BEYOND THE BLOOD GROUP O MOTHERS: EVALUATION OF THE ANTIBODIES IGG ANTI-A AND ANTI-B EXTRACTED BY ELUTION TECHNIQUES IN ABO NEWBORN INCOMPATIBILITIES
- 1Hospital das Clínicas da Universidade Federal de Pernambuco (UFPE), Recife, Brazil
Abstract
Background: The hemolytic disease of the fetus and newborn (HDFN) happens due to IgG antibodies and their capacity to cross the placental barrier and induce fetal or neonatal hemolysis. Although classically associated with blood group O mothers, IgG antibodies from blood group A and B mothers could happen but with unclear relevance. The elution technique enables the detection of antibodies bound to neonatal erythrocytes and may provide an understanding of erythrocyte sensitization in these cases. Objective: To evaluate the presence and intensity of anti-A and anti-B IgG antibodies bound to erythrocytes of newborns with ABO incompatibility, born to non-O mothers, using the elution technique, and their association with the occurrence of HDFN. Methodology: Documentary, retrospective, observational, and quantitative study conducted at Federal University Hospital in Recife, between April and December 2025. Newborns with maternal-fetal ABO incompatibility born to non-O mothers were included. Erythrocyte elution was performed using the freeze-thaw technique (LUI). HDFN was defined by a documented medical diagnosis or by the association between ABO incompatibility with clinical and laboratory evidence of hemolysis. Results: A total of 1,586 newborns were evaluated, of whom 340 (21.4%) presented maternal-fetal ABO incompatibility; among these, 95 (27.9%) were born to non-O mothers. Elution was positive in only 4/95 cases (4.2%), with an intensity of (2+) in three newborns and (1+) in one. The direct antiglobulin test (DAT) was positive in only one case and remained negative in the others. Three newborns had a positive eluate despite a negative DAT, demonstrating the higher sensitivity of elution in detecting mild erythrocyte sensitization. None of the patients had maternal irregular antibodies. Two were diagnosed with unspecified neonatal jaundice and one presented with clinical jaundice; however, none developed significant hyperbilirubinemia, anemia, reticulocytosis, or required phototherapy or other specific treatments for hemolysis. Discussion: The low frequency and intensity of erythrocyte sensitization observed suggest that, although group A and B mothers can produce anti-B or anti-A IgG capable of binding to fetal red blood cells, this response rarely reaches a sufficient magnitude to cause clinically significant HDFN. In contrast to group O mothers, who predominantly has anti-A, anti-B, and anti-AB IgG antibodies of higher titer and affinity, the immune response in non-O mothers appears to be limited, in most cases, to mild sensitization detectable by elution but without relevant hemolytic impact. The absence of HDFN among cases with negative DAT and eluate also suggests a high negative predictive value for this combination in this sample series. Conclusion: This study represents one of the few systematic evaluations of anti-A/anti-B IgG erythrocyte sensitization in ABO incompatibilities involving non-O mothers. Eluate positivity was rare, with low intensity, and was not clinically significant to HDFN. The findings indicate a low therapeutic impact in this subgroup, contributing to the refinement of risk stratification and the rationalization of the diagnostic approach to perinatal ABO incompatibility.
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BibTeX
@article{dunes2026beyond,
title = {{BEYOND THE BLOOD GROUP O MOTHERS: EVALUATION OF THE ANTIBODIES IGG ANTI-A AND ANTI-B EXTRACTED BY ELUTION TECHNIQUES IN ABO NEWBORN INCOMPATIBILITIES}},
author = {Cícero Anthonyelson Teixeira DUNES and Clécia Maria Carvalho OLIVEIRA and Patrícia Menezes ARAÚJO and Karina Mendes MELCHUNA and Elisângela Oliveira SILVA},
journal = {Hematology, Transfusion and Cell Therapy},
year = {2026},
month = oct,
doi = {10.1016/j.htct.2026.106974},
url = {https://doi.org/10.1016/j.htct.2026.106974},
note = {CC BY},
}
RIS
TY - JOUR
TI - BEYOND THE BLOOD GROUP O MOTHERS: EVALUATION OF THE ANTIBODIES IGG ANTI-A AND ANTI-B EXTRACTED BY ELUTION TECHNIQUES IN ABO NEWBORN INCOMPATIBILITIES
AU - Cícero Anthonyelson Teixeira DUNES
AU - Clécia Maria Carvalho OLIVEIRA
AU - Patrícia Menezes ARAÚJO
AU - Karina Mendes MELCHUNA
AU - Elisângela Oliveira SILVA
PY - 2026
DA - 2026/10/23
JO - Hematology, Transfusion and Cell Therapy
DO - 10.1016/j.htct.2026.106974
UR - https://doi.org/10.1016/j.htct.2026.106974
AB - Background: The hemolytic disease of the fetus and newborn (HDFN) happens due to IgG antibodies and their capacity to cross the placental barrier and induce fetal or neonatal hemolysis. Although classically associated with blood group O mothers, IgG antibodies from blood group A and B mothers could happen but with unclear relevance. The elution technique enables the detection of antibodies bound to neonatal erythrocytes and may provide an understanding of erythrocyte sensitization in these cases. Objective: To evaluate the presence and intensity of anti-A and anti-B IgG antibodies bound to erythrocytes of newborns with ABO incompatibility, born to non-O mothers, using the elution technique, and their association with the occurrence of HDFN. Methodology: Documentary, retrospective, observational, and quantitative study conducted at Federal University Hospital in Recife, between April and December 2025. Newborns with maternal-fetal ABO incompatibility born to non-O mothers were included. Erythrocyte elution was performed using the freeze-thaw technique (LUI). HDFN was defined by a documented medical diagnosis or by the association between ABO incompatibility with clinical and laboratory evidence of hemolysis. Results: A total of 1,586 newborns were evaluated, of whom 340 (21.4%) presented maternal-fetal ABO incompatibility; among these, 95 (27.9%) were born to non-O mothers. Elution was positive in only 4/95 cases (4.2%), with an intensity of (2+) in three newborns and (1+) in one. The direct antiglobulin test (DAT) was positive in only one case and remained negative in the others. Three newborns had a positive eluate despite a negative DAT, demonstrating the higher sensitivity of elution in detecting mild erythrocyte sensitization. None of the patients had maternal irregular antibodies. Two were diagnosed with unspecified neonatal jaundice and one presented with clinical jaundice; however, none developed significant hyperbilirubinemia, anemia, reticulocytosis, or required phototherapy or other specific treatments for hemolysis. Discussion: The low frequency and intensity of erythrocyte sensitization observed suggest that, although group A and B mothers can produce anti-B or anti-A IgG capable of binding to fetal red blood cells, this response rarely reaches a sufficient magnitude to cause clinically significant HDFN. In contrast to group O mothers, who predominantly has anti-A, anti-B, and anti-AB IgG antibodies of higher titer and affinity, the immune response in non-O mothers appears to be limited, in most cases, to mild sensitization detectable by elution but without relevant hemolytic impact. The absence of HDFN among cases with negative DAT and eluate also suggests a high negative predictive value for this combination in this sample series. Conclusion: This study represents one of the few systematic evaluations of anti-A/anti-B IgG erythrocyte sensitization in ABO incompatibilities involving non-O mothers. Eluate positivity was rare, with low intensity, and was not clinically significant to HDFN. The findings indicate a low therapeutic impact in this subgroup, contributing to the refinement of risk stratification and the rationalization of the diagnostic approach to perinatal ABO incompatibility.
SN - 2531-1379
SN - 2531-1387
ER -