title: IgG1 and IgG3 anti-D in maternal serum and on the RBCs of infants suffering from HDN: relationship with the severity of the disease.
abstract: BACKGROUND
  Anti-D IgG antibodies that are responsible for severe cases of HDN belong chiefly to IgG1 and IgG3 subclasses. The relationship between the concentrations of IgG1 anti-D and IgG3 anti-D in maternal serum and the amount bound to the surface of infants' RBCs is not known. In addition, the contribution of the two subclasses to the severity of HDN is not well established.
  
  
  METHODS
  Blood samples from 40 infants suffering from severe forms of HDN due to anti-D were collected before transfusion together with sera from their respective mother. The amount of total anti-D IgG as well as IgG1 anti-D and IgG3 anti-D on infants' RBCs and the concentration in maternal sera were determined by ELISA.
  
  
  RESULTS
  The median percentages of IgG1 anti-D and of IgG3 anti-D in maternal sera were 90 and 10 percent, respectively, whereas on infants' RBCs they were 97 and 3 percent, respectively. The differences between maternal and infantile percentages were significant (p < 0.001). IgG1 and IgG3 anti-D bound to infants' RBCs increased concomitantly with the concentration of IgG1 and IgG3 anti-D in maternal sera. The severity of HDN correlated positively with the concentration of IgG1 anti-D in maternal sera, but negatively with the amount of IgG3 anti-D bound to infants' RBCs. In addition, the existence of a high proportion of IgG3 anti-D in maternal serum was associated with a delayed risk of fetal anemia.
  
  
  CONCLUSIONS
  The proportion of IgG3 anti-D relative to the total anti-D IgG on infants' RBCs is only one- third of the proportion present in maternal serum. The study of the correlations between the amount of IgG1 anti-D and IgG3 anti-D and the severity of HDN suggests that IgG1 anti-D are more important than IgG3 anti-D in the pathogenesis of fetal anemia.
authors.affiliation: Immunology Transfusion Unit, National Institute of Blood Transfusion, Paris, France. plambin@ints.fr
authors.forename: Patrick
authors.initials: P
authors.lastname: Lambin
authors.forename: Martine
authors.initials: M
authors.lastname: Debbia
authors.forename: Philippe
authors.initials: P
authors.lastname: Puillandre
authors.forename: Yves
authors.initials: Y
authors.lastname: Brossard
mesh_terms: D000328:Adult; D001805:Blood Transfusion, Intrauterine; D004797:Enzyme-Linked Immunosorbent Assay; D004899:Erythroblastosis, Fetal / Q000097:blood / Q000209:etiology / Q000276:immunology*; D004912:Erythrocytes / Q000276:immunology*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood* / Q000145:classification; D007132:Immunoglobulin Isotypes / Q000097:blood*; D007231:Infant, Newborn; D009035:Mothers; D011247:Pregnancy; D018029:Rho(D) Immune Globulin / Q000097:blood*; D012720:Severity of Illness Index
chemical_list: D007074:Immunoglobulin G; D007132:Immunoglobulin Isotypes; D018029:Rho(D) Immune Globulin