Comparing difference in mean total protein, albumin and globulin based on severity of rhesus isoimmunization: a prospective study
Keywords:Fetal distress, Hypertension in pregnancy, Stillbirths
Background: Maternal RBC alloimmunization results from exposure and response to a foreign RBC antigen. Transplacental fetal to maternal hemorrhage is the most common cause of alloimmunization. Rh incompatibility can lead to either fetuses with hydropic features or non-hydropic. The precise mechanism leading to the development of hydrops is uncertain. Biochemical markers have the potential to be used to assess the severity of problem. But of the mechanisms proposed none have been able to totally explain the phenomenon or predict the prognosis. Objective of this study wads to compare the difference in mean total protein, albumin and globulin bases on severity of isoimmunization and comparing it with normal controls.
Methods: A Total of 40 pregnant patients were enrolled which included 10 hydropic fetuses of Rh isoimmunised mothers, 10 non hydropic fetuses of Rh isoimmunized mothers. Control group included 18 Rh positive women without any fetal complication and 2 fetuses in women undergoing cordocentesis. Blood sampling was done at time of intrauterine transfusion and sent for estimation of total proteins, albumin, globulin in fetal blood. Pregnancies were followed up till delivery and fetal outcome noted.
Results: Mean total protein, albumin and globulin between hydropic, non hydropic group and control group (3.25, 2.17 and 1.18 g/dl) in hydropic, (4.14, 2.70 and 1.44 g/dl) in non hydropic and (4.42, 2.95 and 1.47 g/dl) in control group respectively. Mean total protein, albumin and globulin between mild hydropic (3.43, 2.30 and 2.10 g/dl) and severe hydropic group (2.59, 1.6 and 1.3 g/dl) respectively.
Conclusions: There was significantly lower levels of serum total proteins, albumin and globulin in hydropic fetuses as compared to non hydropic fetuses. Thus, hypoproteinemia can be considered a strong marker for development of hydrops in Rh isoimmunized fetuses.
Sullivan JF, Peckham NH, Jennings ER. Rh isoimmunization: its incidence, timing, and relationship to fetal-maternal hemorrhage. Am J Obstet Gynecol. 1967;15:877-80.
Liley AW. Liquor amnii analysis in management of pregnancy complicated by rhesus sensitization. Am J Obstet Gynecol. 1961;82:135-9.
Liley AW. Errors in the assessment of hemolytic disease from amniotic fluid. Am J Obstet Gynecol. 1963;86:485-94.
Trainor B, Tubman. The emerging pattern of hydrops fetalis-incidence, aetiology and management. Ulster Med J. 2006;75:185-6.
Snyder EL. Prevention of hemolytic disease of the newborn due to anti-D. Prenatal/perinatal testing and Rh immune globulin administration. Am Assoc Blood Banks. 1998;1:321-35.
Nicolini U, Nicolaidis P, Tannirandorn Y, Fisk NM, Nasrat H, Rodeck CH. Fetal liver dysfunction in Rhalloimmunization. Br J Obstet Gynaecol. 1991;98:287-93.
Radunovic N, Lockwood CJ, Alvarez M, Plecas D, Chitkara U, Berkowitz RL. The severely anemic and hydropic isoimmune fetus: changes in fetal hematocrit associated with intrauterine death; Obstet Gynecol. 1992;79:390-3.
Mari G, Deter RL, Carpenter RL. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red cell alloimmunization. Collaborative group for Doppler assessment of the blood velocity in anemic fetuses. N Engl J Med. 2000;342:9-14.
Sohan K, Carroll SG, Fuente SD, Soothill P, Kyle P. Analysis of outcome in hydrops fetalis in relation to gestational age at diagnosis, cause, and treatment. Acta Obstet Gynecol Scand. 2001;80:726.
Nicolaides KH, Soothill PW, Clewell WH, Rodeck CH, Mibashan RS, Fetal haemoglobin measurement in the assessment of red cell isoimmunisation. Campbell S. Lancet.1988;14:1073-5.
Deka D, Buckshee K, Kinra G. Intravenous immunoglobulin as primary therapy or adjuvant therapy to intrauterine fetal blood transfusion: a new approach in the management of severe Rh-immunization. J Obstet Gynaecol Res. 1996;22:561-7.
Nicolini U, Nicolaidis P, Tannirandorn Y, Fisk NM, Nasrat H, Rodeck CH/ Fetal liver dysfunction in Rh alloimmunization. Br J Obstet Gynaecol. 1991;98:287-93.
Marianowski L, Debski R, Rokicki T, Pasek K, Lukaszewicz E, Gromadzki J, et al. Albumin and packed red blood cells in the treatment of severely isoimmunised pregnancies. Materia medica Polona. Mater Med Pol. 1992;24:260-1.