Red Blood Cell Alloimmunization in the Pregnant Patient.

Red blood cell alloimmunization prevalence and hemolytic disease of the fetus and newborn in Israel: A retrospective study.

Hyporegenerative anemia in anti-M-associated hemolytic disease of the fetus.

Haemolytic disease of the fetus and newborn (HDFN) is associated with red cell antibodies. Anti-M usually results in a mild haemolysis and is rarely clinically significant. There is no established consensus on management of pregnancies with anti-M. A case of recurrent HDFN with maternal M alloimmunisation was identified at a tertiary hospital in Australia. We collected the patient and neonate's clinical and pathological data and interpreted the case with available literature. This is the first case in literature of recurrent fetal hydrops in the setting of M alloimmunisation. Neonate was delivered in a poor condition, intubated and admitted to the neonatal intensive care unit for ionotropic support, red cell transfusion and plasma transfusion for coagulopathy. Direct Coombs test was positive, confirming HDFN. Although anti-M rarely causes HDFN, accurate history, fetal surveillance and monitoring is essential for identification of fetal anaemia. Concurrent placental disease may increase fetal risk from anti-M antibodies.

https://casereports.bmj.com/content/bmjcr/12/7/e230552.full.pdf

Recurrent fetal hydrops with maternal M alloimmunisation: not a benign condition

Hemolytic disease and reticulocytopenia of the newborn attributable to maternal immunoglobulin G anti‐M reacting optimally at cold temperatures

Objective The objective of this study was to review the management strategies and outcomes in gravidas with anti-M alloimmunization over 15 years. Study Design Data collected from 195 pregnant patients with anti-M antibodies from July 2000 through June 2016 were reviewed retrospectively. We analyzed indirect antiglobulin test titer results, paternal or fetal/neonatal M antigen status, antepartum course, and perinatal outcomes. Results Anti-M antibodies were found in 146 women and 195pregnancies. Among those with positive indirect antiglobulin tests, 193 pregnancies had titers at or below 1:4. Only one patient with an initial low titer experienced a more than twofold increase to a titer 1:64. Two women underwent an amniocentesis and cordocentesis. Ninety-five (73.6%) of the 129 infants tested were positive for the M antigen. Nine infants required phototherapy. There were no cases of hemolytic disease of the fetus or newborn, mild or severe. Conclusion The incidence of severe hemolytic disease of the newborn due to anti-M is extremely low. We found no cases in our review of 195 pregnancies, despite several cases of severe hemolytic disease of the newborn reported in the literature. We have created an algorithm for the management of anti-M antibodies in pregnancy based on our data and extensive literature review.

/pdf/anti-m-alloimmunization-management-and-outcome-at-a-single-1260xehk26.pdf

Anti-M Alloimmunization: Management and Outcome at a Single Institution.

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Anti-M Alloimmunization: Management and Outcome at a Single Institution.