Riassunto
L’eritroblastosi fetale puÒ essere considerate come una forma molto limitata di rigetto immunologico del feto. Il passaggio di eritrociti dal feto alla madre puÒ awenire prima del parto e dar luogo talvolta alla formazione di anticorpi materni nel corso della gravidanza. Più frequentemente tale passaggio si verifica in occasione del travaglio e, essendo dipendente dal volume cellulare, puÒ dar luogo alla formazione di anticorpi nei mesi successivi o durante 1a successive gravidanza. La gravità della malattia emolitica nel feto dipende da una complessa interreazione di vari fattori in aggiunta alla concentrazione e alle caratteristiche leganti dell’anticorpo IgG nella madre. Il parto precoce, 1a trasfusione di scambio e 1a trasfusione intrauterina, in unione con le migliorate possibilità di stabilire la gravità della malattia fetale, hanno determinato una più rapida guarigione dei bambini colpiti, di circa il 92 % in alcuni centri. È attualmente possibile prevenire l’immunizzazione Rh nella maggior parte delle madri Rh negative somministrando IgG anti-D intramuscoli immediatamente dopo 1a gravidanza Rh positiva. Questa profilassi si è dimostrata efficace in almeno il 95 % dei casi, quando 1a prevenzione dello sviluppo di anticorpi veniva eseguita dopo il parto, e in circa il 90% dei casi, allorché i tests venivano praticati nel corso della successiva gravidanza Rh positiva. Utile puÒ risultare l’impiego di anti-D gammaglobulina i.V., particolarmente in caso di passaggio di notevoli quantità di emazie Rh incompatibili. Il ruolo della terapia anti-D praticata prima del parto è tuttora incerto.
Summary
Erythroblastosis foetalis can be looked upon as a very limited form of immunological rejection of the foetus. Foeto-maternal transfusion of erythrocytes can occurante-partum and occasionally results in maternal antibody formation during pregnancy. Most commonly such transfusion occurs in relation to labour and, depending on the volume of cells, it may result in antibody formation in subsequent months or during the subsequent pregnancy. The severity of haemolytic disease in the foetus depends on a complex interaction of several factors in addition to the concentration and binding characteristics of IgG antibody in the mother. Early delivery, exchange transfusion and intrauterine transfusion, combined with improved assessment of the severity of the disease in the foetus, have resulted in a high salvage rate of affected infants, approximately 92 % in some centres. It is now possible to prevent Rh immunisation in most Rh-negative mothers by administering IgG anti-D intramuscularly immediately after each Rh-positive pregnancy. This prophylaxis is at least 95 % successful as judged by the prevention of the development of antibody in the post-delivery period, or approaching 90 % as judged by tests in the subsequent Rh-positive pregnancy. There may be a place for intravenous anti-D gammaglobulin particularly in the case of large Rh-incompatible transfusion. The place ofante- partum anti-D therapy is at present uncertain.
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Woodrow, J.C. Erythroblastosis Foetalis. advances in management and prevention. La Ricerca Clin. Lab. 1, 199–258 (1971). https://doi.org/10.1007/BF03054462
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DOI: https://doi.org/10.1007/BF03054462