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Alloimmune hemolytic disease of the fetus and newborn: genetics, structure, and function of the commonly involved erythrocyte antigens

Journal of Perinatology volume 43, pages 1459–1467 (2023)Cite this article

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Abstract

Hemolytic disease of the fetus and newborn (HDFN) can occur when a pregnant woman has antibody directed against an erythrocyte surface antigen expressed by her fetus. This alloimmune disorder is restricted to situations where transplacental transfer of maternal antibody to the fetus occurs, and binds to fetal erythrocytes, and significantly shortens the red cell lifespan. The pathogenesis of HDFN involves maternal sensitization to erythrocyte “non-self” antigens (those she does not express). Exposure of a woman to a non-self-erythrocyte antigen principally occurs through either a blood transfusion or a pregnancy where paternally derived erythrocyte antigens, expressed by her fetus, enter her circulation, and are immunologically recognized as foreign. This review focuses on the genetics, structure, and function of the erythrocyte antigens that are most frequently involved in the pathogenesis of alloimmune HDFN. By providing this information we aim to convey useful insights to clinicians caring for patients with this condition.

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Fig. 1: Schematic structure of the erythrocyte surface antigens that are most commonly involved in moderate to severe HDFN.
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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA

    Robert D. Christensen, Timothy M. Bahr & Donna S. Dizon-Townson

  2. Obstetric and Neonatal Operations, Intermountain Health, Salt Lake City, UT, USA

    Robert D. Christensen & Timothy M. Bahr

  3. Intermountain Health Transfusion Services and Department of Pathology, Intermountain Medical Center, Murray, UT, USA

    Sarah J. Ilstrup

  4. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, and Intermountain Health, Salt Lake City, UT, USA

    Donna S. Dizon-Townson

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RDC, conception, writing first draft, revising manuscript, final approval of the manuscript. TMB, conception, revising manuscript, final approval of the manuscript. SJI, conception, revising manuscript, final approval of the manuscript. DSD-Z, conception, revising manuscript, final approval of the manuscript.

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Christensen, R.D., Bahr, T.M., Ilstrup, S.J. et al. Alloimmune hemolytic disease of the fetus and newborn: genetics, structure, and function of the commonly involved erythrocyte antigens. J Perinatol 43, 1459–1467 (2023). https://doi.org/10.1038/s41372-023-01785-3

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