Thyroid hormone in Immunoglobulin Density (IgGp), and postpartum haemorrhage: two case reports

Abstract


Background: The human foetus receives a passive immunization by selective passage across the placenta of maternal gamma immunoglobulin (IgG) by attaching to the constant fraction of neonatal receptor (FcRn) which is a specific IgG transporter. Two of the patients assayed hypothyroid had postpartum haemorrhage (PPH), incidentally also had very low mean thyroid hormone level which should normally increase in pregnancy.

Rationale/Aim: A probable relationship of immunoglobulin density (IgGp) of mothers, their thyroid hormone levels and postpartum haemorrhage was evaluated for possible clinical intervention.

Methodology: Twenty pregnant women were presented at our antenatal clinics and qualified for the inclusion criteria consented freely to participate in the investigation. Ex-vivo placental models of different thyroid states, as well as maternal blood from the antecubital vein and umblical cord blood (mixed blood) were taken within five minutes postpartum. The trafficking of IgG was investigated by immunohistochemical staining and pulsechased at 370C at neutral pH. Maternal thyroid hormone levels were also evaluated.

Results: The IgG in two hypothyroid cases with post partum haemorrhage was significantly (P<0.001) deficient in the sera and (P<0.01) in the other hypothyroids that had no PPH when compared with euthyroid mothers.

Conclusion: The thyroid hormone level of the mother suggests to be an obvious natural determinant of the passive immunization of the neonate and possible occurrence of post partum haemorrhage.

Keywords: Immunoglobulin density, Post-partum haemorrhage, thyroid hormones, hypothyroidism, immunization.

Résumé
Contexte : Le fœtus humain reçoit une vaccination passive par passage sélectif à travers le placenta de l’immunoglobuline gamma maternelle (IgG) en s’attachant à la fraction constante du récepteur néonatal (FcRn) qui est un transporteur IgG spécifique. Deux des patients hypothyroïdiens assayed ont eu l’hémorragie puerpérale (PPH), incidemment ont également eu le niveau moyen très bas d’hormone thyroïdienne qui devrait normalement augmenter dans la grossesse.

Justification / But : Une relation probable de densité d’immunoglobuline (IgGp) des mères, de leurs niveaux d’hormone thyroïdienne et de l’hémorragie puerpérale a été évaluée pour l’intervention clinique possible.
Méthodologie : Vingt femmes enceintes ont été présentées dans nos cliniques prénatales et qualifiées pour les critères d’inclusion qui ont consenti librement à participer à l’enquête. Des modèles placentéraux ex vivo de différents états thyroïdiens, ainsi que le sang maternel de la veine antecubitale et du sang de cordon ombilical (sang mélangé) ont été pris dans les cinq minutes du post-partum. Le trafic d’IgG a été étudié par coloration immunohistochimique et chassé à 370C au pH neutre. Des niveaux maternels d’hormone thyroïdienne ont été également évalués.

Résultats : L’IgG dans deux cas hypothyroïdiens avec l’hémorragie post-partum était significativement (P<0.001) déficient dans le sera et (P<0.01) dans les autres hypothyroïdes qui n’ont eu aucun PPH par rapport aux mères euthyroïdes.

Conclusion : Le niveau d’hormone thyroïdienne de la mère suggère d’être un déterminant normal évident de la vaccination passive du nouveau-né et de l’occurrence possible de l’hémorragie post-partum.

Mots-clés: Densité d’immunoglobuline, hémorragie post-partum, hormones thyroïdiennes, hypothyroïdie, immunisation.

Correspondence: Dr. K Amadi, Department of Human Physiology, College of Medical Sciences, University of Jos, Nigeria. Email: parkers2004amam@yahoo.com

pdf

References

Amadi K., Sabo A.M., Idah O.V., et al. The Influence of Thyroid Hormones on IgGñ and Apgar Score. IJBAIR; 2013., 2(4): 112-116.

Gitlin D., Kumate J., Urrusti, J and Morales C. The Selectivity of the Human Placenta in the Transfer of Plasma Proteins from Mother to Foetus. J. Clin. Invest; 1968., 43: 1938-1951.

Matre R., Tonder O. and Enderesen C. Fcã Receptors in Human Placenta. Scand. J. Immunol; 1975., 4: 741-745.

Goldstein J., Braverman M., Solafia C., Buckley, P. The Phenotype Human Placental Macrophages and its Variation with Gestational Age. Am. J. Pathol; 1988., 133: 648-659.

Micklem K.J., Stross W.P., Willis A.C. et al. Different Isoforms of Human FcRII Distinguished by CDw32 antibodies. J. Immunol; 1990., 144: 2295-2303.

Daniel D.S., Daniel H.D., Upinder S. et al. Expression of IgG Fc Receptor Antigens in Placenta and on Endothelial Cells in Human: An Immunohistochemical Study. A.J.P; 1991., 138(1): 175-181.

Ravetch J.V and Anderson C.L. Fc and Receptor Family. Proteins, Transcripts and Genes: In Metzger H.ed. Fc Receptors and the Action of Antibodies. Am. Soc. Microbial, Washington, D.C. 1990., 211-238.

Huizinga T.W.J., Roos D. and Von dem Borne, AEGKr. Neutrophil Fcã Receptors: A Two-way Bridge in the Immune System. Blood: 1990., 75: 1211-1214.

Johnson P.M., Trenchev P. and Faulk W.P. Immunological Studies of Human Placentae: Binding of Complexed Immunoglobulin by Stromal Endothelial Cells. Clin. Exp. Immunol; 1975., 22: 133-138.

Kristofferson, E.K. Human Placenta Fcã-Binding Proteins in the Maternofoetal Transfer of IgG. APIMS; 1996.,Suppl, 64: 5.

Schmidt, R.E. N4 Cluster Report: CDw32. In: Knap, W., Dorken, B., Gilks, W.R., Rether, P., Stein, H., Von dem Borne AEGK eds. Leucocyte Typing iv. White Cell Differentiation Antigens. New York. Oxford up. 1989., Pp 599.

Amadi K., Sabo A.M., Adelaiye A.B. and Sagay A.S. Dependence of Ca2+ Receptors on Thyroid Hormone for the Regulation of Cellular Functions. Nig. J. Physiol. Sci; 2005., 20 (1-2): 95 - 100.

Amadi K., Nwana E.J.C. and Otubu J.A.M. Morphology and Function of the Oviduct. Effects of Thyroidectomy and Thyroxine Administration. Afri. J. Med. Med. Sci; 2007., 36: 353- 360.

Payne R. Cord IgG and Duration of Labour. Lancet; 1969., 1: 372.

Cochran T.F. Foetal and Maternal Immunoglobulin Concentration at Delivery and Post Partum. J. Obstet. Gynae. Brit. C. Wlth; 1972., 79: 238-243.

Tumereo J.A. Antibody Transfer DuringLabour. Am. J. Obstet. Gynaecol; 1974., 119: 486-491.

Tata H. Biological Action of Thyroid Hormones at the Cellular and Molecular Levels: In: Action of Hormones and Molecular Processes (G. Litwork and D. Kritchevsky, eds). Wiley New York, 1964.