PERINATAL HEMOLYTIC DISEASE: CURRENT ASPECTS
Keywords:
anemia, congenital haemolytic, prenatal diagnosis, erythroblastosis, fetal, Rh alloimmunizationAbstract
Fol!owing the introduction and broad avai!ability of anti-D immunoprophylaxis, there was an evident decline in the alloimmunization incidence of the women at risk in developed countries. However, the incidence rates have remained relatively stable over the /ast years, contributing in a significant manner for perinatal morbidity and mortality and remaining a challenge for fetomaternal medicine. The hemolytic disease of the fetus and the newborn is characterized by different degrees of fetal anemia, with neurological and psychomotor sequelae, hydrops fetalis and fetal death. Nane of the available prenatal diagnostic methods are strong indicators of per/natal prognoses for pregnancies complicated by perinatal hemolytic disease. lntrauterine transfusion is the only specific treatment available in the prenatal period. Mortality rate is about 16% for non-hydropic fetuses and 58% for hydropic ones. The fetal RhD typing can identify fetuses at risk for hemolytic disease of the fetus and the newborn, and can actually be obtained at the molecular levei. This article proposes a review of some aspects of the hemolytic disease of the fetus and the newborn, as a brief history, pathophysiology, diagnostic and therapeutic approaches and actual advances, focused on molecular biology tests.
Downloads
References
Diamond LK, Blackfan KD, Baty JM. Erythroblastosis fetalis and its association with universal edema of the fetus, icterus gravis neonatorum and anemia of the newborn. J Pediatr. 1932; 1:269-309.
Adams MM, Marks JS, Gustafson J, Oakley Jr GP. Rh hemolytic disease of the newborn: using incidence observations to evaluate the use of Rh immune globulin. Am J Public Health. 1981; 71:1031-5.
Urbaniak SJ. Consensus conference on anti-D prophylaxis, April 7 and 8, 1997: final consensus statement. Royal College of Physicians of Edinburg/ Royal College of Obstetrician and Gynecologists. Transfusion. 1998; 38:97-9.
Trolle B. Prenatal Rh-immune prophylaxis with 300mg immune globulin anti-D in the 28th week of pregnancy. Acta Obstet Gynecol Scand 1989; 68:45-7.
Wenk RE, Goldstein P, Felix JK. Keil alloimmunization, hemolytic disease of the newborn and perinatal management. Obstet Gynecol. 1985; 66:473-6.
Moise Jr KJ. Management of Rhesus Alloimmunization in Pregnancy. Obstet Gynecol. 2002; 100:600-11.
Agre P, Cartron J-P. Molecular biology of the Rh Antigens. Blood. 1991; 78:551-63.
Howard H, Martlew V, McFadyen 1, Martlew W, McFadgen 1, Clarke C, et ai. Consequences for fetus and neonate of maternal red cell alloimmunisation. Arch Dis Child. 1998; 78:62-6.
Urbaniak SJ, Greiss MA. RhD haemolytic disease of the fetus and the newborn. Blood Rev. 2000; 14:44-61.
O. Lambin P, Debbia M, Puillandre P, Brossard Y lgG1 and lgG3 anti-D in maternal serum and on the RBCs of infants suffering from HDN: relationship with the severity of the disease. Transfusion. 2002; 42:1537-46.
Contreras M. The prevention of Rh haemolytic of the fetus and newborn: general background. Br J Obstet Gynaecol. 1998; 105(Suppl 18):7-10.
Ulm B, Svolba G, Ulm MR, Bernaschek G, Panzer S. Male fetuses are particularly affected by maternal alloimmunization to D antigen. Transfusion. 1999; 39:169-73.
Cannon M, Jones PB, Murray RM. Obstetric complications and schizophrenia: historical and meta-analysis review. Am J Psychiatry. 2002; 159:1080-92.
ACOG- American College of Obstetricians and Gynecologists. Prevention RhD alloimmunization. ACOG Practice bulletin no. 4. Washington (DC): American College of Obstetrician and Gynecologists; 1999.
Bowman JM, Chown B, Lewis M. Rh isoimmunization during pregnancy: antenatal prophylaxis. Can Med Assoe J. 1978; 118:623-7.
Mari G. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. N Engl J Med. 2000; 342: 9-14.
Sikovanyecz J, Horváth E, Sallay É, Gellén J, Pál A, Szabó J. Fetomaternal transfusion and pregnancy outcome after cordocentesis. Fetal Diagn Ther. 2001; 16:83-9.
Tannirandorn Y, Rodeck CH. New approaches in the treatment of haemolytic disease of the fetus. Baillieres Best Pract Res Clin Haematol. 1990; 3:289-320.
Bowman JM. Antenatal suppression of Rh alloimmunization. Clin Obstet Obstet Gynecol. 1991; 34:296-303.
Poissonnier MH, Brossard Y, Demedeiros N, Vassileva J, Parnet F, Larsen M, et ai. Two hundred intrauterine exchange transfusions in severe blood incompatibilities. Am J Obstet Gyneco. 1989; 161:709-13.
Schumacher B, Moise Jr KJ. Fetal transfusion for red blood cell alloimmunization in pregnancy. Obstet Gynecol. 1996; 88 137-50.
Cabral ACV, Taveira MR, Lopes APBM, Pereira AK, Leite HV. Transfusão intra-uterina na isoimunização materna pelo fator Rh. RBGO. 2001; 23:299-303.
Lo YMD. Fetal RhD genotyping from maternal plasma. Ann Med. 1999; 31:308-12.
Aubin JT, Le Van Kim C, Mouro 1, Colin Y, Bignozzi C, Brossard, et ai. Specificity and sensitivity of RHD genotyping methods by PCR-based DNA amplification. Br J Haematol. 1997; 98:356-64.
Crombach G, Niederacher D, Larbig D, Picard F, Tutschek B, Beckmann M, et ai. Reliability and clinicai application of fetal RhD genotyping with two different fluorescent duplex polymerase chain reaction assays: Three years' experience. Am J Obstet Gynecol. 1999; 180:435-40.
Bianchi DW, Zickwolf GK, Weil GJ, Sylvester S, DeMaria MA. Male fetal progenitor cells persist in maternal blood for as long as 27 years postpartum. Proc Natl Acad USA. 1996; 93:705-8.
Lo YMD, Corbetta N, Chamberlain PF, Rai V, Sargent IL, Redman CWG, et ai. Presence of fetal DNA in maternal plasma and serum. Lancet. 1997; 350:485-7.
Faas BHW, Beuling EA, Christiaens GCML, von dem Borne AEGKr, van der Schoot CE. Detection of fetal RHD-specific sequence in maternal plasma. Lancet. 1998; 352 1196.
Lo YMD, Tein MSC, Lau TK, Haines CJ, Leung TN, Poon PMK, et ai. Quantitative analysis of fetal DNA in maternal plasma and serum: implications for noninvasive prenatal diagnosis. Am J Hum Genet. 1998; 62:768-75.
Nelson M, Eagle C, Langshaw M, Popp H, Kronenberg H. Genotyping fetal DNA by non-invasive means: extraction from maternal plasma. Vox Sang. 2001; 80:112-6.
Benachi A, Steffann J, Gautier E, Ernault P, Olivi M, Dumez Y, et ai. Fetal DNA in maternal serum: does it persist after pregnancy? Hum Genet. 2003; 113:76-9.
Machado IN, Rios M, Pellegrino Jr J, Barini R, Castilho L. Fetal RHD genotyping by analysis of maternal plasma at early gestational ages. Rev Bras Hematol Hemoter. 2003; 25(Suppl 2):223.
