Plasma exchange and high-dose i.v. immunoglobulin in the treatment of severe rhesus hemolytic disease.
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In a study of 46 sera accepted on the basis of routine tests as anti-C + D in 22 cases (50%) coexistence of anti-G antibodies was demonstrated. By means of an evolved and tried out method the possibility is presented of obtaining mino-specific anti-G eluates which may be used for phenotypic studies.
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The authors report one-year experience with the enzymatic test LEN (LISS-Enzym) replacing the one-step papain test in the compatibility testing, and in place of the two-step papain test in the detection and identification of red cells allo-antibodies. A wide range of investigations confirmed the usefulness of this test in the detection and antibodies specificity, mainly from the Rh system which are often undetectable by means of the indirect antiglobulin tests. It is concluded that in compatibility tests the LEN test should replace the low-sensitivity one-step papain test used as yet. It is stressed that in case of positive reactions only in the LEN test suggesting presence of autoantibodies the test should be repeated bringing to 37 degrees C the reacting components before their mixing. This makes possible elimination of clinically not significant cold autoantibodies.
The principles of obtaining monoclonal antibodies against D-antigen of the rhesus system are overviewed. The lines secreting anti-D antibodies are characterized. The strategies for selecting the anti-D producers secreting the antibodies are substantiated, which are useful for developing rhesus-typing diagnostics and preparations to prevent Rh-sensitization.
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A case of rhesus disease in a neonate after sensitisation of a Rh-positive mother with an incomplete D-antigen is presented. Despite severe haemolysis, the outcome was successful. The probable mechanism of sensitisation and the role of Rho(D) immune globulin (RhoGAM) and blood transfusion is discussed.
An anti-D titer of 1:16 was detected in a woman who had received 300 micrograms of Rh immune globulin as antepartum prophylaxis. It has been generally accepted that antibody titers following the administration of Rh immune globulin are less than 1:2. Although Rh immunization is always a potential cause of a titer greater than 1:4, a conservative approach is warranted in managing the patient with elevated anti-D antibody titers detected following the administration of Rh immune globulin.
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Plasmapheresis was performed in order to clean the excess of antibodies in two patients in whom previous fetal loss had occurred, due to rhesus disease. A reduction in antibodies titles was obtained in both cases. Both patients were delivered by cesarean section after normal full term pregnancies. The babies were followed for two years and revealed no fetal abnormalities.
UV irradiation of donor rhesus-positive blood in apparatus, applied in Soviet hospitals for autotransfusion of UV-irradiated blood produces a 2-fold increase of the blood capacity to bind antirhesus antibodies in blood or serum from sensibilized women. The above data can be used for increase in therapeutic effect of blood exchange transfusion in children with rhesus-conflict hemolytic disease.
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Explore the source record for details and available documents.