Immunological principle of development of red blood cell alloimmunization in pregnancy, hemolytic disease of the fetus and prevention of RhD alloimmunization in RhD negative women

Czech version

Authors: L. Roubalová ; M. Lubušký
Authors‘ workplace: Porodnicko‑gynekologická klinika, Lékařská fakulta Univerzity Palackého, Fakultní nemocnice, Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D.
Published in: Ceska Gynekol 2020; 85(6): 408-416
Category: Review Article

Overview

Design: Review article.

Setting: Department of Obstetrics and Gynecology, Palacky University Olomouc, Faculty of Medicine and Dentistry, University Hospital Olomouc.

Methods, results: Every person exposed to a foreign red blood cell antigen (erythrocyte antigen) develops an antibody. If the contact with a foreign erythrocyte antigen occurs during pregnancy, the erythrocyte alloimmunization of the pregnant woman develops and, due to antibodies crossing through the placenta also Haemolytic disease of the foetus and newborn (HDFN) can occur. Antibodies are made by pregnant woman's immune system and their quantity and quality depend on many factors. Their function is to eliminate foetal "foreign" erythrocytes. Ways of elimination of antibody-labelled foetal erythrocytes are the same in the bloodstream of pregnant women and foetuses/newborns and their principle is type II hypersensitivity (cytotoxic), according to the Coombs and Gell classification. Severe forms of HDFN can lead to increased perinatal morbidity and mortality. Prevention of the development of RhD alloimmunization and severe forms of HDFN is based on the administration of polyclonal immunoglobulin (Ig) G anti-D in all potentially sensitizing events. It is assumed that the mechanism of anti-D IgG action is based on the rapid removal of the antigen by antibody overflow, and on antibody mediated immune suppression (AMIS). However, the exact immunological principle is not fully known yet.

Conclusion: This article describes the development of irregular antibodies, methods of foetal erythrocytes destruction and the mechanism of prevention of anti-D immunoglobulin from the immunological point of view.

Keywords:

erythrocyte (red blood cell) alloimmunization – hemolytic disease of the fetus and newborn – antigen "D" – antibody anti-D – type II hypersensitivity – antibody IgG – antibody IgM – RhD alloimmunization – polyclonal immunoglobulin IgG anti-D – AMIS

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