Serological conflict – what is it and who is it at risk? Prevention and treatment of serological conflict

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Serological conflict is a disease of the fetus, and later of the newborn, completely asymptomatic in the mother. The factor that leads to the appearance of a serological conflict is serological incompatibility, consisting in the lack of blood cell antigens (popularly known as the Rh-negative factor) in the blood of a pregnant woman, which is found in the child’s father (Rh-positive).

We are talking then about anti-D antibodies from the Rh system, which are the most common but not the only cause of serological conflict. They are produced only when the fetus inherits the RhD factor from the father, i.e. it will be RhD positive, and during delivery the baby’s blood leaks into the mother’s blood.

These antibodies can persist throughout a woman’s life, which means that in the next pregnancy (no matter when it occurs), and in the presence of the RhD factor, symptoms of serological conflict may arise. However, antibodies can also arise when a blood group is transfused with incompatible blood or when multiple people use the same needle.

If the future mother’s immune system has already developed antibodies to RhD antigens, and the child inherits RhD-positive factor again in the next pregnancy, a serological conflict occurs, which ends with the so-called haemolytic disease of the fetus. This is due to the properties of antibodies that can cross the placenta and attack the fetal blood cells, causing a number of consequences, including destruction of red blood cells in the fetus (leading to anemia), and chronic fetal hypoxia and damage to its organs and systems.

One of the symptoms of a fetal haemolytic disease is, for example, fetal swelling, which can be seen on ultrasound. In the worst case, due to a serological conflict, an intrauterine fetus may die or a non-viable newborn may be born.

If you have any questions for a gynecologist regarding a serological conflict, use the online consultation via the halodoctor.pl portal. The visit will take place without leaving your home and visiting the clinic.

The Rh factor is inherited (passed from parents to children through genes). If the baby’s mother is Rh-negative and the baby’s father is Rh-positive, the baby has a 50 percent or greater chance of getting Rh-positive blood. Simple blood tests can show whether the baby’s mother and father are Rh positive or Rh negative.

If a woman is Rh negative, the risk of serological conflict problems is higher if she has been in contact with Rh positive blood prior to pregnancy. This could have happened during:

1. Earlier pregnancy (usually during childbirth). The expectant mother may also have been exposed to Rh-positive blood if she had bleeding or trauma to her abdomen (for example, as a result of a car accident) during pregnancy.
2. Ectopic pregnancy, miscarriage or induction of abortion. (An ectopic pregnancy is a pregnancy that begins outside the womb.)
3. Improper blood transfusion or transplantation of blood and bone marrow stem cells.
4. Injection or puncture with a needle or other object containing Rh-positive blood.

Some tests may also expose a woman to Rh-positive blood. Examples include amniocentesis and chorionic villus sampling (CVS).

Amniocentesis is a test that a woman may have during pregnancy. The doctor uses a needle to remove a small amount of fluid from the bag around the baby. The fluid is then tested for various reasons.

A cell biopsy is another test that can also be done during pregnancy. In this study, the doctor passes a thin tube through the vagina and cervix to the placenta. He takes a tissue sample from the placenta using gentle suction. The tissue sample is then tested.

If the woman has not been treated with a drug to prevent Rh antibodies (Rh immunoglobulin) after each of these events, there is a risk of a serological conflict during current and future pregnancies.

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Types of serological conflict and symptoms

Serological conflict occurs in three forms:

1. Severe hemolytic jaundice – the first symptoms of jaundice appear in the first XNUMX hours of a child’s life. Immediate steps must be taken to ensure that the blood levels of bilirubin are not exceeded, which could damage the baby’s brain as a consequence. This form of serological conflict is quite rare.

2. Generalized fetal swelling – is the most severe form of serological conflict, it is accompanied by swelling of the skin and subcutaneous tissue, and ecchymosis may also appear. It is very common for a baby to die inside the uterus. Generalized fetal edema is less and less frequent, thanks to appropriate prevention.

3. Severe degree of anemia – is a mild form of serological conflict that occurs more often than those mentioned above. The symptoms are typical of anemia, the baby is pale and has enlarged spleen and liver. Dyspnea appears (wheezing, drawing in the intercostal spaces, the movement of the nostrils while breathing).

Serological conflict – diagnosis

Women in the first trimester of pregnancy should have their blood group, Rh factor and possibly the level of antibodies marked before pregnancy. Pregnant women with the blood group Rh- should have a repeat antibody test at 28 weeks of pregnancy to check for seroconversion (production of antibodies by the mother’s body). Pregnant women diagnosed with antibodies to fetal blood cells must repeat tests at four-week intervals (28, 32, 36) to assess the level of antibodies.

If a woman is Rh negative, her partner can also be tested. If the partner is also Rh-negative, the expectant mother has nothing to worry about. However, if your partner is Rh positive and the woman is Rh negative, your doctor will look for the following signs of a serological conflict.

In addition, it is important to have regular ultrasound scans so that symptoms of a serological conflict can be ruled out. Thanks to this examination, we can diagnose changes early and take appropriate steps.

In a certain group of women, the umbilical vein is punctured and blood drawn from it using ultrasound. After taking a blood sample, it is assessed whether the presence of the Rh factor and antibodies that destroy the blood cells of the fetus is assessed.

If the result is a positive Coombs’ Intermediate Test when testing a blood sample, it is a sign of a serological conflict.

Higher-than-normal levels of bilirubin in an infant’s blood are a sign of a serological conflict. In a term baby who is less than 24 hours old, the bilirubin level should be less than 6,0 milligrams per deciliter.

Also, signs of destruction of red blood cells in the infant’s blood may indicate a serological conflict. This can be determined by the shape and structure of the red blood cells when examined under a microscope.

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Also read about autoimmune disease: Unnecessary tragedies

Serological conflict – treatment

There are several treatment options for your child. In mild cases, treatment may not be needed. If treatment is necessary, your child may be given a medicine called erythropoietin and iron supplements. These treatments can cause your body to produce red blood cells.

Treatment for serological conflict is to remove too much bilirubin that has formed during the destruction of red blood cells (phototherapy is used for this, which involves holding the baby close to fluorescent lamps to reduce the bilirubin in the blood). The procedures can be repeated until the antibodies and excess bilirubin are removed from the child’s blood. Whether or not they need to be repeated depends on the severity of the child’s condition.

Lowering bilirubin levels in the blood is important as high levels of this compound can cause brain damage. High bilirubin is often seen in infants with hemolytic anemia. This is because this compound is formed when red blood cells break down.

In addition, the antibodies that are in the blood must be eliminated because they have passed through the placenta from the mother’s blood. Furthermore, in the treatment of serological conflict, it is important that morphological parameters are aligned. Red blood cells are also given, which do not respond to maternal antibodies.

In rare cases, if the serological conflict is serious and the baby is in danger, the baby may receive special blood transfusions called replacement transfusions before birth (intrauterine transfusions of the fetus) or after delivery. Exchange transfusions replace a baby’s blood with blood containing Rh-negative cells. This stabilizes the levels of red blood cells and minimizes damage from Rh antibodies already in the baby’s bloodstream.

Sometimes, when we are faced with severe anemia and the baby is almost on due date, the doctor may induce labor early. This allows your child’s doctor to start treatment right away.

Serological conflict – complications

Severe cases in which the effects of a serological conflict cannot be prevented can lead to serious complications. These complications may include:

1. a child’s brain damage known as kernicterus (jaundice in the basal ganglia);
2. fluid accumulation or swelling in a child;
3. trouble with mental functions, movement, hearing and speech;
4. seizures;
5. anemia;
6. heart failure.

The child may also die. However, serological conflict is rarely a problem in well-cared countries.

See also: Heart failure is an epidemic of the XNUMXst century

Prevention of serological conflict

At the beginning of pregnancy, women have their blood group marked with the Rh factor. The same is required of the child’s father if the mother is Rh-negative. The determination of blood groups allows the risk of serological conflict to be assessed and provides the basis for subsequent special medical care.

If a pregnant woman is likely to develop a serological conflict, her doctors will give her a series of two injections of anti-D immunoglobulin during her first pregnancy. The woman then receives:

1. first dose around week 28 of pregnancy;
2. a second dose within 72 hours of giving birth.

Anti-D immunoglobulin acts as a vaccine and is designed to destroy Rh-positive fetal blood cells that have entered the mother’s circulation before they are recognized by her immune system and before the immune memory mechanism is built up. This is to prevent problems in the next pregnancy and serious health problems for the newborn.

Once the antibodies are formed, the medicine will no longer help. Therefore, a woman who has Rh negative blood must be treated with anti-D immunoglobulin during any pregnancy or any other event that allows her blood to mix with Rh positive blood. Immunoglobulin is injected into the muscle of the arm or buttock. Side effects may include pain at the injection site and mild fever. It can also be injected intravenously.

A woman may also receive an anti-D immunoglobulin dose if she has had a miscarriage, amniocentesis or bleeding during pregnancy. If the doctor determines that a woman has already developed Rh antibodies, her pregnancy will be carefully monitored to make sure that these levels are not too high.

Early prenatal care can also help prevent some serological conflict problems. For example, a doctor can find out early on whether a woman is at risk of disease. If so, your doctor can closely monitor your pregnancy. He will monitor your baby for signs of haemolytic anemia and will institute appropriate treatment as needed.

Currently, in Poland intra-pregnancy prophylaxis with anti-D immunoglobulin is free (28-32 weeks of pregnancy).

Also check: Prenatal tests – is it worth doing and when? [WE EXPLAIN]