Unit:
Κατεύθυνση Θρόμβωση-Αιμορραγία-Ιατρική των μεταγγίσεωνLibrary of the School of Health Sciences
Author:
Gkarana Ntezire-Amanta
Supervisors info:
Βαλσάμη Σερένα, Αναπληρώτρια καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Τσαντές Αργύρης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μακάριος Ελευθεριάδης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Αλλοανοσοποίηση στην κύηση και οι κλινικές της προεκτάσεις (Αιμολυτική νόσος του νεογνού, αλλοανοσοθρομβοπενία)
Translated title:
Alloimmunization in pregnancy and its clinical implications (Hemolytic disease of the newborn, alloimmune thrombocytopenia)
Summary:
Alloimmunization during pregnancy carries significant risks to both the fetus and the mother, requiring careful management by health care providers. This phenomenon occurs when immune reactions are activated against foreign antigens present on fetal erythrocytes, leading to the production of alloantibodies. This happens due to incompatibility and is affected by many factors. The most common alloantibodies involved in this process are anti-Rh(D)—considered the most immunogenic—and anti-Kell, although other blood group antibodies may also contribute.
These antibodies are called alloantibodies. The risk is significant when the antibodies have already been produced and the mother is re-exposed (e.g. in a subsequent pregnancy or transfusion), in which case ,their titer increases. The degree of risk for alloimmunization in pregnancy is determined by several factors.
Among these antibodies there are some that attack antigens - erythrocytes of the fetal circulation, resulting in the creation of hemolysis. The above phenomenon causes the hemolytic disease of the fetus and newborn.
The above phenomenon may also cause neonatal alloimmune thrombocytopenia, due to transplacental transfer of maternal antibodies which reduce the number of platelets and cause a variety of clinical manifestations in the fetus. This is the result of antiplatelet antigen incompatibility between mother and father in case the fetus inherits the father's genotype.The pathogenesis of the disease involves maternal sensitization to paternal inherited platelet antigens, leading to the production of IgG alloantibodies that cross the placenta and destroy fetal platelets.Most common antigens responsible for the disease are HPA1a, HPA5b, and HLA.
The management and treatment of alloimmunization during pregnancy is a scientific challenge. Certain variables can affect the severity of the disease such as gestational age, the type and concentration of antibodies produced by the mother, the ability of the fetus to replace red blood cells. The timely and accurate detection of maternal alloantibodies through routine tests, which include serological and non-serological methods (Coombs test), non-invasive (NIPT test), molecular (PCR), are vital for early intervention and management of the disease.
Therefore, it is important to obtain a documented history from the physician and explore the strengths and weaknesses of the laboratory tools used to aid in the detection of alloimmunization. Therefore, a thorough understanding of early detection and multidisciplinary care is emphasized to mitigate associated complications and ensure favorable outcomes for both mother and child.
Main subject category:
Health Sciences
Keywords:
Pregnancy, Alloimmunization, Hemolytic disease, Alloimmune thrombocytopenia, Blood group, Immunization, Red blood cells, HDNF, FNAIT
Number of references:
259
