cell alloimmunisation in relation to antigens exposure and their immunogenicity: a cohort study. Lancet Haematol. 2016;3(6):e284-e292.

6. Fairley C, Miller E, Smoleniec J. Observational Study of Effect of Intrauterine Transfusions. Lancet. 1995:1335- 1337.

7. Van Kamp IL, Klumper FJCM, Oepkes D, et al. Complications of intrauterine intravascular transfusion for fetal anemia due to maternal red-cell alloimmunization. Am J Obstet Gynecol. 2005;192(1):171-177.

8. Lindenburg ITM, Van Kamp IL, Oepkes D. Intrauterine blood transfusion: Current indications and associated risks. Fetal Diagn Ther. 2014;36(4):263-271.

9. Tuson M, Hue-Roye K, Koval K, Imlay S, Desai R, Garg G, Kazem E, Stockman D, Hamilton J RM. Possible supression of fetal erythropoiesis by the Kell blood group antibody anti-Kpa. Immunohematology. 2011;27(2):58-60.

10. Radunovic N, Lockwood CJ, Alvarez M, Plecas D, Chitkara U BR. The severely anemic and hydropic isoimmune fetus: changes in fetal hematocrit associated with intrauterine death. Obs Gynecol. 1992;79(3):390-391.

11. Giannina G, Moise KJ, Dorman K. A simple method to estimate volume for fetal intravascular. 1998;4609(813):94-97.

12. Stone J, Berghella V, Sciscione AC, Tate D. Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: the fetus at risk for anemia--diagnosis and management. Am J Obstet Gynecol. 2015;212(6):697-710.

13. Koelewijn JM, Vrijkotte TGM, Van Der Schoot CE, Bonsel GJ, De Haas M. Effect of screening for red cell antibodies, other than anti-D, to detect hemolytic disease of the fetus and newborn: A population study in the Netherlands. Transfusion. 2008;48(5):941-952.

14. Alcaraz-López JL, Bonilla-Zavala R, Luna-González J, Montes-Ledesma M, Chávez-Durán MA. Investigación en el trabajo diario de inmunohematología. Fenotipos eritrocitarios y protocolo para encontrar sangre compatible en pacientes con aloanticuerpos antieritrocitos. Gac Med Mex. 2007;143:23-27.

15. Pogo AO, Chaudhuri A. The Duffy protein: a malarial and chemokine receptor. Semin Hematol. 2000;37(2):122-129.

16. Brecher ME. AABB Technical Manual.15th ed. 2005;731-799.

17. Prevención, diagnóstico y manejo de la aloinmunización materno-fetal. México. Secretaría de Salud. CENETEC. 2011. Dirección URL: < http://www.cenetec.salud.gob. mx/descargas/gpc/CatalogoMaestro/307_GPC_AloinmunizacixnRH/ GER_Aloinmunizacion.pdf>.

18. Norma Oficial Mexicana Para la Atención de la Mujer Durante el Embarazo, Parto y Puerperio, y de la Persona Recién Nacida. Diario Oficial de la Federación. NOM-007- SSA2-2016. Dirección URL: [Consulta: mayo 2016].