19 Maternal Alloimmunization and Hemolytic Disease: Italian and Foreign Immigrants Newborns

Abstract

The aim of this work is to present 40 newborns affected by alloimmunization: 26 Italians (0.18%) and 14 foreign immigrants (0.56%). 23 of them had anti D antibodies, 10 anti D+C, 1 anti D+C+E, 4 anti c, 1 anti jka, 1 anti Kell. 12 italians newborns had anti D antibodies, 7 anti D+C, 1 anti D+C+E, 4 anti c, 1 anti Kell, 1 anti jka. 11 foreign immigrants newborns had anti D antibodies, 3 anti D+C. Exchange tranfusion (ET), immunoglobulin infusion, phototerapy, and red cell transfusion (T) were performed depending on the severity of the immunization. Italian women direct Coombs' titer was 1/64. A titer >1/8000 was found only in foreign immigrants women. 9 patients required fetal transfusions (FT). Mean gestational age was 36.2 weeks, mean neonatal weight was 2795 grams. Mean hemoglobin at birth was 14.2 g/dl. Mean hematocrit was 41.6% 15 newborns received 1 ET. Greatest bilirubin value was 39 mg/dl. After discharge blood samples were collected every 3 weeks for hemoglobin, hematocrit, reticulocyte count and direct Coombs test. All the patients presented regular neurologic development and growth. 15 newborns required at least 1 T. According to our experience,a newborn requires FT if Coombs' titer of yhe mother at birth is >1/256, ET if it is >1/128, T if it is >1/128. It was always performed one of them if the titer was >1/2048. Because a increasing number of foreign immigrants, the incidence of Rh isoimmunization is raising. Foreign immigrants newborns developed the majority of alloimmunization because of the lack of maternal prophylaxis, with highest titers and most severe illnesses. It would be important to create an international screening and prophylaxis program in order to obtain again an reduction of Rh isoimmunization and to avoid fetal death and severe handicap.