Maternal Antibody in Breast Milk

[Bb_in_the_rain]

Has anybody look in maternal breast milk for IgG antibody in cases of prolonged HDFN? I just come across this article and found it to be very interesting. 

Leonard et al, "Identification of Red Cell Antibody in Maternal Breast Milk Implicated in Prolonged Hemolytic Disease of Fetus and Newborn" 

 

 

Edited May 31, 2019 by Bb_in_the_rain

[Mabel Adams]

I found this article fascinating. 

 

[galvania]

could you post the article????

[Ebb]

 to

Abstract for the Leonard paper published in Transfusion

 

Transfusion. 2019 Apr;59(4):1183-1189. doi: 10.1111/trf.15154. Epub 2019 Feb 5.

Identification of red blood cell antibodies in maternal breast milk implicated in prolonged hemolytic disease of the fetus and newborn.

Leonard A¹, Hittson Boal L¹, Pary P², Mo YD², Jacquot C², Luban NL^1,2, Darbari DS¹, Webb J^1,2.

Author information

Abstract

BACKGROUND: Alloantibodies against more than 50 non-ABO blood group antigens have been implicated in hemolytic disease of the fetus and newborn (HDFN) and are expected to wane within weeks after delivery. Persistent anemia leads to the hypothesis of continued exposure to red blood cell (RBC) alloantibodies via breast milk, which has been shown in a murine model and suggested in rare case reports.

CASE REPORT: We report three cases of prolonged HDFN in two neonates with anti-D HDFN and one with anti-Jk^a HDFN. Patient 1 demonstrated 4+ anti-D serologic testing beyond 2 months; therefore, antibody testing was performed on maternal breast milk.

METHODS: Maternal serum samples were tested for the presence of unexpected antibodies using standard Ortho gel card and 37 °C 60 minutes with anti-human globulin (AHG) tube saline methods. Antibody titrations were performed using the standard 37 °C 60 minutes to AHG tube saline method. Fresh breast milk samples were tested using the standard 37 °C 60 minutes to AHG tube saline method for both unexpected antibodies and titration study. Fresh breast milk from an O-positive, antibody-negative donor was used as control for any reactivity that may have been due to milk solids or proteins alone.

RESULTS: Using a known methodology applied in a novel way to test breast milk for RBC alloantibodies, antibodies against fetal RBCs were identified in the maternal breast milk of three patients.

CONCLUSION: Maternal RBC alloantibodies are present in breast milk and may be clinically significant in patients with prolonged recovery from HDFN.

© 2019 AABB.

[carolyn swickard]

Years ago, when we had a case of a 3rd B baby to an O mommy with high titer IgG anti-B - the OBs would not let her breastfeed her 3rd child because they knew it would contribute to the baby's problem.  With fore knowledge of the problem, Bilirubin light therapy, heavy hydration (I don't know how they did that) and no breast feeding - the 3rd baby did not have to have an exchange transfusion as the 2nd baby had to have.  Interesting case.

I do wonder how the IgG gets from the baby's gut to the RBCs in the baby's circulation though?  Is that a normal process anyway?  Any articles on that?  

 

Edited June 4, 2019 by carolyn swickard
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[Malcolm Needs ☆]

Sorry all; I was supposed to post a paper about this myself, and forgot all about it (mind like a sieve).  I also thought it derived from the Netherlands, but got that wrong too- it was a paper from the USA.  Anyway, it was:

Santhanakrishnan M, Tormey CA, Natarajan P, Liu J, Hendrickson JE.  Clinically significant anti-KEL RBC alloantibodies are transferred by breast milk in a murine model.  Vox Sanguinis 2016; 111: 79-87.  DOI: 10.1111/vox.12387.