Maternal IgG in hemolytic disease of the fetus and newborn-ABO incompatibility
DOI:
https://doi.org/10.13181/mji.oa.247269Keywords:
ABO incompatibility, hemolytic disease of newborn, immunoglobulin GAbstract
BACKGROUND Hemolytic disease of the fetus and newborn (HDFN) is a type of anemia in the fetus or newborn, characterized by anemia, jaundice, hyperbilirubinemia, and brain damage. IgG is the only antibody that can cross the placenta. The IgG subtypes have a different ability to destroy red blood cells (RBCs). IgG1 and IgG3 can bind to Fc-phagocyte cell receptors and cause hemolysis, while IgG3 has more ability than IgG1. This study aimed to identify the antibody IgG subtype contributing to clinical manifestation differences in HDFN.
METHODS This study used blood and umbilical cord blood samples from 30 pairs of mother-baby. The samples were grouped into control (not jaundice/normal bilirubin levels) and jaundice/hyperbilirubinemia groups. A self-developed IgG subtype enzyme-linked immunosorbent assay protocol was performed on maternal samples, resulting in optical density. Statistical analysis was performed using SPSS software version 23.
RESULTS Blood type was associated with total bilirubin expression (p = 0.005). IgG1 anti-A, IgG3 anti-A, IgG4 anti-A, IgG1 anti-B, IgG3 anti-B, and IgG4 anti-B significantly affected hyperbilirubinemia in newborns (p = 0.041, 0.013, 0.017, 0.028, 0.001, and 0.007, respectively).
CONCLUSIONS IgG1 and IgG3 were more significant in causing clinical problems. IgG4 suppressed IgG activation, resulting in no destruction of the infant’s RBCs.
Downloads
References
Fasano RM. Hemolytic disease of the fetus and newborn in the molecular era. Semin Fetal Neonatal Med. 2016;21(1):28-34. https://doi.org/10.1016/j.siny.2015.10.006
Watchko JF. Common hematologic problems in the newborn nursery. Pediatr Clin North Am. 2015;62(2):509-24. https://doi.org/10.1016/j.pcl.2014.11.011
de Haas M, Thurik FF, Koelewijn JM, van der Schoot CE. Haemolytic disease of the fetus and newborn. Vox Sang. 2015;109(2):99-113. https://doi.org/10.1111/vox.12265
Delaney M, Matthews DC. Hemolytic disease of the fetus and newborn: managing the mother, fetus, and newborn. Hematology Am Soc Hematol Educ Program. 2015;2015:146-51. https://doi.org/10.1182/asheducation-2015.1.146
Zama I, Ati SR, Erhabor O. Heamolytic disease of the foetus and new born due to ABO blood group incompatibility between mother and their babies in Specialist Hospital Sokoto, Nigeria. SF Obste Heal J. 2017;1(2):1-6.
Bandyopadhyay AR, Chatterjee D, Chatterjee M, Ghosh JR. Maternal fetal interaction in the ABO system: a comparative analysis of healthy mother and couples with spontaneous abortion in Bengalee population. Am J Hum Biol. 2011;23(1):76-9. https://doi.org/10.1002/ajhb.21102
Soni N, Mukherjee BM. A study on foetal wastage and ABO blood groups incompatibility among the Gonds of Garriyaband, Chhattisgarh, India. Anthropologist. 2009;11(3):229-31. https://doi.org/10.1080/09720073.2009.11891107
Bhat YR, Kumar CG. Morbidity of ABO haemolytic disease in the newborn. Paediatr Int Child Health. 2012;32(2):93-6. https://doi.org/10.1179/2046905512Y.0000000002
Yahya N, Yuniati T, Lubis L. Characteristics of neonatal hyperbilirubinemia at west java's top referral hospital, Indonesia. Althea Med J. 2017;4(2):167-72. https://doi.org/10.15850/amj.v4n2.1065
Nurrahmah S, Wibowo H, Gantini RS. [Analysis of titer and subtypes antibody in ABO incompatibility that causes hemolytic disease of fetus and newborn]. Med Ilm Kes. 2022;11(1):17-22. Indonesian. https://doi.org/10.30989/mik.v11i1.675
Kronimus Y, Dodel R, Galuska SP, Neumann S. IgG Fc N-glycosylation: alterations in neurologic diseases and potential therapeutic target? J Autoimmun. 2019;96:14-23. https://doi.org/10.1016/j.jaut.2018.10.006
Brouwers HA, Overbeeke MA, van Ertbruggen I, Schaasberg W, Alsbach GP, van der Heiden C, et al. What is the best predictor of the severity of ABO-haemolytic disease of the newborn? Lancet. 1988;2(8612):641-4. https://doi.org/10.1016/S0140-6736(88)90466-7
Dharmayani D, Gatot D, Rohsiswatmo R, Tridjaja B. Serological profile and hemolytic disease in term neonates with ABO incompatibility. Paediatr Indones. 2009;49(4):219-23. https://doi.org/10.14238/pi49.4.2009.219-23
Klein HG, Anstee DJ. Mollison's blood transfusion in clinical medicine. 12th ed. West Sussex: Wiley-Blackwell; 2014. https://doi.org/10.1002/9781118689943
Ding Z, Zhang X, Li H. Application of IgG antibody titer and subtype in diagnosis and severity assessment of hemolytic disease of the newborn. Transl Pediatr. 2022;11(9):1544-51. https://doi.org/10.21037/tp-22-385
Kurian R. To study the prevalence of ABO incompatibility in O blood group mothers and assessment of IgG subclasses (IgG1 and IgG3) in them and its correlation with occurrence and severity of ABO hemolytic disease of newborn (ABO HDN) in a tertiary health care centre in South India [dissertation]. Vellore: The Tamil Nadu DR.M.G.R University; 2020.
Kaplan M, Merlob P, Regev R. Israel guidelines for the management of neonatal hyperbilirubinemia and prevention of kernicterus. J Perinatol. 2008;28(6):389-97. https://doi.org/10.1038/jp.2008.20
Goulet DR, Atkins WM. Considerations for the design of antibody-based therapeutics. J Pharm Sci. 2020;109(1):74-103. https://doi.org/10.1016/j.xphs.2019.05.031
Wu Q, Zhang Y, Liu M, Wang B, Liu S, He C. Correlation of Fc(gamma)RIIa (CD32) polymorphism and IgG antibody subclasses in hemolytic disease of newborn. Neonatology. 2009;96(1):1-5. https://doi.org/10.1159/000189239
Haque KM, Rahman M. An unusual case of ABO-haemolytic disease of the newborn. Bangladesh Med Res Counc Bull. 2000;26(2):61-4.
Published
How to Cite
Issue
Section
License
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.
