Prediction of ABO hemolytic disease of the newborn using pre- and perinatal quantification of maternal anti-A/anti-B IgG titer

Autor: Bo Mølholm Hansen, Thomas Bergholt, Anette Kjærbye-Thygesen, Mette Line Donneborg, Finn Ebbesen, Morten Hanefeld Dziegiel, Per Albertsen, Grethe Risum Krog, Mette Kiel Smed, Kristian Vestergaard Jensen, Frederik Banch Clausen, Henriette Lorenzen
Rok vydání: 2020
Předmět:
Zdroj: Krog, G R, Donneborg, M L, Hansen, B M, Lorenzen, H, Clausen, F B, Jensen, K V, Kjærbye-Thygesen, A, Albertsen, P, Ebbesen, F, Bergholt, T, Smed, M K & Dziegiel, M H 2021, ' Prediction of ABO hemolytic disease of the newborn using pre-and perinatal quantification of maternal anti-A/anti-B IgG titer ', Pediatric Research, vol. 90, no. 1, pp. 74-81 . https://doi.org/10.1038/s41390-020-01232-5
ISSN: 1530-0447
0031-3998
DOI: 10.1038/s41390-020-01232-5
Popis: Background: Hemolysis in fetus/newborns is often caused by maternal antibodies. There are currently no established screening procedures for maternal ABO antibodies harmful to fetus/newborn. We investigated the clinical significance, and predictive value of maternal anti-A/B titer for hyperbilirubinemia in ABO-incompatible newborns. Methods: We conducted a case–control study of blood group O mothers and their ABO-compatible (O) vs. -incompatible (A/B) newborns receiving phototherapy, and of ABO-incompatible newborns receiving phototherapy vs. no phototherapy. Newborn data and treatment modalities were recorded, and total serum bilirubin and hemoglobin were measured. Maternal anti-A/B immunoglobulin-γ (IgG) titers were measured prenatally and perinatally, and negative and positive predictive values (NPV, PPV) were calculated to assess the risk of developing hyperbilirubinemia requiring phototherapy. Results: We found a significantly higher maternal IgG antibody titer in the case group (p < 0.001). Maternal anti-A/B titers at first trimester had modest predictive values: NPV = 0.82 and PPV = 0.65 for neonatal hyperbilirubinemia; titers at birth improved the predictive values: NPV = 0.93 and PPV = 0.73. Newborn hemoglobin was significantly lower in incompatibles compared to compatibles (p = 0.034). Furthermore, increased anti-A/B IgG production during pregnancy was associated with hyperbilirubinemia and hemolysis in incompatible newborns. Conclusions: There was a significant association between maternal anti-A/B IgG titer and hyperbilirubinemia requiring treatment. Impact: Maternal anti-A/B IgG titer in the first trimester and at birth is predictive of hemolytic disease of the ABO-incompatible newborn.Increased IgG anti-A/B production throughout pregnancy in mothers to ABO-incompatible newborns developing hyperbilirubinemia contrasts a constant or reduced production in mothers to newborns not developing hyperbilirubinemia.Screening tools available in most immunohematology laboratories can identify clinically important IgG anti-A/B.Use of maternal samples taken at birth yielded NPV = 0.93 and PPV = 0.73.
Databáze: OpenAIRE
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