Maternal antibodies pose many risks to the fetus and neonate. Most common to the transfusion medicine service are antibodies against red blood cell antigens causing hemolytic disease of the newborn and antibodies against platelets causing neonatal alloimmune thrombocytopenia. Even among these antibodies, there are some with unique properties which pose a different constellation of risk to the pregnancy such as anti-PP1Pk. However, these are not the only maternal antibodies of concern to the obstetrician. Anti-phospholipid antibodies may causes recurrent fetal loss. Antibodies against SS-A and SS-B are known to cause congenital heart block; thyroid stimulating immunoglobulin can cause fetal hyperthyroidism; and anti-acetylcholine receptor antibodies can cause neonatal myasthenia gravis. Pregnancy may also precipitate antibody mediated events in the mother such as thrombotic thrombocytopenic purpura.
Herein we present an overview of red cell, platelet, and other antibodies with unique obstetrical implications. We will also present a literature review on the use of therapeutic apheresis during pregnancy and explore cutting edge research into placental Fc receptors as potential targets for therapy.
Explain and review the role of Antibody-mediated (Type II) Hypersensitivity in causation of fetal and neonatal disease.
Describe the role of the placenta and its Fc receptors in facilitating passive acquisition of immunity for the fetus as well as detrimental effects of allo and autoantibodies.
Examine specific fetal and neonatal diseases that occur as a result of antibody mediated disease by using clinical examples such as hemolytic disease of the newborn, neonatal alloimmune thrombocytopenia, neonatal lupus and other disorders and explore the underlying immunohematological theories and implications.
Appraise conventional treatments for antibody-mediated disease in the fetus and newborn (both maternal and fetal/neonatal therapies) and explore recent research into placental Fc receptors as potential targets for therapy.