Prevalence of red-blood-cell and non-red-blood-cell-targeted autoantibodies in alloimmunized postpartum women

Schonewille, H.; Watering, L.M.G. van de; Oepkes, D.; Lopriore, E.; Cobbaert, C.M.; Brand, A. (2020)

Article / Letter to editor

Background and Objectives Alloantibodies against red-blood-cell (RBC) antigens often coincide with alloantibodies against leucocytes and platelets and sometimes with autoantibodies towards various antigens. Chimerism may be one of the factors responsible for the combination of allo- and autoantibodies. Women with alloantibodies against RBC antigens causing haemolytic disease of the fetus and neonate may need to receive intrauterine transfusions. These transfusions increase not only maternal antibody formation but also fetomaternal bleeding and may enhance fetal chimerism. We determined the prevalence of and risk factors for autoantibodies against some common clinical target antigens, in alloimmunized women after IUT.Materials and Methods We tested for autoantibodies against RBC, anti-thyroid peroxidase, anti-extractable nuclear antigens, anti-cyclic citrullinated proteins and anti-tissue transglutaminase. Women with and without autoantibodies were compared for age; number of RBC alloantibodies, pregnancies and IUTs, and other factors that may play a role in immunization.Results Non-RBC-targeted autoantibodies were present in 40 of 258 tested women (15 center dot 5%, with 90% anti-TPO specificity), comparable to the prevalence reported in healthy Dutch women of these ages. Surprisingly, compared with women who had a single RBC alloantibody, a significantly higher proportion of women with multiple RBC alloantibodies had autoantibodies (5 center dot 3% and 18 center dot 4%, respectively; odds ratio 4 center dot 06, 95% CI: 1 center dot 20-13 center dot 7). Other characteristics of women with and without autoantibodies were not different.Conclusion Multiple RBC alloantibodies after extensive allogeneic exposure during pregnancy and presumed increased fetomaternal chimerism are not associated with (selected) autoantibodies. Lack of allo-RBC multi-responsiveness seems associated with decreased auto(-TPO) antibody formation.

• alloantibodies
• autoantibodies
• red blood cells
• TPO antibodies
• transfusion

• All authors: Schonewille, H.; Watering, L.M.G. van de; Oepkes, D.; Lopriore, E.; Cobbaert, C.M.; Brand, A.
• Date: 2020-05-26
• Journal: Vox Sanguinis
• Volume: 115
• Issue: 8
• Pages: 783 - 789
• DOI: doi:10.1111/vox.12941
• Link: https://onlinelibrary.wiley.com/doi/10.1111/vox.12941