The hemolytic disease of the newborn (HDN) continues to be a clinical problem in spite of prophylaxis. To date, none of the available tests, developed to predict the severity of HDN, has provided complete reliability. The objective of the present study was to determine the IgG1 and IgG3 subclasses in 42 isoimmunized pregnant women, and to correlate them with clinical severity of hemolytic disease. The IgG subclasses were determined employing flow cytometry. According to the clinical severity of HDN, fetuses and newborn babies were classified as 13 mild, 16 moderate and 13 severe cases. The IgG subclasses were detected in 33 of the 42 pregnant women. Of these, IgG1 was predominant in 72.7% of the cases; either isolated (42.4%) or in association with IgG3 (30.3%). IgG1 was present in all the three clinical severity categories, however, its values were significantly higher in cases with greater clinical severity of HDN (p<0.01). On the other hand, the distribution of IgG3 values within each group was not statistically significant (p=0.11). IgG3 seems to be more associated with the mild hemolytic form of the disease, whereas the association of IgG1 and IgG3 suggested a clinically more severe form of HDN. It is possible, however, that the severity in these cases is related to the presence of IgG1. These results suggest that IgG1 and IgG3 isotypes should be included in multi-parametric protocols for the evaluation of clinical severity of HDN, as International literature does not give support to the use of IgG subclass determination alone as a reliable indicator to predict severity or prognosis of the disease.
IgG subclasses; hemolytic disease of newborn; maternal isoimmunization; IgG1; IgG3
