Abstract
Objective: to conduct an atomic force microscopy (AFM) study of the red blood cell nanostructure in neonatal infants with ABO and rhesus (Rh) isoimmunization. Subjects and methods. The investigation included 27 neonates, including 13 infants with Rh sensitization and 14 with ABO isoimmunization. The course of pregnancy complicated by Rh sensitization was characterized by the emergence of the blood titers of Rh D antibodies and immunoglobulin G (IgG) subclasses: IgG1, IgG2, and IgG3. IgG production increased at 34 weeks' gestation when all the subclasses were detectable in different titers. There was either Rh or ABO incompatibility between the newborns and their mothers. Differential diagnosis of isoimmunization was made in the pair of an O (I) Rh-negative mother and an A (II) Rh-positive baby. Complete blood count and blood biochemical indicators were estimated; Rh D and IgG antibody titers were determined; red blood cells from 11 neonatal infants were examined using an AFM. The investigation was performed with residual umbilical cord blood and central venous blood during neonatal treatment. Results. Combination therapy for neonatal Rh or ABO isoimmunization terminates a cascade of immunological responses and erythrocyte hemolysis, lowers bilirubin levels, but fails to influence the morphological composition and macrostructure of red blood cell membranes. The consequences of the perinatal effects on the red blood cell membrane persist for a certain time and are outside the early neonatal period.
Highlights
Despite the successes in the study of pathogenesis and clinic of hemolytic disease of a fetus and newborn the studies of immunological interaction of the fetus and the mother remains actual that challenge prevention, diagnos tics and treatment strategies [1, 2].One effective method to prevent the isoimmunisa tion is to inject Rh immuneglobulin to unsensitized Rh negative women
In developed countries they succeed ed to reduce the number of women with Rh sensitization to 0,2 0,1% due to the introduction of Rh immunoglobulin into clinical practice In Russia the number of women with Rh sensitisa tion remains as high as 1.2%, the hemolytic disease occurs in 0.6% of newborns [1,2,3]
Analyzing the nanostructure of red blood cells (RBCs) membranes, we found that the height of the first order (h1) underwent the greatest changes
Summary
Despite the successes in the study of pathogenesis and clinic of hemolytic disease of a fetus and newborn the studies of immunological interaction of the fetus and the mother remains actual that challenge prevention, diagnos tics and treatment strategies [1, 2].One effective method to prevent the isoimmunisa tion is to inject Rh immuneglobulin to unsensitized Rh negative women. In case of rhesus (Rh) sensitization the administration of anti — RhD by Rh negative mothers prevents their primary sensitization by the Rh — positive RBCs of the fetus due to the elimination of the antigen from mother's blood. In developed countries they succeed ed to reduce the number of women with Rh sensitization to 0,2 0,1% due to the introduction of Rh immunoglobulin into clinical practice. The Rh antigen D is the most immunogenic of all the RBC antigens It is responsible for 80% cases of hemolytic disease of fetus and newborn. Due to the high immunogenicity the RhD antigen is of most important for the development of the disease
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