Document Type : Case Report

Authors

1 Shenzhen Institute of Transfusion Medicine, Shenzhen Blood Center, Shenzhen, Guangdong, China.

2 Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China.

3 R&D Division, Shenzhen Ritzcon Biological Technology Co., Ltd., Shenzhen, Guangdong, P.R.China.

4 Guangdong Key Laboratory for Research and Development of Natural Drugs, Department of Pharmacology, Marine Medicine Research Institute, Guangdong Medical University, Zhanjiang, Guangdong, P.R.China.

5 Department of Biomedical Sciences, City University of Hong Kong, Hong Kong SAR, China. R&D Division, Shenzhen Ritzcon Biological Technology Co., Ltd., Shenzhen, Guangdong, P.R.China. Centre for Regenerative Medicine and Health, Hong Kong Institute of Science & Innovation, Chinese Academy of Sciences, Hong Kong SAR, P.R.China.

Abstract

Several cases of the hemolytic disease of the fetus and newborn (HDFN) caused by immunoglobulin G (IgG) anti-M antibodies have been reported, in which almost all the HDFN-associated anti-M were warmly reacting. Here we report two cases of severe HDFN associated with cold-reacting IgG anti-M. In both cases, pregnancy was terminated, in weeks 33 and 23 respectively, due to a diagnosis of fetal growth retardation (FGR). To our knowledge, these are the most severe HDFN cases caused by cold-reacting IgG anti-M.

Keywords

  1. Levine P, Pollack W. Hemolytic disease of the fetus and newborn. Med Clin North Am. 1965; 49:1647-60.
  2. de Haas M, Thurik FF, Koelewijn JM, et al. Haemolytic disease of the fetus and newborn. Vox Sang. 2015; 109(2):99-113.
  3. Egbor M, Knott P, Bhide A. Red-cell and platelet alloimmunisation in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2012; 26(1):119-32.
  4. 4. Abbasi N, Johnson J, Ryan G. Fetal anemia. Ultrasound Obstet Gynecol. 2017; 50:145-53.
  5. 5. Prefumo F, Fichera A, Fratelli N, Sartori E. Fetal anemia: Diagnosis and management. Best Pract Res Clin Obstetr Gynaecol. 2019; 58:2-14.
  6. 6. Ghesquière L, Garabedian C, Coulon C, Verpillat P, Rakza T, Wibaut B, et al. Management of red blood cell alloimmunization in pregnancy. J Gynecol Obstetr Hum Reprod. 2018; 47:197-204.
  7. 7. Yasuda H, Ohto H, Nollet KE, Kawabata K, Saito S, Yagi Y, et al. Hemolytic disease of the fetus and newborn with late-onset anemia due to anti-M: a case report and review of the Japanese literature. Transfus Med Rev. 2014; 28:1-6.
  8. Armstrong B, Smart E. Haemolytic diseases. ISBT Science Series 2008;3:93-109.
  9. 9. Heathcote DJ, Carroll TE, Flower RL. Sixty years of antibodies to MNS system hybrid glycophorins: what have we learned? Transfus Med Rev. 2011; 25:111-24.
  10. Habibi B, Bretagne M, Bretagne Y, et al. Blood group antigens on fetal red cells obtained by umbilical vein puncture under ultrasound guidance: a rapid hemagglutination test to check for contamination with maternal blood. Pediatr Res. 1986; 20(11):1082-4.
  11. Xu P, Li Y, Yu H. Prevalence, specificity and risk of red blood cell alloantibodies among hospitalised Hubei Han Chinese patients. Blood Transfus. 2014; 12(1):56-60.
  12. 12. Makroo RN, Arora B, Bhatia A, Chowdhry M, Luka RN. Clinical significance of antibody specificities to M, N and Lewis blood group system. Asian J Transfus Sci. 2014; 8:96.
  13. 13. Wikman A, Edner A, Gryfelt G, Jonsson B, Henter JI. Fetal hemolytic anemia and intrauterine death caused by anti-M immunization. Transfusion. 2007; 47:911-7.
  14. 14. Ishida A, Ohto H, Yasuda H, Negishi Y, Tsuiki H, Arakawa T, et al. Anti-M antibody induced prolonged anemia following hemolytic disease of the newborn due to erythropoietic suppression in 2 siblings. J Pediatr Hematol Oncol. 2015; 37:e375-e7.
  15. 15. Stetson B, Scrape S, Markham KB. Anti-M alloimmunization: management and outcome at a single institution. Am J Perinatol Rep. 2017; 7:e205-e10.
  16. 16. Philip J, Kushwaha N, Jain N. Report of two cases of anti-M antibody in antenatal patients. Asian J Transfus Sci. 2015; 9:89.
  17. 17. Parsh BS. Hemolytic disease of the newborn due to anti S antibodies. J Natl Med Assoc. 2000; 92:91.

 

  1. Li S, He Z, Luo Y, et al. Distribution of maternal red cell antibodies and the risk of severe alloimmune haemolytic disease of the foetus in a Chinese population: a cohort study on prenatal management. BMC Pregnancy Childbirth. 2020; 20(1):539.
  2. Yudin J, Heddle NM. A 13-question approach to resolving serological discrepancies in the transfusion medicine laboratory. Lab Med. 2014;45(3):193-206.
  3. Smith ML, Beck ML. The immunoglobulin structure of human anti-M agglutinins. Transfusion. 1979; 19(4):472-4.
  4. Duro EA, Desalvo L, Kuret S. Severe hemolytic disease of the newborn caused by anti-m antibodies. Iranian J Pediatr. 2013; 23:607-8.
  5. Mohd Nazri H, Noor Haslina MN, Shafini MY, et al. Anti-M induced severe haemolytic disease of foetus and newborn in a Malay woman with recurrent pregnancy loss. Malays J Pathol. 2017; 39(1):73-6.
  6. 23. Andersen LH, Jacob EK, McThenia SS, Tauscher CD, Patterson ER, Oliveira JL, et al. Hemolytic disease and reticulocytopenia of the newborn attributable to maternal immunoglobulin G anti‐M reacting optimally at cold temperatures. Transfusion. 2021; 61:974-8.
  7. Crispin P, Sliwinski K, Wilson C, et al. Cold reacting anti-M causing delayed hemolytic disease of the newborn. Transfusion. 2019; 59(12):3575-9.
  8. Gao XY, Huang H, Li LD. Hemolytic disease of neonates due to anti-M: report of one case and review of reports of 21 cases. Zhonghua Er Ke Za Zhi. 2009; 47(9):648-52.
  9. Bajic G, Degn SE, Thiel S, et al. Complement activation, regulation, and molecular basis for complement-related diseases. EMBO J. 2015; 34(22):2735-57.