Prevalence of alloantibodies associated with haemolytic disease of the fetus and newborn in pregnant women at the Ekiti State University Teaching Hospital, Ado-Ekiti, Southwest Nigeria

Ayodeji O. Olayanju, Nyong I. Chris, Adams E. Emmanuel, Akinloye B. Oyetunde, Kosamat Y. Adebisi, Chisara S. Okolo

Abstract

Haemolytic disease of the fetus and newborn (HDFN) is caused by maternal alloimmunization against red blood cell antigens, which could result in fetal anaemia, hyperbilirubinaemia, kernicterus, and death. This study was designed to determine the prevalence of alloantibodies against erythrocyte antigens in blood samples of pregnant women during the first trimester which may cause HDFN. A total of 123 consenting pregnant women attending the antenatal clinic of Ekiti state University Teaching Hospital, Ado Ekiti participated in the study which lasted three months. The participants were within the ages of 16 to 45 years old across the major ethnic group in Nigeria. ABO/Rh typing, screening and identification of red blood cell alloantibodies were carried out using standard protocols. 15 (12.2%) subjects had detectable antibodies known to cause haemolytic disease of the fetus and newborn (HDFN). The specificity of the antibodies was as follows: anti-K (5, 33%), anti-k (3, 20%), anti- Jsa (2, 13%), anti-C. (3, 20%), and anti-E (2, 13 %). Based on ethnicity, the prevalence of Kell antibodies was highly significant among the Yorubas as well as anti-C and anti-E. The observation was similar in the Igbo and Hausa groups. There is a need to determine these antibodies and monitor their titre in pregnant women to manage or prevent the morbidity and mortality associated with HDFN during routine antenatal care.

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Shanthala AM, Vanamala AA, Sitalakshmi KR and Rita M. Red blood cell antibody screening in pregnancy. Asian Journal Transfusion Science. 2011; Vol .5 (1): 56.

Weinstein L. Irregular antibodies causing hemolytic disease of the newborn: a continuing problem. Clin Obstet Gynecol 1982; 25:321

Zaccheaus J, Augustina M, Fiekumo IB and Teddy CA. Frequencies of Maternal red blood cell alloantibodies in Port Harcourt, Nigeria. Asian J Transfus Sci 2011; 5: 39 – 41.

Jeremiah ZA, Biribo AA, Adias TC and Uko EK. Uncommon Rh Phenotypes in a Cross Section of Nigerian Antenatal Women: Implications for Molecular Genotyping of Blood Groups 2012; J Blood Disord Transfus S10:001. doi:10.4172/2155-9864.S10-00.

Karamatic CV, Tilley LA, Satchwell TJ, AlSubhi SA, Jones B, Spring FA, Walser PJ Martins Freire C, Murciano N, Rotordam MG, Woestmann SJ, Hamed M, Alradwan R, AlKhrousey M, Skidmore I, Lewis S, Hussain S, Jackson J, Latham T, Kilby MD, Lester W, Becker N, Rapedius M, Toye AM and Thornton NM. Missense mutations in PIEZO1, encoding the Piezo1 mechanosensor protein, define the Er red blood cell antigens. Blood. 2022 Sep 19: blood.2022016504. doi: 10.1182/blood.2022016504. Epub ahead of print. PMID: 36122374.

Naje AA and Abbas HA. Red blood cell alloimmunization among Saudi Pregnant women in the central province of Saudi Arabia. Kuwait Med J; 2008; 40:116–23.

Soumya Das. Hemolytic Disease of the Fetus and Newborn 2019; In (Ed.), Blood Groups. IntechOpen. https://doi.org/10.5772/intechopen.85316.

Eneh AU and Orumabo RS. Neonatal jaundice in a special care baby unit (SCBU) in Port Harcourt in Nigeria. A prospective study. Port Harcourt Med J. 2008; 2: 110 – 7.

Smith HM, Shirey RS, Thoman SK and Jackson JB. Prevalence of clinically significant red blood cell alloantibodies in pregnant women folk at a large tertiary-care facility 2013. Immunohematology, 29 ( 4 ) : 127 – 30 . DOI: https://doi.org/10.21307/immunohematology-2019-134

Filbey D, Hanson U and Wesstrom G. The prevalence of red cell antibodies correlated to the outcome of the newborn. A 12year study in central Sweden. Acta Obstet Gynecol Scand. 1995; 74:687-92.

Koelewijn JM, Vrijkotte TG and Vander-Schoot CE. Effect of screening for red cell antibodies, other than anti-D, to detect hemolytic disease of the fetus and newborn: a population study in the Netherlands. Transfusion. 2008; 48: 941–52.

Garg P and Gogia S. Reducing neonatal mortality in developing countries: low-cost interventions are the key determinants. J Perinatol 2009; 29, 74–75. https://doi.org/10.1038/jp.2008.123.

Islam MA, Butt ZA and Sathi NJ. Prevalence of Neonatal Mortality and its Associated Factors: A Meta-analysis of Demographic and Health Survey Data from 21 Developing Countries. Dr. Sulaiman Al Habib Med J 2022; 4, 145–152. https://doi.org/10.1007/s44229-022-00013-y

Slavica D, Srđana Č, Vedran S and Jelena L. Relationship between previous maternal transfusions and haemolytic disease of the foetus and newborn mediated by non-RhD antibodies. Blood Transfus. 2013; 11(4): 528–532.

Randriamanantany ZA, Rajaonatahina DH, Razafimanantsoa FE, Rasamindrakotroka MT, Andriamaheninav R and Rasoarilalamanarivo FB. Phenotypic and allelic profile of ABO and Rh D blood group system among blood donor inAntananarivo. Int J Immunogenet. 2012; 39(6):477–9.

Loua A, Lamah MR, Haba NY and Camara M. Frequency of blood groups ABO and Rh D in the Guinean population. Transfus Clin Biol. 2007; 14 ( 5) :435- 9. Doi: 10.1016/j.tracil.2007.12.008.

Chima OK, Mohammed TB, Aisha KG, Alhaji SA, Muhammad BM and Kwaru AH. ABO and Rhs among blood donors in Kano, North-Western Nigeria 2012; Niger J Basic Clin Sci; 9:11-3. DOI: 10.4103/0331-8540.102105.

Mukhtar IG and Abdulkadir AY. Frequencies of ABO and Rh (D) blood group phenotypes among pregnant women attending antenatal clinic at Murtala Muhammad Specialist Hospital, Kano, Nigeria 2019; J Med Trop; 21:31-6. DOI: 10.4103/jomt.jomt_4_19.

Anifowoshe AT, Owolodun OA, Akinseye KM, Iyila OA and Oyeyemi BF. Gene frequencies of ABO and Rh in Nigeria: a review. Egypt J Med Hum Genet 1990; 18:205-10. http://dx.doi.org/10.1016/j.ejmhg.2016.10.004.

Ahmed A, Singh J, Khan Y, Seshan SV and Girardi G. A new mouse model to explore therapies for preeclampsia 2010; PLoS One 5 (10):13663.

Ellis SA. HLA- G: at the interface. American Journal of Reproductive Immunology 1990; 23: 84 – 86.

Omar SA, Alaesh JS and Algadeeb KB. Delayed Haemolytic Transfusion Reaction in a patient with Sickle Cell Disease: Case Report 2020; Vol. 2020: 13 pg 307- 311.

Gregor B, Britta R, Wiebke S, Dorothea S, Stephaine P and Daniel F. Targeted antenatal anti – D prophylaxis for RhD- negative pregnant women: systematic review. BMC Pregnancy and Childbirth. 2020; 20: 83. http://doi.org./10.1186/s12884- 020- 2742-4.

Dajak S, Stefanović V and Čapkun V. Severe hemolytic disease of fetus and newborn caused by red blood cell antibodies undetected at first-trimester screening. Transfusion. 2011; 51:1380–8.

Vijay K, Ashish J, Sandeep SP, Praveen K, Neelam M and Ratti RS. Significance of serological monitoring in a Bombay Rh (D) negative phenotype pregnant woman: A case report 2012; Volume 47, issue 3, p251-252. DOI: https://doi.org/10.1016/j.transci.2012.06.026.

Erhabor O, Ladan MA, Zama I, Ahmed Y and Mairo H. Distribution of Kell phenotype among pregnant women in Sokoto, North-Western, Nigeria. The Pan African Medical Journal. 2015; 21:30 doi: 10:11604/pamj.2015.21.301.4636.

Ugboma HA and Nwauche CA. Kell blood group antigen in Port Harcourt, Nigeria - A pilot study 2009; Port Harcourt Medical Journal.; 4 (2):0795-3038.

Mollison PL, Engelfnet CP and Contreras M. 10th ed. Oxford: Blackwell Scientific Publications1997; Blood transfusion in clinical medicine.

Moise KJ. Non-anti-D antibodies in red cell alloimmunization 2000; Eur J Obstet Gynecol Reprod Biol. 92:75–81.

Ammar K, Raed F, Saeed-Mohammad K and Mansour A. Prevalence of Kell Blood Group System in Blood Donors of Makkah City, Saudi Arabia. Clinical Laboratory 2021; 67(6):1- 7 DOI:10.7754/Clin.Lab.2020.200946).

Vaughan JI, Manning M, Warwick RM, Letsky EA, Murray NA and Roberts IA. Inhibition of erythroid progenitor cells by anti-Kell antibodies in fetal alloimmune anemia. N Engl J Med. 1998; 338:798–803. Doi: 1056/NEJM 199803193381204. PMID 9504940.

Meunier D, Peng S and Clarke G. Kell System: ANTI- Jsa (Internet). Ottawa: Canadian blood Services; 2019 sept 25 2019; Available from http://profedu.blood.ca/en/transfusion/practices/serological -best- practices.

Jeremiah ZA and Odumody C. Rh antigens and phenotype frequencies of the Ibibio, Efik, and Ibo ethnic nationalities in Calabar, Nigeria 2005; Immunohematology 21: 21-24.

Reid ME and Lomas-Francis C. The Blood Group Antigen Facts Books (2nd Edition), Elsevier Academic Press 2004; New York, USA.

Daniels G. The molecular genetics of blood group polymorphism 2005; Transplant Immunology, Volume 14, Issues 3–4, Pages 143-153.

Gita N and Gaur DS. Anti- Rh haemolytic Disease due to Anti- C Antibody: Is testing for Anti- D Antibodies enough? Indian Journal of Haematology and blood transfusion 2012; 28: 121 – 122.

Cheepsattayacorn R, Fongsatitkul L, Chotinaruemol S and Mahawongtong M. Anti-E as a cause of haemolytic disease of the newborn. J Med Assoc Thai. 1997; 80(suppl 1): S1–4.

Adiyyatu SU, Rapiaah M, Noraida R and Sirajo AD. Haemolytic disease of the fetus and new born caused by anti-E. Asian J Transfus Sci 2013; 7 (1): 84-85.

Pepperell RJ, Barrie JU and Fliegner JR. Significance of red-cell irregular antibodies in the obstetric patient. Med J Aust. 1977; 2 (14): 453 – 6.

Daniels GJ, Poole M, De-Silva, T, Callaghan S and MacLennan NS. The clinical significance of blood group antibodies 2002; Transfusion Medicine Volume 12, Issue 5 p. 287-295.

Schulze TJ, Meike G, Erwin A, Scharberg PB and Karin J. Development of Anti-G, Anti-C and Anti-Jk(b) in a 22-Year-Old Mother during Her Fourth Pregnancy. Transfus Med Hemother. 2013; 40 (3): 207–209.

Ronsmans C, Etard JF, Kodio B, Walraven G, Hoj L, Dumont A and De-Bernis L. Maternal mortality and access to obstetric services in West Africa; Tropical Medicine & International Health. 2003; Vol.8, Issue 10, p.940-948.

Gharehbaghian A, Ghezelbash B, Aghazade S and Hojjati MT. Evaluation of Alloimmunization Rate and Necessity of Blood Type and Screening Test among Patients Candidate for Elective Surgery. International journal of hematology-oncology and stem cell research, 2014; 8(1), 1–4

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