Significance of Immunohematology Testing in the Management of Hemolytic Disease of the Newborn in the Republic of Macedonia

Background: The hemolytic disease of the fetus and the newborn (HDFN) is a clinical syndrome at which the basic patho-physiological disorder represents a hemolytic anemia of the fetus or the newborn.

Aim: Prompt discovery of allosensibilisation to RBC’s antigens during pregnancy and successful management of HDFN in the Republic of Macedonia, in order to decrease morbidity and mortality of the fetus and the newborn.

Materials and Methods: The study comprises in total 23,800 patients, 14,858 pregnant women and 8,842 newborn babies. The immune-hematological testing for all pregnant women has been executed in the immunehematology laboratory at the Institute for Transfusion Medicine in Republic of Macedonia.

Results: The screening and identification of anti-RBC’s antibodies detected in a total of 216 alloantibodies, out of which 81% (175) had a clinical significance. Out of the above-mentioned 164 alloantibodies (65.9%) belong to the Rh system. The most often reason for a severe hemolytic disease is the anti-D antibody. The HDFN symptoms of mild and moderate degrees were demonstrated in 32.5%, and 18.9% had symptoms of severe fetal suffering, and almost half of them (48%) were with or with mild HDFN and had no need for therapy. In 15% it was about alloantibodies of other Rh antigens: anti-C, anti-E and anti-c, at which in most cases there were no signs of HDFN, or it showed weak symptoms (89%), just one case of anti-c ended with intrauterine death.

Conclusions: Still, a hemolytic disease of the fetus and the newborn caused by anti-D is one of the most often reasons for HDFN in most underdeveloped countries in the world. Anti-D antibody represents a need of intrauterine transfusion and exsanguino transfusion. Anti-c is the only antibody that demonstrated the same potential for severe HBN as the anti-D. The most often reason for alloimmunisation of the mother is the lack of RhIG prophylaxis (97.8): postnatal, antenatal and in case of possible sensible conditions during pregnancy. It is recommended to adopt a national program for RhIG prophylaxis in the Republic of Macedonia