Correlation between immunoglobulin G anti-A/B titer and neonatal hemolytic disease in pregnant women with O-type blood group from ABO blood group incompatibility couples

国际输血及血液学杂志 Pub Date : 2019-09-20 DOI:10.3760/CMA.J.ISSN.1673-419X.2019.05.009

Jing Li, Yunqing Shen

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Abstract

Objective To investigate the correlation between immunoglobulin (Ig) G anti-A/B titer and neonatal hemolytic disease (HDN) in pregnant women with O blood group from ABO blood group incompatibility couples. Methods From February 2015 to August 2017, a total of 104 pregnant women with O-type and Rh-positive blood group who underwent prenatal blood group antibody test because of couples with ABO blood group incompatibility in the Blood Type Reference Laboratory of Blood Center Shandong Province were selected as subjects. The average age of pregnant women were (26.5±6.8) years. According to gravidity of these pregnant women, they were divided into 3 groups : first pregnancy group (n=31), twice pregnancy group (n=35) and≥3 times pregnancy group (n=38). Micro-column method were performed to detect the ABO blood group of the couples, the Rh blood group and titer of serum IgG anti-A/B of pregnant women. The umbilical vein blood samples of newborns were tested by direct anti-globulin test, free antibody test and antibody elution test. The positive rate of serum IgG anti-A/B in pregnant women, the incidence of ABO-HDN in newborns, as well as the correlation among gravidity, serum IgG anti-A/B titer and incidence of ABO-HDN were calculated, respectively. The age and gestational age of pregnant women among 3 groups were compared by variance analysis. The positive rate of serum IgG anti-A/B of pregnant women among 3 groups, and the incidence of ABO-HDN of newborns among different maternal serum IgG anti-A/B titer, were compared by chi-square test, respectively. And further pairwise comparison of above data used Bonferroni method to adjust the significance level. The correlation among the gravidity maternal, serum IgG anti-A/B titer, and neonatal ABO-HDN incidence were analyzed with Spearman rank correlation analysis. The procedures followed in this study were in accordance with the standards established by the Medical Ethics Committee of Blood Center Shandong Province, and this study was approved by the committee. All the subjects signed the informed consents for clinical trials. Results ① In this study, ABO blood group of all 104 pregnant women were O-type, and Rh blood group were positive. The ABO blood group of their husbands included 41 cases of A-type, 48 cases of B-type and 15 cases of AB-type. The ABO blood group of the newborns included 45 cases of A-type, 50 cases of B-type and 9 cases of O-type. ② Among the 104 pregnant women in this study, the total positive rate of serum IgG anti-A/B was 65.4% (68/104). The positive rates of serum IgG anti-A/B of pregnant women in the first, twice, ≥3 times pregnancy groups were 45.2% (14/31), 65.7% (23/35) and 81.6% (31/38), respectively. The overall difference was statistically significant among the 3 groups (χ2=10.007, P=0.008). The positive rate of serum IgG anti-A/B of pregnant women in the ≥3 times pregnancy group was higher than that of the first pregnancy group, and the difference was statistically significant (χ2=9.981, P=0.002). But there was no significant difference between the first group and ≥3 times pregnancy group (χ2=9.981, P=0.002). ③ Among 104 newborns in this study, the incidence of ABO-HDN was 17.3% (18/104). The incidences of ABO-HDN in newborns of maternal serum IgG anti-A/B titer 0.05). ④ In this study, the gravidity of 104 pregnant women were positively correlated with their serum IgG anti-A/B titers, which were positively correlated with the incidences of ABO-HDN in their newborns, and the maternal serum IgG anti-A/B titers was positively correlated with the incidences of ABO-HDN in their newborns (r=0.423, P=0.035; r=0.473, P=0.031; r=0.491, P=0.021). Conclusions The serum IgG anti-A/B positive rate of O-type blood group pregnant women with multiple pregnancies from ABO blood group incompatibility couples increased, and the risk of ABO-HDN in their newborns was high. Key words: Blood group incompatibility; ABO blood-group system; Pregnant women; Immunoglobulin G; Erythroblastosis, fetal

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ABO血型不合夫妇O型孕妇免疫球蛋白G抗A/B滴度与新生儿溶血病的相关性

目的探讨ABO血型不合的O型孕妇免疫球蛋白(Ig) G抗a /B滴度与新生儿溶血病(HDN)的相关性。方法选取2015年2月至2017年8月在山东省血液中心血型参考实验室因ABO血型不合夫妇接受产前血型抗体检测的o型和rh阳性孕妇104例为研究对象。孕妇平均年龄为(26.5±6.8)岁。根据孕妇的妊娠情况将其分为3组:首次妊娠组(n=31)、两次妊娠组(n=35)和≥3次妊娠组(n=38)。采用微柱法检测夫妇ABO血型、孕妇Rh血型及血清IgG抗a /B滴度。采用直接抗球蛋白试验、游离抗体试验和抗体洗脱试验对新生儿脐静脉血样进行检测。分别计算孕妇血清IgG抗a /B阳性率、新生儿ABO-HDN发生率、妊娠、血清IgG抗a /B滴度与ABO-HDN发生率的相关性。采用方差分析比较三组孕妇的年龄和胎龄。比较三组孕妇血清IgG抗a /B阳性率及不同母体血清IgG抗a /B滴度下新生儿ABO-HDN发生率，采用卡方检验。对以上数据进一步两两比较，采用Bonferroni法调整显著性水平。采用Spearman秩相关分析分析孕妇妊娠、血清IgG抗a /B滴度与新生儿ABO-HDN发生率的相关性。本研究所遵循的程序符合山东省血液中心医学伦理委员会制定的标准，并经该委员会批准。所有受试者均签署了临床试验知情同意书。结果①本组104例孕妇ABO血型均为o型，Rh血型均为阳性。丈夫的ABO血型a型41例，b型48例，ab型15例。新生儿ABO血型a型45例，b型50例，o型9例。②本组104例孕妇血清IgG抗a /B抗体总阳性率为65.4%(68/104)。第一次妊娠组、两次妊娠组、≥3次妊娠组血清IgG抗a /B阳性率分别为45.2%(14/31)、65.7%(23/35)、81.6%(31/38)。三组间总差异有统计学意义(χ2=10.007, P=0.008)。≥3次妊娠组血清IgG抗a /B阳性率高于首次妊娠组，差异有统计学意义(χ2=9.981, P=0.002)。第1次妊娠组与≥3次妊娠组间差异无统计学意义(χ2=9.981, P=0.002)。③本组104例新生儿ABO-HDN发生率为17.3%(18/104)。新生儿ABO-HDN的发生率(母体血清IgG抗a /B滴度0.05)。④本研究发现，104例孕妇的妊娠程度与血清IgG抗a /B滴度呈正相关，血清IgG抗a /B滴度与新生儿ABO-HDN发生率呈正相关(r=0.423, P=0.035;r = 0.473, P = 0.031;r = 0.491, P = 0.021)。结论ABO血型不合夫妇多胎妊娠的o型血孕妇血清IgG抗a /B阳性率增高，新生儿ABO- hdn风险高。关键词:血型不合;ABO血型系统;孕妇;免疫球蛋白G;母红血球病,胎儿

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来源期刊

国际输血及血液学杂志

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发文量

10610

期刊介绍： The International Journal of Transfusion and Hematology was founded in September 1978. It is a comprehensive academic journal in the field of transfusion and hematology, supervised by the National Health Commission and co-sponsored by the Chinese Medical Association, West China Second Hospital of Sichuan University, and the Institute of Transfusion Medicine of the Chinese Academy of Medical Sciences. The journal is a comprehensive academic journal that combines the basic and clinical aspects of transfusion and hematology and is publicly distributed at home and abroad. The International Journal of Transfusion and Hematology mainly reports on the basic and clinical scientific research results and progress in the field of transfusion and hematology, new experiences, new methods, and new technologies in clinical diagnosis and treatment, introduces domestic and foreign research trends, conducts academic exchanges, and promotes the development of basic and clinical research in the field of transfusion and hematology.