Original article

Blood Transfusion - 2 2021 (March-April)

Successful prenatal management of two foetuses affected by antibodies against GP.Mur with prenatal genotyping analysis and a literature review

Authors

Key words: antibodies against GP.Mur, Mi.III, haemolytic disease of the foetus and newborn, high-resolution melting method, intrauterine transfusion
Publication Date: 2020-10-09

Abstract

Background - GP.Mur belongs to the GP(B-A-B) hybrid glycophorin family, which is the most common hybrid glycophorin in Southeast Asia. Antibodies against GP.Mur may cause a clinically significant haemolytic disease of the foetus and newborn (HDFN) although, so far, not many cases have been reported in mainland China.
Materials and methods - Two Chinese women with a history of severe hydrops foetalis were seen in our centre. Alloantibody identification and GYP.Mur genotyping analysis were used for prenatal evaluation. Intrauterine transfusion was performed in two pregnancies in case 1. The features of these two women are described and literature-reported cases of HDFN related to antibodies against GP.Mur are summarised.
Results - The phenotype of both mothers was Mia- Mur-, while the fathers’ was Mia+ Mur+ with a heterozygous GYP.Mur hybrid gene as determined by a high-resolution melting method of genotyping. In case 1, the antibodies against GP.Mur were detected in the mother’s serum and the cord blood of two foetuses. Fortunately, the latest foetus was successfully saved after intrauterine transfusion. In case 2, hydrops foetalis occurred in the first two pregnancies, but the risk of HDFN was excluded for the third foetus because of the GP.Mur negative phenotype. The literature review showed that 68.8% (11/16) of the reported cases of HDFN related to antibodies against GP.Mur occurred in the Chinese population, and that 37.5% (6/16) of them were cases of severe HDFN.
Discussion - More cases of severe HDFN caused by antibodies against GP.Mur are presumably undetected as GP.Mur cells are not included in the panel of obligatory screening tests in most Southeast Asian countries including mainland China. The high-resolution melting method for GYP.Mur genotyping and zygosity detection is helpful in prenatal management.

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Authors

Si Li - Department of Obstetrics, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

Ling Wei - Institute of Clinical Blood Transfusion, Guangzhou Blood Centre, Guangzhou, China

Qun Fang - Foetal Medicine Centre, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

Yanli Ji - Institute of Clinical Blood Transfusion, Guangzhou Blood Centre, Guangzhou, China

Lin Lin - Department of Obstetrics, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

Yu Gao - Department of Obstetrics, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

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