Incompatibility Feto-maternal
Feto-maternal incompatibility is the result of a difference between antigens of the formed elements of the blood of a mother and her fetus may lead to the formation of antibodies in the mother.
When these antibodies exist, they pass the placental barrier, and destroy all cells recognized, erythrocytes, platelets and leukocytes.
It is clear that certain examinations (typing of platelets leukocytes or, research and antibody), or certain interventions (cord puncture, exchange transfusion) can be performed only in a few laboratories and specialized institutions.
- If it’s red blood cells, is hemolytic disease of the newborn due to differences of groups blood érythroctaires, which may be serious, resulting in more or less severe anaemia, in utero or at birth.
- If it comes to platelets, it is neonatal thrombocytopenia by Feto-maternal conflict due to differences in the various systems HPA (Human Platelet Antigen). The most frequent (85% of incompatibilities), and the most serious of these incompatibilities (5-10% of bleeding intra-tested) is related to the HPA – 1a (ex PlA1) Antigen, followed in frequency (10%) by the HPA – 5 b incompatibility. This thrombocytopenia, if it is important to know if the platelet count is less than 20 Giga/l, can cause brain haemorrhage or already in utero, at birth.
As a general rule, it is at the birth of the first child that the diagnosis was raised, and that maternal immunization is established. Moderate thrombocytopenia requires no intervention. A transfusion of platelets may be performed in the child if the platelet count is less than 20 Giga/l. These compatible donors are very rare, to the point that are sometimes used the platelets déplasmatisées (to remove these antibodies) and irradiated (due to the HLA semi-identité) mother. This transfusion of platelets may be associated with a partial exchange transfusion with the aim of eliminating maternal antibody. This thrombocytopenia resolve in about three weeks.
When the mother is already known as immune, monitoring of the fetus must be made. Fetal platelet typing, affirming or reversing the incompatibility, can be done in molecular biology in reference, from the free Fetal DNA laboratories, on a sample of blood from the tenth week of pregnancy. Significant thrombocytopenia detected by cord puncture associated with transfusion of platelets will be whether corticosteroid therapy in the mother, associated with infusions of immunoglobulins IgG. As a last resort, because risk, weekly platelets fetal transfusions may be necessary until the 36th week of gestation, when an induced delivery possible for support of the child.
- If it’s white blood cells, neutrophils, it is neutropenia associated with system AST (antigens AST – 1A, AST – 1 b, AST – 1 c). This violation is without consequences in-utero, the fetus develops in a sterile and less serious environment at birth, the rise in the rate of leukocytes ranging from two weeks to four months, avoiding simple hygiene and antibiotic treatment if needed cutting infection.
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