Abstract：
Hemolytic disease of the fetus and newborn (HDFN) is characterized by destruction of fetal/neonatal red blood cells (RBCs) secondary to maternally derived antibodies, which are typically thought to be passively acquired via placental transfer. Few cases have examined the possibility of HDFN mediated by maternal antibodies passively transferred via breast milk.
We describe two cases of persistent HDFN in infants potentially mediated by passively acquired antibodies via maternal breast milk. We discuss supporting and refuting evidence that may account for this possibility and describe testing methodology illustrating how maternal alloantibodies can be detected in breast milk.
In both cases, anti-D antibodies were detected in maternal breast milk. One patient experienced a significant decrease in anti-D plasma titer from 64 to 4 dilutions following 2 weeks of breastfeeding cessation. The other patient experienced a resolution of anemia without breastfeeding cessation.
There is a paucity of data regarding the lifespan of passively acquired RBC antibodies in neonatal circulation, with significant variation noted between passively acquired IgG based on studies utilizing intravenous immunoglobulin compared to studies of maternally-acquired antiviral IgG antibodies. While our data do not definitively implicate passive transfer of alloantibodies in breast milk as a mediator of HDFN, they do illustrate the need for further investigation into the mechanisms and kinetics of passively acquired antibodies in neonatal circulation.
We describe two cases of persistent HDFN in infants potentially mediated by passively acquired antibodies via maternal breast milk. We discuss supporting and refuting evidence that may account for this possibility and describe testing methodology illustrating how maternal alloantibodies can be detected in breast milk.
In both cases, anti-D antibodies were detected in maternal breast milk. One patient experienced a significant decrease in anti-D plasma titer from 64 to 4 dilutions following 2 weeks of breastfeeding cessation. The other patient experienced a resolution of anemia without breastfeeding cessation.
There is a paucity of data regarding the lifespan of passively acquired RBC antibodies in neonatal circulation, with significant variation noted between passively acquired IgG based on studies utilizing intravenous immunoglobulin compared to studies of maternally-acquired antiviral IgG antibodies. While our data do not definitively implicate passive transfer of alloantibodies in breast milk as a mediator of HDFN, they do illustrate the need for further investigation into the mechanisms and kinetics of passively acquired antibodies in neonatal circulation.
摘要：
背景：胎儿和新生儿的溶血病（HDFN）的特征是继发于母源抗体的胎儿/新生儿红细胞（RBC）的破坏，通常被认为是通过胎盘转移被动获得的。很少有病例检查了通过母乳被动转移的母体抗体介导的HDFN的可能性。
方法：我们描述了两例婴儿持续性HDFN可能通过母体母乳被动获得抗体介导的病例。我们讨论了可能解释这种可能性的支持和驳斥证据，并描述了说明如何在母乳中检测母体同种抗体的测试方法。
结果：在这两种情况下，在母乳中检测到抗D抗体.一名患者在停止母乳喂养2周后，抗D血浆滴度从64稀释度显著降低至4稀释度。另一名患者在没有停止母乳喂养的情况下经历了贫血的解决。
结论：关于新生儿循环中被动获得的红细胞抗体的寿命的数据很少，与母体获得的抗病毒IgG抗体研究相比，基于使用静脉内免疫球蛋白的研究的被动获得IgG之间存在显着差异。虽然我们的数据没有明确暗示母乳中同种抗体作为HDFN的介质的被动转移，他们确实表明需要进一步研究新生儿循环中被动获得抗体的机制和动力学。
方法：我们描述了两例婴儿持续性HDFN可能通过母体母乳被动获得抗体介导的病例。我们讨论了可能解释这种可能性的支持和驳斥证据，并描述了说明如何在母乳中检测母体同种抗体的测试方法。
结果：在这两种情况下，在母乳中检测到抗D抗体.一名患者在停止母乳喂养2周后，抗D血浆滴度从64稀释度显著降低至4稀释度。另一名患者在没有停止母乳喂养的情况下经历了贫血的解决。
结论：关于新生儿循环中被动获得的红细胞抗体的寿命的数据很少，与母体获得的抗病毒IgG抗体研究相比，基于使用静脉内免疫球蛋白的研究的被动获得IgG之间存在显着差异。虽然我们的数据没有明确暗示母乳中同种抗体作为HDFN的介质的被动转移，他们确实表明需要进一步研究新生儿循环中被动获得抗体的机制和动力学。
