Vox Sang. 34: 241-243 (1978)

Maternofetal Transfusion during Delivery and Sensitization of the Newborn against the Rhesus D-Antigen

E . Carapella-de Luca, A . M . Casadei, R . Pascone, C . Tardi and C . Pacioni Istituto Puericultura, Universith di Roma, Roma

Abstract. The presence of maternal cells was determined in a blood sample of 86 rhesus D-negative newborns with a rhesus D-positive mother using the ‘minor cell population techni- que’ of Jones and Silver. Maternal cells were found in 43% of the samples, irrespective of ABO incompatibility. Anti-D antibodies were detected in 22.2% of serum samples from 53 children taken at 6-10 months after birth. There was no correlation between the presence of anti-D and the results of the minor cell population technique at birth. The results are discussed.

Introduction Methods

in 11 % of such cases using automated anti- body detection.

We had the opportunity to investigate the presence of maternal red cells in a blood sample taken during the first 3 days of life of 86 D-negative infants with D-positive mothers. The serum of 53 of these children could be examined for the presence of anti-D antibodies 6-10 months after birth. The re- sults are reported here.

Results

In table1 the results are shown of the minor cell population technique applied to the blood of the 86 newborns. Maternal red cells were detected in 47 of the samples. 11.9% of the infants in whose blood such cells were found, were ABO incompatible for the mother. In the negative cases there

242 Carapella-de Luca/Casadei/Pascone/Tardi/Pacioni

Table I. Results of the minor cell population technique in rhesus D-negative newborn infants from rhesus D-positive mothers

Number Results ABO incompati- of subjects bility examined

86 positive 41 7 (14.9%) negative 39 11 (28.2%)

Table II. Detection of anti-D antibodies at 6-10 months in rhesus D-negative children from rhesus D-positive mothers

Number of Number of positive subjects tested '-stage 2-stage IAGT total

papain bromelin _ _ _ _ _ _ ~

28 0 6 1 8 6 25 a 0 5 1 6

53 0 11 2 12 (22.2 Yo)

Minor cell population test positive. Minor cell population test negative. Also positive in the bromelin test.

a *

was fetomaternal ABO incompatibility in 28.5%. The difference is not significant.

In table11 it is shown that anti-D anti- bodies were detectable in the serum of 2 out of 53 children with the indirect anti- globulin test (IAGT). In the serum of 11 children anti-D was detectable by the 2- stage bromelin test. One of these sera was also positive in the IAGT. The 2-stage papain test was always negative. It is clear that there is no relation between these serological results and the fact whether maternal red cells were detectable in the child's blood or not.

Discussion

From these results it may be concluded that by the minor cell population technique of Jones and Silver [6], maternal red cells can be detected in a high percentage of new- borns. In our hands, this technique detects 1 foreign cell in 10,000 cells and not 1 in 100,000 cells as reported by Jones and Sil- ver. That no significant correlation was found between the percentage of positive cases and fetomaternal ABO incompatibility was ac- cording to expectation, as also in our ex- perience, alloantibodies anti-A or -B are usually not detectable during the first 3 days of life. The percentage of cases in which we found anti-D antibodies is higher than that reported by either Hindemann (5%) or Bowen and Renfield (11%). This may be due to a greater sensitivity of the 2-stage bromelin test as compared to the methods used by these investigators, i.e., multiple dose technique and an automated method described by Lalezari [7], respectively.

It is also possible that the higher fre- quency is due to the optimal moment of testing, i.e. at 6-10 months, while Hinde- mann took all his samples at 6 months and Bowen and Renfield at 1-9 months. It is curious that the 2-stage papain method gave negative results in all cases (confirmed sev- eral times).

In the results there is no relation between the outcome of the minor cell population technique and the detection of anti-D anti- bodies. This may mean that the minor cell population technique is very insensitive. It may, however, also mean that in many cases the maternofetal transfusion takes place be- fore birth. The fact that Bowen and Ren- field [2] found anti-D already 1-3 months after birth in several cases may also point to

Maternofetal Transfusion during Delivery 243

maternofetal transfusion during pregnancy as in cases of weak sensitization against the D-antigen the lapse between the introduc- tion of the antigen and the appearance of antibody is usually much longer even in adults with a mature immunocompetent sys- tem.

Our findings confirm the possible signif- icance of immunization against the D-anti- gen after birth for the immunization of rhe- sus D-negative women during the first preg- nancy.

References

1 Beer, A.E. and Billingham, R.E.: Immuno- logic coexistence in the maternal-fetal relation- ship; in Gluck, Modern perinatal medicine (Yearbook, Chicago 1974).

2 Bowen, F. W., jr. and Renfield, M.: The detec- tion of anti-D in Rho (D)-negative infants born of Rho (D)-positive mothers. Pediat. Res. 10: 213-215 (1976).

3 Hindemann, P.: Maternofetal transfusion dur- ing delivery and Rh-sensitisation of the new- born. Lancet i: 46 (1973).

4 Hindemann, P.: Untersuchungen zur Rhesus- immunisierung des Neugeborenen durch ma- terno-fetaleTransfusion; in Schneider und Weit- zel, Prophylaxe der Rhesussensibilisierung (Me- dizinische Verlagsgesellschaft, MarburgILahn 1974).

5 Hughes-Jones, N. C.; Polley, M. J.; Telford, R.; Gardner, B., and Kleinschmidt, G.: Optimal conditions for detecting blood group antibodies by the antiglobulin test. Vox Sang. 9: 385 (1964).

6 Jones, A. R. and Silver, S.: The detection of minor erythrocyte populations by mixed ag- glutinates. Blood 13: 763 (1958).

7 Lalezari, P.: A new method for the detection of red blood cell antibodies. Transfusion 8: 372 (1968).

Received: May 28, 1977 Accepted: July 7, 1977

E. Carapella-de Luca, Istituto Puericultura, Universiti di Roma, Roma (Italy)