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Hi All I'm looking for some stats on cases of ABO HDFN requiring intervention either in utero (IUT) or in the immediate postnatal period (exchange transfusion) to include both normal conceived pregnancy and pregnancy by assisted reproductive technology (donor egg and donor sperm). I'm writing up a case report for submission to a fertility journal on ABO HDFN in a donor egg pregnancy: A case of increased severity due to double A antigen expression. I have the paper almost complete except for the background section on ABO HDFN. Thanks in advance. John Quigley
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Mrs X Para 2+1 with dichorionic diamniotic twins. Anti-D+G present Anti-D quantitation levels at 13+2 and 29+3 weeks were 21IU/mL-1 and 330IU/mL-1 respectively. Mum O RhD Positive rr, Dad A Rh D Positive R2Ro Twin 1: A RhD Positive DAT 4+, did not go over 1.5MoMs on middle cerebral artery Doppler peak systolic velocity surveillance and did NOT require IUT. Postnatally only required top up Tx’s Twin 2: O RhD Positive R2r DAT 4+. required three intrauterine transfusions. Postnatally required Exchange Tx, IVIg and phototx and serial top-ups Although both twins in this case were RhD positive only one was severely affected. What are the possible reasons / theories to explain this disparity? According to Mollison there are 3 circumstances the fetus may be unaffected or only mildly affected despite a strong positive result in a cellular bioassay. These are: 1. Fetus Rh D Negative 2. Presence of Fc receptor blocking antibodies 3. Diminished transport of maternal IgG to the fetus Are there any other suggestions theories or advice?
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So the other day, I had an interesting question from a neonatologist. Her question (and I am summarizing, not directly quoting) was in regards to a microscopically positive DAT and if there is less antibody present. Her concern was how aggressively she needed to treat the baby, because the baby was jaundiced at less than 12 hours. Mom was O pos, baby A pos, and had microscopically positive DAT. So there was some ABO incompatibility I wasn't completely sure how to explain this, but my co-worker said there was a smaller fetal bleed. Today, I was reading a text that stated "the strength of the reaction does not correlate well with the severity of the HDN." The text was Modern Blood Banking & Transfusion Practices, 5th edition, by Denise Harmening, page 389. So in your experience, does the strength of a reaction correlate with the severity of a fetomaternal hemorrhage? How should I explain this in the future? Thanks y'all. -
Dear All I am writing a paper and I am finding difficulty sourcing a reference for the following statement I am making in the paper. I know I have read it somewhere but for some reason I cannot find it now Background: once an Intrauterine transfusion has happened, the transfusion procedure itself is known to increase antibody levels. Therefore carrying out serial quantitations post IUT are unnecessary as the patient will be closely monitored by MCA Doppler US. Best wishes John
