Prognostic Significance of Anti-D IgG Subclasses with Severity of Hemolytic Disease of Fetus and Newborn| Chapter 1 | Medicine and Medical Research: New Perspectives Vol. 6

 

Aim: According to the literature, HDFN cases with IgG1 and IgG3 have more severity compared to IgG2 and IgG4.The aim of this study was to investigate the influence of subclasses to IgG anti-D on the intensity of Hemolytic Disease of Fetus and Newborn (HDFN) in North Macedonia.

 

Materials and Methods: In retrospective and prospective studies, in a period of 10 years, from 2004 to 2014, there have been immunohematology tests performed on 22,009 samples on serums of pregnant women. The tests were performed with column agglutination method for: ABO blood groups, Rh phenotype, detection and identification of alloantibodies.

 

Results: From the total number of anti-D IgG1, IgG3 senzibilised pregnant women at 37.78% IgG1 and IgG3 were the reason for severe HDFN. At 17.77% of the total, cases with only IgG1 detected were responsible for varying intensities of hemolytic disease of the fetus (HDF), ranging from serious to mild, depending on the titer levels. The correlation of the titer to anti-D antibodies in the mother’s serum and the intensity of HDFN were researched in 48 newborns. The titers between 1:8 and 1:32 resulted in 3 cases of HDFN with symptoms of severe disease and in 4 cases there were no signs of HDFN. At 12 women that had a titer between 1:32 and 1:512, five of the newborns developed severe HDFN, and seven had symptoms of mild and weak intensity form. In 3 cases, the titer was higher than 512, and out of them one newborn had weak symptoms of HDFN, one developed severe HDFN and one ended with fetal death. Only in one case, the titer reached a value higher than 1000, and it ended with a fetal death.

 

Conclusions: The titers of the pregnant women's serum that are lower than 32 in most cases are not the cause for HDFN, instead of higher than 1000 which are usually provoke severe symptoms, so we can say that titers lower than 32 and those higher than 1000 can well predict HDFN. The titers of anti-D antibodies between 64 and 512 have no exact predictive value, by themselves. IgG1 and IgG3 subclasses of anti-D have no predictive value by themselves, and cannot foresee the outcome of HDFN. The severity of HDFN was significantly higher when IgG1 &/or IgG3 were present alone or in combination, compared to cases with the absence of IgG1 or IgG3. The research study results suggest that IgG1 and IgG3 should be included in a multi-parameter protocol for evaluation of the HDFN intensity. They can give a real assessment of the expected HDFN intensity in combination with the titer height and the significance of the antibodies.

 

Author (s) Details

Emilija Velkova
Institute of Transfusion Medicine in Republic of Macedonia, Vodnjanska 17, 1109 Skopje, Republic of Macedonia.

 

Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v6/1632

 

Migraine Prophylaxis: Comparing the Effect of Propranolol and Lisinopril | Chapter 8 | Pharmaceutical Research: Recent Advances and Trends Vol. 7

Background: Migraine is the most common and highly disabling neurological disorder. It is characterized by headaches, having at least five attacks that last 4–72 h, that are unilateral, pulsating, moderate or severe in intensity and aggravated by or cause avoidance of routine physical activity and are also accompanied by nausea/vomiting, and photophobia. Treatment of headaches can be either abortive or prophylactic. Here meaning of prophylactic treatment is to reduce the frequency or severity of headaches. Very few studies have been done regarding the safety and efficacy of lisinopril in migraine prophylaxis so the study focuses on prophylactic therapy for migraine.

 

Aim and Objective: The aim of the study was (i) to compare the effect of propranolol and lisinopril in migraine as prophylaxis and (ii) to assess the adverse drug reaction of lisinopril.

 

Materials and Methods: This was a prospective observational, open-label, and comparative study. Sixty outpatients diagnosed with Migraine in the medicine department, HIMS Hassan, and willing to give consent are included for 3 months. Thirty Patients/group, Group 1 – Lisinopril 5 mg/day od (once daily) and Group 2 – Propranolol 20 mg t.i.d. (three times a day) given regular treatment. All the patients were provided with a migraine diary and advised to record the number of attacks of migraine. Patients were followed up at the end of 1st and 3rd months. The change in the migraine frequency and pain intensity was checked (Visual Analog Scale) and also adverse drug reaction. All collected data were entered into an Excel Sheet and analyzed. Descriptive statistics and the Chi-square test were used.

 

Results: Migraine episodes and headache severity index were reduced by 84% and 43%, with lisinopril compared with propranolol. Other side effects were dizziness and, a tendency to faint was more with propranolol. Days with migraine were reduced in 11 participants for lisinopril. Eight patients reported an adverse effect like cough during lisinopril therapy.

 

Conclusion: Lisinopril has better prophylactic therapy in migraine. The smaller sample size and short duration of follow-up were the limitations of the study, highlighting the need for future studies on the efficacy of lisinopril for migraine prophylaxis.

 

Author (s) Details

Neelamma P
Department of Pharmacology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India.

 

Nalini GK
Department of Pharmacology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India.

 

Suresh RM
Department of Medicine, Hassan Institute of Medical Sciences, Hassan, Karnataka, India.

 

Deepak P
Department of Pharmacology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India.

Sahana GN
Department of Pharmacology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India.

 

Jayashree VN
Department of Pharmacology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India.

 

Bhavishya Keerthi Anna Valder
Department of Pharmacology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/prrat/v7/2338

Significance of Immunohematology Testing in the Management of Hemolytic Disease of the Newborn in the Republic of Macedonia | Chapter 2 | Achievements and Challenges of Medicine and Medical Science Vol. 13

Background: The hemolytic disease of the fetus and the newborn (HDFN) is a clinical syndrome at which the basic patho-physiological disorder represents a hemolytic anemia of the fetus or the newborn.

Aim: Prompt discovery of allosensibilisation to RBC’s antigens during pregnancy and successful management of HDFN in the Republic of Macedonia, in order to decrease morbidity and mortality of the fetus and the newborn.

Materials and Methods: The study comprises in total 23,800 patients, 14,858 pregnant women and 8,842 newborn babies. The immune-hematological testing for all pregnant women has been executed in the immunehematology laboratory at the Institute for Transfusion Medicine in Republic of Macedonia.

Results: The screening and identification of anti-RBC’s antibodies detected in a total of 216 alloantibodies, out of which 81% (175) had a clinical significance. Out of the above-mentioned 164 alloantibodies (65.9%) belong to the Rh system. The most often reason for a severe hemolytic disease is the anti-D antibody. The HDFN symptoms of mild and moderate degrees were demonstrated in 32.5%, and 18.9% had symptoms of severe fetal suffering, and almost half of them (48%) were with or with mild HDFN and had no need for therapy. In 15% it was about alloantibodies of other Rh antigens: anti-C, anti-E and anti-c, at which in most cases there were no signs of HDFN, or it showed weak symptoms (89%), just one case of anti-c ended with intrauterine death.

Conclusions: Still, a hemolytic disease of the fetus and the newborn caused by anti-D is one of the most often reasons for HDFN in most underdeveloped countries in the world. Anti-D antibody represents a need of intrauterine transfusion and exsanguino transfusion. Anti-c is the only antibody that demonstrated the same potential for severe HBN as the anti-D. The most often reason for alloimmunisation of the mother is the lack of RhIG prophylaxis (97.8): postnatal, antenatal and in case of possible sensible conditions during pregnancy. It is recommended to adopt a national program for RhIG prophylaxis in the Republic of Macedonia.

 

Author (s) Details

 

Emilija Velkova
Institute of Transfusion Medicine in Republic of Macedonia, Vodnjanska 17, 1109 Skopje, Republic of Macedonia.

 

Please see the book here:- https://doi.org/10.9734/bpi/acmms/v13/3716