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Re: Auntie Em! Auntie Em!From: T-H Bui, Clinical Genetics, Karolinska Hospital (bui@gen.ks.se)Fri Apr 12 03:27:03 1996
At 15.25 1996-04-11 -0500, Gary Kleinman wrote: >My partner says that @ the recent SPO, a convincing paper concluded that >one doesnt have to worry about severe isoimmunization with Anti - M. > >I found references on Medline of cases of severe hemolytic disease of the >newborn from Anti - M. > > Duguid, et al Vox Sanguinis 1995;68(3):195 > Furukawa, et al. Experimental and Clinical Immugenetics 199310(3):161 > >("Now that's a horse of a different color!) I dont have easy access to >these journals. > >Are high titers of Anti - M in a gravida with an M positive partner >concerning, or not? Gary, It is of some concern (I know of one proven case at this hospital). What is the obstetric history of this patient? The MNSs blood group system seldom gives rise to HDN, or to transfusion reactions. Because anti-M antibodies may consist of only immunoglobulin M (IgM) they may not be offensive to the fetus. However, in many cases there are an IgG component that may give rise to HDN or very rarely even fetal death. The spectrum of findings were well discussed by Thompson et al. (Anti-M antibody in pregnancy. Obstet Gynecol Surv 44(9): 637-41, 1989). The question is therefore if anti-M found in your pregnant patient has an IgG component optimally reactive at 37 degrees C. If so the fetus may be at risk. To my knowlegde, there is no documented knowledge that titers of anti-M predict severity of disease. Thus, serial antibody titers are not reliable. I would suggest that amniotic fluid bilirubin studies should be done, or at least serial US-scans should be performed, maybe using the Doppler indices for fetal anemia discussed previously in this forum. After birth the baby's MN antigen status should be analysed. A negative direct Coombs' test may be found in the presence of anti-M and hemolysis. The-Hung Bui, MD Associate Head Director Fetal Diagnosis Program Dept. of Clinical Genetics, Karolinska Hospital, S-171 76 Stockholm, Sweden Consultant Obstetrician-Gynecologist (Fetal Medicine) Dept. of OB&GYN, Huddinge University Hospital, Karolinska Institute, S-141 86 Huddinge, Sweden phone: +46 8 729 4989 (office) or 729 2472 (secretary) fax: +46 8 32 77 34; e-mail: bui@gen.ks.se
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