What is a serological conflict? When does it occur and what are its effects?

What are blood types?

Blood type is determined by proteins (antigens) that are present on the surface of blood cells – especially red blood cells (erythrocytes). They organize themselves into different systems, so in humans several groups are distinguished. According to the best-known division, they are: A, B, AB and 0. However, the Rh system, which consists of 5 antigens, is also very important: D, C, c, E, e. If the first one is present on the surface of erythrocytes, the person is referred to as Rh+ . The others, however, are Rh- blood.

What is a serological conflict?

Serological conflict occurs when there is an incompatibility in blood type – especially the Rh system – between mother and child. It leads to the activation of an immune response in the mother’s body, resulting in the production of antibodies (anti-D) directed against the baby’s blood cells.

How does a serological conflict occur?

When is there a serological conflict? It occurs in circumstances where:

• The pregnant woman has Rh- blood type and her partner Rh+;
• The child will inherit the antigen system on red blood cells from the father;
• A certain amount of the baby’s fluid will enter the mother’s blood.

In the vast majority of cases, a serological conflict in the first pregnancy may not occur until delivery. This is when the baby’s blood is most likely to enter the woman’s circulatory system. This is because throughout intrauterine life, the bloodstreams of mother and fetus are separated by the placental barrier. For this reason, the pregnant woman’s body cannot produce anti-D antibodies beforehand. It is important to realize that a serological conflict in the first pregnancy is possible (for example, when the placenta detaches, so that the blood of the fetus enters the mother’s body).

It is possible to have a serological conflict when there is incompatibility in other blood systems. We are mainly talking about the situation in which the pregnant woman has group 0, and her child inherits the group with A or B antigens from his dad. However, this is a rare situation.

It is worth adding that serological conflict does not occur when:

• The woman is Rh+, and her partner is Rh-;
• The child will not inherit the Rh+ group from his dad,
• The woman and her partner have the Rh- group.

Serological conflict – symptoms

Blood conflict during pregnancy does not usually manifest itself in women. The exception to this is when she develops a polycystic condition that can contribute to problems associated with an excessively enlarged abdominal girth. Symptoms of the condition, however, are visible in the fetus and include:

• anemia,
• thrombocytopenia,
• early jaundice with predominantly free bilirubin of varying degrees of severity,
• Liver and spleen enlargement,
• edema in the form of the presence of free fluid in the abdominal cavity, pleural cavities or pericardial sac.

How to recognize a serological conflict?

The basic test that detects the risk of serological conflict is to check the presence of immune antibodies in the blood serum of the Rh- group mother-to-be. Such a test should be repeated every approx. 2 months. If the doctor diagnoses a serological conflict, then it is necessary for the parent to be under constant specialized control. It is also necessary to perform a systematic ultrasound to measure blood flow in the toddler’s brain artery. This is because too rapid and intense a flow can indicate anemia, requiring cordocentesis, which is the puncture of the umbilical cord and direct evaluation of the morphology of his blood.

The consequences that come with serological conflict

Complications of serological conflict are particularly dangerous for the child. As a result of abnormalities, he may develop an immune-mediated disease that eventually even leads to death. This is the so-called. Hemolytic disease of the newborn, which is characterized by the fact that the baby’s blood cells are attacked by anti-D antibodies. As a result, they break down, anemia develops, hypoxia occurs and internal organs are damaged.

Treatment of serological conflict (more specifically, hemolytic disease) involves blood transfusions directly into the fetal bloodstream. In this way, anemia does not occur while the baby is in the womb. After birth, the newborn may be given phototherapy. When this is ineffective, a blood transfusion is required.

Serological conflict and second pregnancy

Anti-D antibodies stay in a woman’s body forever. For this reason, the risk of serological conflict in subsequent pregnancies may occur even before delivery. It is worth remembering that the phenomenon poses a real threat to the life of the child. To prevent such a situation, therefore, it is necessary to ensure that the mother’s bloodstream does not develop antibodies during childbirth during the first pregnancy.

Read also: Week 26 of pregnancy – what month is it? Baby’s weight, norms, ultrasound

Serological conflict – prevention and incidence

Serological conflict is a condition that can be prevented – especially since there is intra-pregnancy prophylaxis in Poland. The mother is given 300ug of anti-D immunoglobulin at 28. week of pregnancy and a second dose immediately after delivery, but no later than within 72 hours. Immunoglobulin is a substance that is produced from the blood, and it is designed to destroy the red blood cells of the fetus that have entered the mother’s blood. As a result of this method, the presence of antibodies is negligible, which minimizes the risk of future serological conflict.

Specialists have estimated that the occurrence of blood discrepancies between mother and child is becoming increasingly rare. It is still not a marginal problem, although thanks to effective immunoprophylaxis, the incidence of conflicts caused by Rh system D antigen range incompatibility has decreased.

FAQ:

• What are the factors affecting the risk of serological conflict?

The conflict occurs through the incompatibility of the mother’s blood and the baby’s. This can occur when a woman has Rh- blood type and her partner Rh+. Then there is the production of anti-D antibodies, which are particularly dangerous during the second pregnancy.

• When is anti-D immunoglobulin given to a woman?

Anti-D immunoglobulins are part of intrapregnancy prophylaxis and are used to prevent the production of harmful proteins. It is recommended to use them after childbirth, when the baby is diagnosed with Rh+ blood type, and in case of removal of ectopic pregnancy or heavy bleeding during pregnancy.

• What is the prognosis of serological conflict?

The development of immunoprophylaxis offers a promising chance for a healthy pregnancy. However, it is important to prevent as early as possible, as later management may prove more difficult for both the mother and her child.