Finding out you have antibodies is a scary thing, but it doesn't have to be! Armed with the right knowledge, you can be informed about your baby's condition, and be a partner in your baby's health. If you're pregnant, pop on over to the Pregnancy page. If you're getting close to birth, check out the Birth page for more info on what needs to be done around birth. No matter where you are on your Iso journey, there's always Things to Think About. There's also some Info that's helpful to everyone. Whenever you see a number in parenthesis (1), it's a reference number. You can look this number up on the References page and see the exact medical article the information was sourced from.
This page exists to help women advocate for their babies. We do this by providing information to moms so they can better understand their disease; by increasing understanding of isoimmunization; and by raising public awareness about isoimmunization. All About Antibodies empowers women to be partners in their prenatal care. We are sharing information today to save the lives of tomorrow.
An Overview of Isoimmunization
What is Isoimmunization (Iso)?
Isoimmunization (also called alloimmunization), occurs when a woman’s immune system is sensitized to foreign blood cell antigens. This causes the woman to make antibodies that cross the placenta and destroy baby's blood cells (1).
During pregnancy, some of the mother's antibodies are transported across the placenta and enter the fetal circulation. This is necessary because newborns have only a primitive immune system, and the presence of maternal antibodies helps them survive while their immune system matures. A downside to this protection is that by targeting fetal blood cells, maternal antibodies can also cause HDN (2). Blood production in the fetus begins at about 3 weeks, and the baby's blood cells can have antigens on the red cell membrane as early as 38 days after conception (4).
Antibody? Antigen? What’s my body doing again?
Antigen – foreign protein on red blood cells of dad or baby
Antibody – made by mom to defend her body from the antigen
Antigens are foreign. Antibodies defend the body.
How it works
Dad makes the E antigen and passes it to baby. When baby’s blood and mom’s blood mix, mom’s blood finds the foreign antigen and makes antibodies to defend her body. This is called sensitization. The antibodies then find the foreign cells and destroy them in a process called hemolysis (hemo = cell, lysis = death). The next time mom’s sensitized body finds the E antigen, her antibodies are primed and ready to attack the foreign cells. So when mom has baby #2, who has dad’s E antigen, her antibodies cross the placenta and attack the baby’s blood.
How did I become sensitized?
The most common ways maternal sensitization occurs are (1):
Chorionic villus sampling
Percutaneous umbilical blood sampling
External cephalic version (trying to turn a breech baby)
Manual removal of the placenta (instead of spontaneous delivery of the placenta)
Why is Iso dangerous?
Isoimmunization is dangerous because the antibodies can cross the placenta during pregnancy and if the fetus is positive for the specific antigens, the fetal red blood cells are destroyed. This can result in anemia, hemolytic disease of the newborn (HDN), fetal hydrops (sometimes fatal), and more (1).
If you are sensitized, it is NOT a death sentence for your baby, and it does not mean you cannot have additional children. Advancements in fetal surveillance and treatment allow for successful outcomes for most of the affected fetuses. For the Rh D- woman, the drug Rhogam has reduced the risk of sensitization to less than 1% of susceptible pregnancies. Because of this other alloantibodies have increased in relative importance. These include antibodies to other antigens of the Rh blood group system (ie, c, C, e, E) and other atypical antibodies known to cause severe anemia, such as anti-Kell (ie, K, k), anti-Duffy (ie, Fya), and anti-Kidd (ie, Jka, Jkb) (1).
How do I know if I have an antibody?
There is only one way to know if you have an antibody, you have to get tested. Routine antibody screening is done in the US on all pregnancies (unless refused) as part of the basic prenatal blood work.
What do I do? Where do I start?
Start by keeping a binder or folder. Use this to write down all your questions (and the doctor's answers). No question is silly. It is important that you are informed and able to actively participate in your care and advocate for your baby. Ask for copies of all your test results and keep them in your folder. Don't forget to get a copy of each ultrasound report and MCA scan (complete with all the PSV values, not just the highest or lowest). This way you can see how things are changing and how baby is doing. This is also helpful if you have to have multiple doctors. Sometimes things don't always get passed along between offices, so it is very important to have your own record. It is also a great place to put keepsakes such as ultrasound photos, bracelets, etc. Consider having someone come with you to tests and appointments for support or to drive you home after procedures. The printables on the Info page are a great place to get started with things to put in your folder.
You also need to get a medical alert card for your wallet or a medical alert bracelet. Mine says “Transfusion Alert: Anti-E”. This is important even after you're not pregnant. If you are ever in an accident or unconscious and need blood, you do not want to have a life threatening transfusion reaction. Some blood banks, hospitals, or doctor's offices will provide them for you. There are also multiple places online where you can order a bracelet, or in the pharmacy section of our local Meijer, there is a USB medical alert card that you can put your entire medical record, not just your antibody status. Some cell phones have an In Case of Emergency or ICE section where you can write your antibody status and include emergency contact information for your MFM too. I’ve attached a printable medical alert card here, and there's one on the Info page.
A visual of how antibodies need to match their antigen on the blood cell or they cannot bind. The blood cell on the right has no antigens. The green antibody does not have anything to grab on to so it cannot attack the cell. The blood cell on the right has 2 DIFFERENT antigens. In this illustration, the green antibody has a square shape and needs a square antigen in order to attack. The green antibody cannot bind to the triangle shaped antigens. It is specific to the squares.
As a quick recap:
Step 1: Get a medical alert card or bracelet. There’s one on the Info page.
Step 2: Start a notebook or binder.
Step 3: Get your current titers: ________________.
Step 4: Get dad phenotyped for the antigen(s). Dad is __ __.
Step 5: Get a referral to MFM for a treatment plan. Ask questions such as:
Draw titers every _____________________.
Come back when titers reach ___________.
Will you consult with other doctors? ________
Start MCA scans at _____ weeks.
Repeat MCA scans every ______________.
Start BPPs at _____ weeks. Repeat every ______.
Start NSTs at _____ weeks. Repeat every ______.
Is IVIG an option? _________
The earliest start for IVIG is ____________.
The latest start for IVIG is _____________.
Will the Dr do IUTs? ________
How many IUTs have you done? _______
What is your success rate? __________
The earliest the Dr can do IUTs is _______.
The latest the Dr will do IUTs is _________.
Will the Dr induce? _______
Induce at _____ weeks if titers are below critical.
Induce at _____ weeks if MCAs are good.
Induce at _____ weeks if MCAs are bad.