Rh(D) fraction incompatibility causing hemolytic disease of the newborn. Report of two cases in a Chinese family

Upregulation of miR-181a-5p and miR-125b-2-3p in the Maternal Circulation of Fetuses with Rh-Negative Hemolytic Disease of the Fetus and Newborn Could Be Related to Dysfunction of Placental Function

The transplacental transfer of maternal antibodies to the fetus is a critical mechanism for infant protection and perinatal disease. Hemolytic disease of the fetus and newborn (HDFN) is a representative fetal disease caused by transplacental transfer of maternal IgG antibodies. However, it is unclear whether placental-related miRNAs are expressed in Rh-HDFN. Through the investigation of the miR-181a-5p and miR-125b-2-3p levels in maternal plasma using qPCR, we found that both miR-181a-5p and miR-125b-2-3p were highly expressed in maternal plasma of newborns with Rh-HDFN compared with healthy controls, indicating the potential roles of these two miRNAs in Rh-HDFN. To demonstrate whether dysregulation of miR-125b-2-3p and miR-181a-5p contributes to Rh-HDFN development, we analyze the placental miRNA-/mRNA sequencing data (GSE73714) using weighted gene coexpression network analysis (WGCNA), miRNA target predictive databases, and DAVID (Database for Annotation, Visualization, and Integrated Discovery). The results showed that miR-125b-2-3p and miR-181a-5p could regulate several biological processes including cytoplasmic microtubule organization and angiogenesis. Moreover, core promoter sequence-specific DNA binding and protein binding were highly enriched molecular functions, indicating the potential roles of transcriptional regulation. Further pathway enrichment showed that miR-181a-5p and miR-125b-2-3p could regulate several biological pathways that were closely related to placental function, including the FoxO signaling pathway, focal adhesion, mTOR signaling pathway, and central carbon metabolism in cancer. In conclusion, the present results first revealed miRNA expression in the maternal circulation of newborns with Rh-HDFN, which could be caused by dysfunction of the placenta.

Rh-incompatible hemolytic disease of the newborn in Hefei

BACKGROUND

Anti-D antibody is not the common cause of Rh-isoimmunization in Chinese neonatal jaundice. Recent change in national population policy has followed by an increase in Rh-isoimmunization related hemolytic disease of the newborn (HDN). Unfortunately, regional status of Rh-HDN is unavailable. We hypothesize that Rh-HDN in our region is most commonly due to anti-E antibody.

AIM

To investigate the prevalence of hemolytic disease of the newborn due to Rh-isoimmunization in Hefei City.

METHODS

Retrospective review of data obtained from Children’s Hospital of Anhui and Hefei Blood Center between January 2017 and June 2019. Status of minor blood group antibody was studied in the corresponding mothers.

RESULTS

Totally 4138 newborns with HDN admitted during the study period and 116 (2.8%) received blood exchange transfusion (BET). Eighteen newborns (0.43%) with proven Rh-incompatible HDN were identified. All were not the first-born baby. Thirteen mothers were RhD (+) (72%) and five were RhD (-). The distribution of Rh-related antibodies in mothers was ten anti-E (55%), five anti-D (27%), and for one anti-C, anti-c, and anti-E/c (6%) each. Thirteen (72.2%) were qualified for BET, relative risk for BET was 28.9 as compared to other types of HDN, but only 10 received due to parenteral refusal. All (100%) RhD related HDN received BET which is not significantly different from RhE related HDN (81.8%).

CONCLUSION

As expected, all Rh-incompatible HDN newborns were not the first-born. Contrary to the Caucasian population, anti-D induced HDN is not the most common etiology. In our region, anti-E (11/18, 61%) is the most common cause of Rh-HDN.

Human monoclonal anti-D with reactivity against category DVI cells used in blood grouping and determination of the incidence of the category DVI phenotype in the DU population

B-lymphoblastoid cell lines transformed by Epstein-Barr virus were produced from cells obtained from a hyperimmunised donor with serum anti-D activity against category DVI red cells and enriched for this activity by rosetting with category DVI red cells. Three clones produced IgG1 anti-D and had stable cell growth and continuous secretion of antibody in prolonged culture. The monoclonal antibodies reacted with category DVI red cells, when assessed manually and in an automated blood grouping system, and are useful blood grouping reagents for the detection of the category DVI phenotype. Using a radiometric technique, the number of antibody molecules bound to category DVI red cells from 5 individuals was estimated to range from 2,800 to 11,200 per cell. Five percent of blood donors classed as Du in the south western region were found to have the category DVI phenotype.