Análise dos aspectos imuno-hematológicos na condução da doença hemolítica perinatal no Hospital Naval Marcílio Dias.

Abstract

Introduction: Hemolytic disease of the fetus and newborn (HDFN) is a pathology that begins in utero and may extend to the neonatal period, triggered by the hemolytic action of maternal antibodies on fetal erythrocyte antigens. Serological, clinical and molecular tests performed during prenatal care represent essential tools in pregnancy follow-up, allowing the monitoring of fetal anemia progression and ensuring the adoption of appropriate therapy to improve the newborn's prognosis. Objective: To analyze the prenatal and postpartum immunohematological tests requested at Hospital Naval Marcílio Dias to assist in the laboratory diagnosis of HDFN. Methods: Cross-sectional descriptive and retrospective study, based on manual and computerized records of exams performed in pregnant women and their respective newborns affected by HDFN, attended at the HNMD in the period from January 2011 to December 2019. Results: Of the 27 pregnancies analyzed, 17 (63%) alloimmunizations occurred after the first pregnancy and, although RhD positive pregnant women were the most affected (n=17 / 63%), the most frequent maternal erythrocyte antibody was anti-D (n=10 / 37.0%). Irregular antibody testing was requested during prenatal care for 17 pregnant women (63%), of whom 10 (58.8%) had at least one request request for repeat testing during pregnancy and eight (29.6%) had critical titer ≥16. Noninvasive complementary exams were performed in six pregnant women (22.2%) and eight newborns (29.6%) received treatment for HDFN. Conclusion: The analyses performed reinforced the importance of the correct and comprehensive use of immunohematological tests in the investigation of maternal alloimmunization and in the follow-up of newborns affected by HDFN. The study proposes protocol recommendations for perinatal care.