Fetal-maternal incompatibility in the Rh system. Rh isoimmunization associated with hereditary spherocytosis: case presentation and review of the literature.

Bibliographic Details
Title:	Fetal-maternal incompatibility in the Rh system. Rh isoimmunization associated with hereditary spherocytosis: case presentation and review of the literature.
Authors:	Neamţu SD; Department of Anesthesiology and Intensive Care, Prof. Dr. Matei Balş National Institute of Infectious Diseases, Bucharest, Romania; nav29.adela@yahoo.com; Department of Legal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania; lillystanca@yahoo.com., Novac MB, Neamţu AV, Stanca ID, Boldeanu MV, Gluhovschi A, Stanca L, Dijmărescu AL, Manolea MM, Trăistaru MR, Mateescu GO, Siminel MA
Source:	Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie [Rom J Morphol Embryol] 2022 Jan-Mar; Vol. 63 (1), pp. 229-235.
Publication Type:	Journal Article; Review
Language:	English
Journal Info:	Publisher: Editura Academiei Române Country of Publication: Romania NLM ID: 9112454 Publication Model: Print Cited Medium: Internet ISSN: 2066-8279 (Electronic) Linking ISSN: 12200522 NLM ISO Abbreviation: Rom J Morphol Embryol Subsets: MEDLINE
Imprint Name(s):	Original Publication: Bucuresti, România : Editura Academiei Române, [1990-
MeSH Terms:	Rh Isoimmunization/prevention & control , Jaundice , Pregnancy Complications*, Blood Group Incompatibility/complications ; Cesarean Section ; Female ; Hemolysis ; Humans ; Infant ; Infant, Newborn ; Pregnancy
Abstract:	Next to A and B antigens, agglutinogen D exhibits the highest immunogenicity. Following the transfusion of D-positive red blood cells (RBCs), almost 80% of D-negative recipients develop anti-D antibodies (Abs). Subsequently, anti-D immunization further promotes the synthesis of Abs towards other blood group antigens in or outside the Rh system. The D antigen is also involved in 95% of cases of hemolytic disease of the newborn. Transfusions, hemotherapy, grafts, and obstetric history (abortions, ectopic pregnancy, births) are all risk factors for Rh isoimmunization. In the case of ABO compatibility between mother and fetus, Rh-positive fetal RBCs that have reached the maternal bloodstream are not destroyed by group agglutinins, and Rh antigenic sites are not hidden by the maternal immune system. But a Rh-negative mother with a homozygous Rh-positive husband will certainly have a Rh-positive fetus. As it has an irreversible evolution, the Rh isoimmunization once installed cannot be influenced in the sense of decreasing the Ab titer, therefore, injectable globulin has no effect. A particular case was that of a newborn with Rh system incompatibility associated with hereditary spherocytosis The clinical balance at birth reflects the severe jaundice of the female newborn of 3140 g, gestational age 38∕39 weeks, extracted by lower-segment transverse Caesarean section, with a double loop nuchal cord, Apgar score 8. Because the jaundice was severe and atypical (face and upper chest), we considered the possibility of coexistence of hemolytic disease of the newborn by Rh blood group incompatibility associated with hereditary spherocytosis, as it turned out to be true and mentioned. Changes in genes encoding proteins in the structure of the RBC membrane have amplified hemolysis induced by maternal-fetal isoimmunization in the Rh system. Massive hemolysis accentuated by congenital spherocytosis, confirmed later, imposed blood transfusion and dynamic monitoring.
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Entry Date(s):	Date Created: 20220908 Date Completed: 20220912 Latest Revision: 20250728
Update Code:	20260130
PubMed Central ID:	PMC9593129
DOI:	10.47162/RJME.63.1.26
PMID:	36074689
Database:	MEDLINE

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ISSN:	2066-8279
DOI:	10.47162/RJME.63.1.26