Erythroblastosis

  • Kurt Benirschke
  • Peter Kaufmann

Abstract

Erythroblastosis fetalis, or hemolytic disease of the newborn, is a condition caused by specific antibodies of the mother directed against red blood cell antigens of the fetus. These are largely Rh(D) antigens, but rare cases of sensitization against other antigens (e.g., Kell) and ABO incompatibility with fetal hemolytic disease have been described. Leventhal and Wolf (1956) have presented Kell isoimmunization as a cause of fatal erythroblastosis (EF), which was also found in the well illustrated case of Ivemark et al. (1959). It does not differ pathologically from anti-D-induced erythroblastosis. Relatively few cases of typical, severe EF have been described as being due to ABO incompatibility. They were summarized by Freda and Carter (1962). A fatal case was delineated by Miller and Pétrie (1963), but usually the hemolytic disease of ABO incompatibility is mild.

Keywords

Hydatidiform Mole Chorionic Villus Sampling Hemolytic Disease Fetal Hydrops Placental Pathology 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Alenghat, E., and Esterly, J.R.: Intravascular hemato-poiesis in chorionic villi. Am. J. Clin. Pathol. 79:225–227, 1983.PubMedGoogle Scholar
  2. Becker, V., and Bleyl, U.: Placentarzotte bei Schwangerschaftstoxikose und fetaler Erythroblastose im fluorescenzmikroskopischen Bilde. Virchows Arch. [Pathol. Anat.] 334:516–527, 1961.CrossRefGoogle Scholar
  3. Beischer, N.A., Pepperell, R.J., and Barrie, J.U.: Twin pregnancy and erythroblastosis. Obstet. Gynecol. 34:22–29, 1969.PubMedGoogle Scholar
  4. Berkowitz, R.L., Chitkara, II., Goldberg, J.D., Wilkins, I., Chervenak, F.A., and Lynch, L.: Intrauterine intravascular transfusions for severe red blood cell isoimmunization: ultrasound-guided percutaneous approach. Am. J. Obstet. Gynecol. 155:574–581, 1986.PubMedGoogle Scholar
  5. Bouissou, H., Kanoun, T., Bierme, S., and Bierme, R.: Foie et placenta au cours de la maladie hémolytique par iso-immunisation Rh (étude histologique et déductions). Pathol. Biol. 17:109–120, 1969.PubMedGoogle Scholar
  6. Burger, K.: Mit Hydrops foetus et placentae einhergehende Luteinzysten. Zentralbl. Gynâkol. 69:533–536, 1947.Google Scholar
  7. Burstein, R.H., and Blumenthal, H.T.: Vascular lesions of the placenta of possible immunogenic origin in erythroblastosis fetalis. Am. J. Obstet. Gynecol. 83: 1062–1068, 1962.PubMedGoogle Scholar
  8. Busch, W., and Vogel, M.: Die Plazenta beim “Morbus haemolyticus neonatorum”. Z. Geburtshilfe Perinatol. 176:17–28, 1972.PubMedGoogle Scholar
  9. Christie, R.W.: Lutein cysts of ovaries associated with erythroblastotic hydrops fetalis: assay of gonadotropin in serum of Rh-sensitized women in later stages of pregnancy. Am. J. Clin. Pathol. 36:518–523, 1961.PubMedGoogle Scholar
  10. Driscoll, S.G., and Steinke, J.: Pancreatic insulin content in severe erythroblastosis fetalis. Pediatrics 39:449–450, 1967.Google Scholar
  11. Eklund, J.: Embryonic rhesus-positive red cells stimulating a secondary response after early abortion. Lancet 2:748, 1981.PubMedCrossRefGoogle Scholar
  12. Freda, V.J., and Carter, B.-A.: Placental permeability in the human for anti-A and anti-B isoantibodies. Am. J. Obstet. Gynecol. 84:1351–1367, 1962.PubMedGoogle Scholar
  13. Freda, V.J., Gorman, J.G., Galen, R.S., and Treacy, N.: The threat of Rh immunisation from abortion. Lancet 1:147–148, 1970.CrossRefGoogle Scholar
  14. Friesen, R.F., Bowman, J.M., Barnes, P.H., Grewar, D., Mclnnis, G., and Bowman, W.D.: Intrauterine transfusions for erythroblastosis. Am. J. Obstet. Gynecol. 97:343–339, 1967.PubMedGoogle Scholar
  15. Goto, S., Nishi, H., and Tomoda, Y.: Blood group Rh-D factor in human trophoblast determined by immuno-fluorescent method. Am. J. Obstet. Gynecol. 137: 707–712, 1980.PubMedGoogle Scholar
  16. Grannum, P.A.T., Copel, J.A., Moya, F.R., Scioscia, A.L., Robert, J.A., Winn, H.N., Coster, B.C., Bur-dine, C.B., and Hobbins, J.C.: The reversal of hydrops fetalis by intravascular intrauterine transfusion in severe isoimmune fetal anemia. Am. J. Obstet. Gynecol. 158:914–919, 1988.PubMedGoogle Scholar
  17. Grimes, D.A., Geary, F.H., and Hatcher, R.A.: Rh immunoglobulin utilization after ectopic pregnancy. Am. J. Obstet. Gynecol. 140:246–249, 1981.PubMedGoogle Scholar
  18. Harman, C.R., Bowman, J.M., Menticoglou, S.M., Pollock, J.M., and Manning, F.A.: Profound fetal thrombocytopenia in rhesus disease: serious hazard at intravascular transfusion. Lancet 2:741–742, 1988.PubMedCrossRefGoogle Scholar
  19. Hatjis, C.G.: Nonimmunologic fetal hydrops associated with hyperreactio luteinalis. Obstet. Gynecol. 65: 11S–13S, 1985.Google Scholar
  20. Hellman, L.M., and Hertig, A.T.: Pathological changes in the placenta associated with erythroblastosis of the fetus. Am. J. Pathol. 14:111–120, 1937.Google Scholar
  21. Houston, C.S., and Brown, A.B.: An unusual complication of intrauterine transfusion. Can. Med. Assoc. J. 94:1274–1277, 1966.PubMedGoogle Scholar
  22. Iakovtsova, A.G.: Morphologic changes in the placenta in isoantigenic incompatibility of maternal and fetal blood. Pediatr. Akhush. Ginekol. 1:53–55, 1964.Google Scholar
  23. Ivemark, B.I., Högman, C., Rudert, P.O., and Andersen, B.: Kelliso-immunization as the cause of fatal erythroblastosis fetalis. Acta Pathol. Microbiol. Scand. 45:193–202, 1959.CrossRefGoogle Scholar
  24. James, G.B.: Histology of the placenta after repeated intrauterine transfusions. Proc. Roy. Soc. Med. 63:54, 1970.PubMedGoogle Scholar
  25. Jarkowski, T.L., Rosenblatt, M., Wolf, P., and Pearson, B.: Tissue-fixed antigens of the Rh blood group system in placentae and fetuses; with particular reference to hemolytic disease of the newborn. Lab. Invest. 13: 937, 1964.Google Scholar
  26. Jones, C.J.P., and Fox, H.: An ultrastructural study of the placenta in materno-fetal rhesus incompatibility. Virchows Arch. [Pathol. Anat.] 379:229–241, 1978.Google Scholar
  27. Jorgensen, J.: Rhesus-antibody development after abortion. Lancet 2:1253–1254, 1969.PubMedCrossRefGoogle Scholar
  28. Lee, J.-N., Huang, S.-C., Ouyang, P.-C., and Chard, T.,: Circulating placental proteins in pregnancies complicated by Rh isoimmunization. Obstet. Gynecol. 64:131–132, 1984.PubMedGoogle Scholar
  29. Leventhal, M.L., and Wolf, A.M.: Erythroblastosis (hydrops) fetalis from Kell sensitization. Am. J. Obstet. Gynecol. 71:452–454, 1956.PubMedGoogle Scholar
  30. Luca, E.C. de, Casadei, A.M., Pascone, R., Tardi, C., and Pacioni, C.: Maternofetal transfusion during delivery and sensitization of newborn against the rhesus D-antigen. Vox Sang. 34:241–243, 1978.CrossRefGoogle Scholar
  31. MacGregor, S.N., Socol, M.L., Pielet, B.W., Sholl, J.T., and Minogue, J.P.: Prediction of fetoplacental blood volume in isoimmunized pregnancy. Am. J. Obstet. Gynecol. 159:1493–1497, 1988.PubMedGoogle Scholar
  32. Manning, F.A., Bowman, J.M., Lange, I.R., and Chamberlain, P.P.: Intrauterine transfusion in an Rh-immu-nized twin pregnancy: a case report of successful outcome and a review of the literature. Obstet. Gynecol. 65:2S–6S, 1985.Google Scholar
  33. Matthews, C.D., Matthews, A.E.B., and Gilbey, B.E.: Antibody development in rhesus-negative patients following abortion. Lancet 2:318–319, 1969.PubMedCrossRefGoogle Scholar
  34. Miller, D.F., and Pétrie, S.J.: Fatal erythroblastosis fetalis secondary to ABO incompatibility. Obstet. Gynecol. 22:773–777, 1963.PubMedGoogle Scholar
  35. Mollison, P.L.: Suppression of Rh-isoimmunisation by passively administered anti-Rh. Bit. J. Haematol. 14: 1–4, 1968.CrossRefGoogle Scholar
  36. Montemagno, U., Stefano, M. di, and Cardone, A.: Aspetti istoimmunologici della placenta nella incom-patibilita Rh. In, Simpos. sui Problemi Ostetrico-Pediatrici della Sofferenza Fetale, pp. 649–655. Offic. Grafiche Stianti-Sanscasciano, Siena, Italy, 1966.Google Scholar
  37. Murray, S., and Barron, S.L.: Rhesus isoimmunization after abortion. Brit. Med. J. 3:87–89, 1971.CrossRefGoogle Scholar
  38. Nicolaides, K.H., Soothill, P.W., Clewell, WH., Rodeck, C.H., Mibashan, R.S., and Campbell, S.: Fetal haemoglobin measurement of red cell isoimmunization. Lancet 1:1073–1075, 1988a.PubMedCrossRefGoogle Scholar
  39. Nicolaides, K.H., Thilaganathan, B., Rodeck, C.H., and Mibashan, R.S.: Erythroblastosis and reticulocy-tosis in anemic fetuses. Am. J. Obstet. Gynecol. 159: 1063–1065,1988b.PubMedGoogle Scholar
  40. Nicolaides, K.H., Thilaganathan, B., and Mibashan, R.S.: Cordocentesis in the investigation of fetal erythropoi-esis. Am. J. Obstet. Gynecol. 161:1197–1200, 1989.PubMedCrossRefGoogle Scholar
  41. Pattison, N., and Roberts, A.: The management of severe erythroblastosis fetalis by fetal transfusion: survival of transfused adult erythrocytes in the fetus. Obstet. Gynecol. 74:901–904, 1989.PubMedGoogle Scholar
  42. Pielet, B.W., Socol, M.L., MacGregor, S.N., Ney, J.A., and Dooley, S.L.: Cordocentesis: an appraisal of risks. Am. J. Obstet. Gynecol. 159:1497–1500, 1988.PubMedGoogle Scholar
  43. Pilz, I., Schweikhart, G., and Kaufmann, P.: Zur Abgrenzung normaler, artefizieller und pathologischer Strukturen in reifen menschlichen Plazentarzotten. III. Morphometrische Untersuchungen bei Rhesus-Inkom-pabilität. Arch. Gynecol. 229:137–154, 1980.PubMedCrossRefGoogle Scholar
  44. Price, J.R.: Rh sensitization by hydatidiform mole. New Engl. J. Med. 278:1021, 1968.PubMedGoogle Scholar
  45. Queenan, J.T., and Douglas, G.R.: Intrauterine transfusion: a preliminary report. Obstet. Gynecol. 25:308–321, 1965.PubMedGoogle Scholar
  46. Queenan, J.T., and Nakamoto, M.: Postpartum immunization: the hypothetical hazard of manual removal of the placenta: report of a study. Obstet. Gynecol. 23: 392–395, 1964.PubMedGoogle Scholar
  47. Rabinowitz, P., Harris, E.J., and Friedman, I.S.: Thecalutein cysts of the ovaries: a case of erythroblastosis with abruptio placentae and acute renal failure. J. A.M. A. 177:509–510, 1961.PubMedCrossRefGoogle Scholar
  48. Reece, E.A., Gabrielli, S., Abdalla, M., O’Connor, T.Z., and Hobbins, J.C.: Reassessment of the utility of fetal umbilical vein diameter in the management of isoimmunization. Am. J. Obstet. Gynecol. 159:937–938, 1988.PubMedGoogle Scholar
  49. Rodeck, C.H., Nicolaides, K.H., Warsof, S.L., Fysh, W.J., Gamsu, H.R., and Kemp, J.R.: The management of severe rhesus isoimmunization by fetoscopic intravascular transfusions. Am. J. Obstet. Gynecol. 150:769–774, 1984.PubMedGoogle Scholar
  50. Scott, J.R., Beer, A.E., Guy, L.R., Liesch, M., and Elbert, G.: Pathogenesis of Rh immunization in primigravidas: fetomaternal versus maternofetal bleeding. Obstet. Gynecol. 49:9–14, 1977.PubMedGoogle Scholar
  51. Socol, M.L., MacGregor, S.N., Pielet, B.W., Tamura, R.K., and Sabbagha, R.E.: Percutaneous umbilical transfusion in severe rhesus isoimmunization: resolution of fetal hydrops. Am. J. Obstet. Gynecol. 157:1369–1375.Google Scholar
  52. Stedman, C.M., Quinlan, R.W., Huddleston, J.P., Cruz, A.C., and Kellner, K.R.: Rh sensitization after third-trimester fetal death. Obstet. Gynecol. 71:461–463, 1988.PubMedGoogle Scholar
  53. Steinke, J., Gries, F.A., and Driscoll, S.G.: In vitro studies of insulin inactivation with reference to erythroblastosis fetalis. Blood 30:359–363, 1967.PubMedGoogle Scholar
  54. Szulman, A.E.: The A, B and H blood-group antigens in human placenta. New Engl. J. Med. 286:1028–1031, 1972.PubMedCrossRefGoogle Scholar
  55. Taylor, J.F.: Sensitization of Rh-negative daughters by their Rh-positive mothers. New Engl. J. Med. 276: 547–551, 1967.PubMedCrossRefGoogle Scholar
  56. Vidyasagar, D., and Haworth, J.C.: Placental dimensions, cell size, and cell number in erythroblastosis fetalis. Am. J. Obstet. Gynecol. 115:267–270, 1973.PubMedGoogle Scholar
  57. Warren, R.C., Butler, J., Morsman, J.M., McKenzie, C., and Rodeck, C.H.: Does chorionic villus sampling cause fetomaternal hemorrhage? Lancet 1:691, 1985.PubMedCrossRefGoogle Scholar
  58. Wentworth, P.: The placenta in cases of hemolytic disease. Am. J. Obstet. Gynecol. 98:283–289, 1967.PubMedGoogle Scholar
  59. Wiener, A.S., Wexler, I.B., and Schutta, E.J.: A pair of male fraternal twins with contrasting manifestations of Rh hemolytic disease. Acta Genet. Med. Gemellol. (Roma) 11:17–28, 1962.Google Scholar
  60. Zipursky, A., and Israels, L.G.: The pathogenesis and prevention of Rh immunization. Can. Med. Assoc. J. 97:1245–1257, 1967.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1990

Authors and Affiliations

  • Kurt Benirschke
    • 1
    • 2
  • Peter Kaufmann
    • 3
  1. 1.Pathology and Reproductive MedicineUniversity of CaliforniaSan DiegoUSA
  2. 2.University Medical CenterSan DiegoUSA
  3. 3.Institut für Anatomie der Medizinischen Fakultät, Rheinisch-Westfälische TechnischeHochschule AachenAachenGermany

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