Different distribution of maternal red cell antibodies and risk on the severe alloimmune haemolytic disease of the foetus in a Chinese Population: a retrospective cohort study on prenatal management

Abstract BACKGROUND: The distribution of antibodies that cause haemolytic disease of the foetus (HDF) in China and the effects of multiple antibodies on the severity of HDF are needed to further evaluation. METHODS: A retrospective cohort study was conducted in two affiliated Hospitals of Sun Yat-sen University. Total 268 pregnant women and foetuses pairs were divided into four groups: anti-D, anti-D combined others, other single-antibody and other multiple-antibody. The obstetrics history, the incidence of severe HDF and foetal outcomes were collected and compared in each group. The logistics regression analysis and the survival analysis were conducted for analysis. RESULTS: Anti-D was the most common cause of HDF, followed by the anti-M of MNS system. No anti-K or isolate anti-c associated HDF was found. Upon the mothers with anti-D combined other antibodies, the incidence of severe HDF was increased than those with anti-D alone(P=0.046). Foetuses in the other single-antibody group had lower reticulocytes (P=0.007), more IUT times (P =0.007) and an earlier onset of severe HDF (P=0.003). High maternal antibody titer (P＜0.001), multiple affected pregnancies (P＜0.001) and other single-antibody (P=0.030) were the independent risk factor for HDF developing. And the lower foetal haematocrit (P =0.012) and higher reticulocyte counts (P =0.035) were the independent risk factors of severe HDF in the anaemia foetuses affected by RhD alloimmunization. CONCLUSION: The distribution of HDF-associated antibodies in China is different from that in western countries. Other single non-Rh(D) and multiple antibodies could both increase the risk of HDF but anti-D combined with other antibody would not influence the severity of the disease than anti-D alone.