Hyporegenerative anemia in anti-M-associated hemolytic disease of the fetus.

Autor: Li S; Department of Obstetrics, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.; Fetal Medicine Center, Department of Obstetrics, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China., He Z; Fetal Medicine Center, Department of Obstetrics, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China., Mo C; Guangzhou Blood Center, Insititute of Clinical Blood Transfusion, Guangzhou, China., Ji Y; Guangzhou Blood Center, Insititute of Clinical Blood Transfusion, Guangzhou, China., Luo Y; Fetal Medicine Center, Department of Obstetrics, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China., Fang Q; Fetal Medicine Center, Department of Obstetrics, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China., Gao Y; Department of Obstetrics, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Jazyk: angličtina
Zdroj: Transfusion [Transfusion] 2021 Jun; Vol. 61 (6), pp. 1908-1915. Date of Electronic Publication: 2021 May 03.
DOI: 10.1111/trf.16350
Abstrakt: Background: The anti-M antibody can lead to hemolytic disease of the fetus and newborn (HDFN) and adverse fetal outcomes, especially in the Asian population. However, fetal erythropoiesis resulting from M alloimmunization needs further investigation.
Study Design and Methods: We analyzed erythropoiesis in eight fetuses with M alloimmunization and compared them with the fetuses affected by anti-D. They were matched as pairs according to the gestational age of diagnosis and the hematocrit before treatment. Paired t-tests or paired Wilcoxon rank-sum tests were conducted to compare the difference in the cord blood indexes. Pearson correlation analysis was used to evaluate the correlativity between hematocrit and the reticulocyte percentage in the two groups.
Results: The fetuses in the MN group had lower reticulocyte count and percentage than those in the RhD group (p < .05). All of the fetal reticulocyte production indexes (RPIs) in the MN group were less than 2, indicating an inadequate hemopoietic response to anemia, while the majority of the RPIs in the RhD group (85.7%) were significantly higher (p = .003), with 6 cases greater than 2.5. Hematocrit was negatively correlated with reticulocyte percentage (y = 54.7-171.7x, r 2  = 0.825, p = .005) in the RhD group, while no significant correlation was found in the MN group. No difference in the number of IUT, interval, or the fetal outcome was found between the two groups.
Conclusion: Fetal reticulocytopenia provided direct evidence of an inadequate hemopoietic response in HDFN due to anti-M, leading to hyporegenerative anemia. Once the IgG component of anti-M is detected, close monitoring should be considered.
(© 2021 AABB.)
Databáze: MEDLINE
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