The indication for IUT in our institution has to date been limited to red cell alloimmunization due to anti-D. Alpha thalassaemia and congenital infections such as Parvovirus are not uncommon in this region of the world, but the foetal and neonatal specialists in our centre have generally not advocated IUT for them. Certainly, we would not embark on an IUT programme for HbBarts that would be considered as incompatible with life. Question 2 Anti-D has been the only reason for IUT in our population. We identify anti-D in 0Á35% of our non-transfused female population, mainly from the antenatal clinic. The majority of this is due to anti-D administered through the antenatal anti-D prophylaxis programme, but we do get 1-2 cases that occur as a result of RhD immunization resulting in moderate to severe HDFN. The common antibodies we otherwise identify in our nontransfused female population (prevalence in parentheses) are anti-Mi a (0Á24%), anti-Le a (0Á24%), anti-E (0Á14%) and anti-M (0Á12%). As you would note, these antibodies are rarely associated with HDFN. Anti-K and anti-c which are more commonly associated with HDFN has a prevalence of only 0Á01% in our population of non-transfused females. Question 3 We only perform 1-2 IUTs per year. In 2018, we had no IUT procedures and in 2019, we have only performed one procedure to date. Blood sample testing Question 4 Foetal red cell typing is limited to ABO and RhD, C, c, E and e phenotyping. Blood product selection (Red blood cell (RBC) concentrates): Question 5 We select Group O red cells, preferably from a donor with low titres of anti-A/B. If a suitable donor with low anti-A/ B titre cannot be located, we will elect to reconstitute the red cells with AB plasma. Question 6 We obtain allogeneic red cells from our pool of selected donors. Question 7 All red cell units supplied are K negative as well as antigen matched as close as possible to the maternal phenotype. At the minimum, the red cells supplied must be CcEe-matched. Question 8 Units supplied would be considered Day-0, as we prepare red cells from a fresh bleed on the day of the IUT procedure. The donor workup which includes ABO and RhD typing, red cell phenotyping, antibody screening, IAT crossmatch with maternal plasma, anti-A/B titration as well as microbiology testing (HIV, HBV, HCV, TPPA, NAT) would be completed prior to the donation from a sample obtained from the donor not more than 72 h before the planned blood collection. e18 Question 9 Whole blood is collected into a collection bag containing CPD (Citrate, Phosphate and Dextrose) prior to processing. Question 10 No, we do not assess CMV status. CMV prevalence is high within our population, and we therefore have found it difficult to maintain a pool of suitable CMV donors.
