המשך - הריון - ונוגדנים.

ד"ר ציצוביץ שלום רב, לגבי היחס של 1:1 ב c ו e לא התיחסת. הבנתי שהיחס הוא כמעט אפסי, האם זה נכון? האם יש סיכוי שזה ישאר ככה? ואם לא האם יש זריקה שאפשר לתת כמו שנותנים לrh שלילי? (אני אכן קיבלתי גם ערוי דם בתהליך של הפסקת ההריון הקודם כי איבדתי דם רב). כמו כן, אם זה עלול לבוא מבעלי שסוג הדם שלו ab מינוס אז למה לא עושים באופן שיגרתי גם בדיקות דם לגבר?? הרי זה עלול לקרות לכל אחד עם שילוב של מינוס ופלוס ולא רק לבעלי rh מינוס. לא? שוב תודה, אגב, הייתי אצל מיטב הרופאים. שילמתי ממיטב כספי. אני מטופלת אצל הטוב ביותר (פרופ' אייל שיף) ואני סומכת עליו. אבל מכיוון שזה הגוף שלי אני תמיד חוקרת ובודקת ומגלה שזה תמיד כדאי.

אינני יודע האם היחס של 1:1 מבטא את הרמה האמיתית או את הרמה של "הזכרון" של מערכת החיסון ואם תחשפי שוב לאנטיגן E עלולה להיות עליה ניכרת ברמה (כמו זריקת דחף). נותנים אנטי D כדי "ללכוד" כדוריות דם D חיוביות של העובר ולמנוע יצירת נוגדנים אצל האם. זה לא עוזר כאזר יש כבר נוגדנים ואין - למיטה ידיעתי - תכשירים של אנטי E או C. מכל מקום - לך כבר יש נוגדנים. מה משמעותם - אינני יכול להשיב לך, וכדאי לבדוק עם הגינקולוג ואולי עם בנק הדם, אבל אני יודע שקיום נוגדנים אנטי E אצל האם יש לו משמעות. ראי התקציר הבא: Anti-E in pregnancy. Moran P, Robson SC, Reid MM Department of Obstetrics and Gynaecology, Royal Victoria Infirmary, Newcastle upon Tyne, UK. [Medline record in process] Since the introduction of anti-Rhesus (Rh) D prophylaxis for RhD-negative women, other Rh and non-Rh red cell alloantibodies have become relatively more important and are now responsible for the greater proportion of haemolytic disease of the newborn. Anti-C and anti-E are the most commonly implicated non-D Rh antibodies in the pathogenesis of haemolytic disease of the newborn'. In 1977 Pepperell et al. reported the outcome of 44 women with anti-E. This is the only published series that investigates the implications of anti-E during pregnancy. The present report presents a retrospective study of the outcome of 122 pregnancies in which anti-E was the sole alloantibody detected. גם נוגדנים אחרים עלולים לגרום להפרעות: [Hemolytic disease of the newborn and irregular blood group antibodies in the Netherlands: prevalence and morbidity]. [Article in Dutch] van Dijk BA, Hirasing RA, Overbeeke MA TNO Preventie en Gezondheid, divisie Jeugd, Leiden, Amsterdam. OBJECTIVE: To inventory prevalence and morbidity of haemolytic disease of newborn caused by irregular anti-erythrocyte antibodies other than antirhesus-D. DESIGN: Prospective registration study. METHOD: All paediatricians (n = 380) in general hospitals and contact persons (n = 79) in university hospitals were asked for monthly reports of clinical cases of haemolytic disease of newborn during 2 years (1996-1997). RESULTS: Response was 97%. A total of 130 reports were received in two study years, 49 of which could not be confirmed as non-RhD-non-AB0 antagonism. In the group of which the transfusion history was known (n = 60), 29 pregnant women (48%) had received transfused blood at some time. Of the antibodies found, anti-c, anti-E and anti-K were the most frequent. The direct antiglobulin test was positive in 61 of the 81 cases, negative in 10 cases, while in 10 cases it was unknown or false-negative due to earlier intrauterine transfusions (in three neonates). The highest bilirubin levels recorded were 572, 559 and 520 mumol/l (all three with maternal anti-c antagonism). Therapeutic data were known concerning 80 of the 81 newborn: 21 (16%) received no treatment, 24 (29%) only phototherapy and the others--in addition to phototherapy if any--also blood transfusion, exchange transfusion or intrauterine transfusion, or a combination of these. CONCLUSION: It was calculated that the actual prevalence of irregular anti-erythrocyte antibodies in Dutch pregnant women probably amounts to approximately 0.25%. This finding may possibly be confirmed since starting 1 July 1998 all pregnant women in the country are screened for the presence of these antibodies. It is recommended that girls and women in the reproductive age group should receive primary prevention of development of irregular anti-erythrocyte antibodies by application of a selective blood transfusion policy, taking into account the occurrence of the antigens c, E and K *********************************************** Prenat Diagn 1999 Jun;19(6):533-6 Haemolytic disease of the newborn caused by anti-c, anti-E and anti-Fya antibodies: report of five cases. Babinszki A, Berkowitz RL Department of Obstetrics, Gynecology and Reproductive Sciences, Mount Sinai School of Medicine, New York, NY 10029, USA. Fetal haemolytic disease caused by irregular antibodies is discussed on the basis of three cases with maternal anti-c alone, one with anti-E along with anti-c, and one with anti-Fya sensitization. All fetuses suffering from maternal c-allo-immunization alone were treated with intra-uterine transfusions and the newborns received exchange transfusions. These interventions were also required in the case of simultaneous E and c-allo-immunization, and this was the most severe of the five cases. Delta OD450 results were consistent with the severity of the fetal condition in the c and/or E allo-immunization cases. Maternal anti-Fya sensitization caused only mild jaundice of the neonate, but the results of amniotic fluid analysis were quite misleading in that case. Antibody titres did not prove to have good prognostic values (though they were all above the critical level), and the direct antiglobulin test from cord blood was negative in three cases. Regular sonographic evaluations were performed and fetal blood samplings were a cornerstone of management. וסקר אודות שכיחות נוגדנים: Female alloimmunization with antibodies known to cause hemolytic disease. Geifman-Holtzman O, Wojtowycz M, Kosmas E, Artal R Department of Obstetrics and Gynecology, State University of New York Health Science Center, Syracuse, USA. OBJECTIVE: To determine the current frequency of red blood cell antigen alloimmunizations that are capable of causing hemolytic disease and would be suitable for prenatal DNA studies. METHODS: We reviewed blood-bank records at a single large tertiary center to identify patients with a positive antibody screen between January 1993 and June 1995. Data were analyzed based on age, gender, and specific blood-group alloimmunizations. The incidence of antibodies as published in the literature was reviewed and compared with our data. RESULTS: We identified 452 women who had a positive antibody screen. The frequencies of specific alloimmunization relevant to the development of fetal hemolytic disease were: anti-D, 18.4%; anti-E, 14%; anti-c, 5.8%; anti-C, 4.7%; Kell group, 22%; anti-MNS, 4.7%; anti-Fya (Duffy), 5.4%; and anti-Jka, 1.5%. Compared with other populations, in our group the frequency of antibodies to RhD decreased and Kell alloimmunization increased between 1967 and 1996. CONCLUSIONS: Despite the use of rhesus immune globulin, anti-D is still a common antibody identified in women presenting to a tertiary care center. The frequency of the Kell-group alloimmunization is higher among the central New York female population than in other populations. Rhesus and Kell antigen status can be determined by DNA studies. Research in prenatal determination of fetal antigen status should continue, as alloimmunization to these antigens is common.