An Overview of Isoimmunization
Understanding your disease is so important to helping get your baby here safely. This page will explain the disease and what is going on inside your body.
What is Isoimmunization (Iso)?
Isoimmunization (also called alloimmunization), occurs when a woman’s immune system is sensitized to foreign blood cell antigens. This causes the woman to make antibodies that can cross the placenta and destroy baby's blood cells (1).
During pregnancy, some of the mother's antibodies are transported across the placenta and enter the fetal circulation. This is necessary because newborns have only a primitive immune system, and the presence of maternal antibodies helps them survive while their immune system matures. A downside to this protection is that by targeting fetal blood cells, maternal antibodies can also cause HDN (2). Blood production in the fetus begins at about 3 weeks, and the baby's blood cells can have antigens on the red cell membrane as early as 38 days after conception (4).
Antibody? Antigen? What’s my body doing again?
Antigen – foreign protein on red blood cells of dad or baby
Antibody – made by mom to defend her body from the antigen
Antigens are foreign. Antibodies defend the body.
How it works
Dad makes the E antigen and passes it to baby. When baby’s blood and mom’s blood mix, mom’s blood finds the foreign antigen and makes antibodies to defend her body. This is called sensitization. The antibodies then find the foreign cells and destroy them in a process called hemolysis (hemo = cell, lysis = death). The next time mom’s sensitized body finds the E antigen, her antibodies are primed and ready to attack the foreign cells. So when mom has baby #2, who has dad’s E antigen, her antibodies cross the placenta and attack the baby’s blood.
A visual of how antibodies need to match their antigen on the blood cell or they cannot bind. The blood cell has 3 antigens - a star, a diamond, and a hexagon. The pink antibody has diamond shaped receptors, so it needs a diamond antigen to grab onto. No matching antigen = no attack. If the antibody does not have anything to grab on to then it cannot attack the cell.
How did I become sensitized?
The most common ways maternal sensitization occurs are (1):
Chorionic villus sampling
Percutaneous umbilical blood sampling
External cephalic version (trying to turn a breech baby)
Manual removal of the placenta (instead of spontaneous delivery of the placenta)
Why is Iso dangerous?
Isoimmunization is dangerous because the antibodies can cross the placenta during pregnancy and if the fetus is positive for the specific antigens, the fetal red blood cells are destroyed. This can result in anemia, hemolytic disease of the fetus and newborn (HDFN), fetal hydrops (sometimes fatal), and more (1).
If you are sensitized, it is NOT a death sentence for your baby, and it does not mean you cannot have additional children. Advancements in fetal surveillance and treatment allow for successful outcomes for most of the affected fetuses. For the Rh D- woman, the drug Rhogam has reduced the risk of sensitization to less than 1% of susceptible pregnancies. Because of this other alloantibodies have increased in relative importance. These include antibodies to other antigens of the Rh blood group system (ie, c, C, e, E) and other atypical antibodies known to cause severe anemia, such as anti-Kell (ie, K, k), anti-Duffy (ie, Fya), and anti-Kidd (ie, Jka, Jkb) (1).
How do I know if I have an antibody?
There is only one way to know if you have an antibody, you have to get tested. Routine antibody screening is done in the US on all pregnancies (unless refused) as part of the basic prenatal blood work.
What do I do? Where do I start?
Start by keeping a binder or folder. Use this to write down all your questions (and the doctor's answers). No question is silly. It is important that you are informed and able to actively participate in your care and advocate for your baby. Ask for copies of all your test results and keep them in your folder. Don't forget to get a copy of each ultrasound report and MCA scan (complete with all the PSV values, not just the highest or lowest). This way you can see how things are changing and how baby is doing. This is also helpful if you have to have multiple doctors. Sometimes things don't always get passed along between offices, so it is very important to have your own record. It is also a great place to put keepsakes such as ultrasound photos, bracelets, etc. Consider having someone come with you to tests and appointments for support or to drive you home after procedures. The printables on the Info page are a great place to get started with things to put in your folder.
You are your baby's biggest advocate.
With proper treatment, you have every reason to expect a live baby.
We have great ways of monitoring baby now and several options for helping earlier than ever.
Your baby is not automatically going to be anemic, brain damaged, or anything else.
You can have a perfectly healthy baby when this is over.
You can have more children.