Royal Children's Hospital, Parkville, australia

Diagnostic utility of combined C4d and C5b-9 staining in the diagnosis of Gestational Alloimmune Liver Disease (GALD)

Gestational Alloimmune Liver Disease (GALD) is currently diagnosed using correlation of clinical, biological, radiological and pathological findings. The diagnosis of GALD may be difficult to make as there are no specific clinical or pathological features. The diagnosis is often made after excluding other fetal and neonatal liver diseases. GALD is proposed to cause destruction of fetal liver cells due to binding of maternal alloimmune antibodies with complement activation. This may result in fetal demise or Neonatal Hemochromatosis. Treatment of women in subsequent pregnancies with intravenous immunoglobulin (IVIG) is indicated following diagnosis of GALD in affected babies. It is important to establish a firm diagnosis of GALD prior to IVIG treatment. The current methodology relies on the use of a single marker, C5b-9, for the membrane attack complex showing a positive reaction in liver cells. This project examines the utility of combining immunohistochemistry for C4d, a marker of activation of the classical complement pathway, with C5b-9 in the diagnosis of GALD. It demonstrates that with well-preserved liver tissue, combined C4d and C5b-9 staining can be used to improve the sensitivity and specificity of a diagnosis of GALD.




Bron Christiansen is the Principal Scientist in the Anatomical Pathology Laboratory at the Royal Children's Hospital in Melbourne. She has worked in a number of public and private pathology services and has recently completed her Fellowship in Anatomical Pathology via the Australian Institute of Medical Science. Bron investigated this topic as her dissertation submission for FAIMS.