A descriptive single‐centre experience of the management and outcome of maternal alloantibodies in pregnancy

Chatziantoniou, V.; Heeney, N.; Maggs, Tim; Rozette, Claire; Fountain, Christine; Watts, Timothy; Harrison, Claire; Pasupathy, Dharmintra; Sankaran, Srividhya; Kyle, Pippa; Robinson, S.

doi:10.1111/tme.12430

Cited by 15 publications

(15 citation statements)

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“…These antigens are the second‐most potent for triggering an immune reaction, after those of the ABO blood group. Anti‐Rh alloantibodies can cause severe or fatal haemolytic transfusion reaction and severe HDFN (Chatziantoniou et al, ; Michalewska et al, ). Overall, the frequencies of all antigens (C, c, E, e) in this study differed from those Thais in Bangkok (Fongsarun et al, ), Mainland Chinese (Yu et al, ), north Indians (Makroo, Gupta, Bhatia, & Rosamma, ) and Taiwanese (Lin et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…Alloantibodies against Rh (E, c), MNS (Mi a ) and Kidd (Jk a ) blood groups are the most commonly reported in Asian populations (Cheng, Lee, & Lin, ; Romphruk et al, ; Tian et al, ). Moreover, these antibodies have frequently been identified as a cause of haemolytic transfusion reactions and HDFN in a range of studies (Chatziantoniou et al, ; Michalewska, Ejduk, & Pniewska, ).…”

Section: Introductionmentioning

confidence: 99%

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Phenotype frequencies of Rh (C, c, E, e), M, Mi^a and Kidd blood group systems among ethnic Thai blood donors from the north‐east of Thailand

Romphruk

Butryojantho

Jirasakonpat

et al. 2019

Int J Immunogenetics

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We here report the first study of antigen and phenotype frequencies of Rh (C, c, E, e), M, Mia and Kidd antigens in north‐east Thai blood donors. Blood transfusion services aim to ensure availability of adequate and safe blood to minimize the development of transfusion reactions. For pre‐transfusion testing, the most important blood group systems are ABO and RhD. The transfusion of ABO‐compatible otherwise unknown phenotype blood may result in alloimmunization, especially in multi‐transfused patients. Extended red blood cell (RBC) phenotyping and selection of blood negative for specific antigens reduce post‐transfusion complications and allow for effective blood transfusion regimens to be achieved. A total of 13,567 regular repeated, voluntary Thai blood donors were included for red‐cell antigen typing of Rh (D, C, E, c, e). Samples from 12,768, 9,389 and 13,059 donors were typed for Kidd, M and Mia antigens, respectively. Amongst Rh antigens, e was the most common (96.80%) followed by C (95.50%), c (34.40%) and E (32.20%) with CCDee (60.00%) being the most common phenotype. For Kidd phenotypes, Jk(a+b+) was the most common (46.73%) and Jk(a−b−) was rare (0.07%). For the M and Mia antigen, M(+) was most frequently found (94.96%) and Mia(+) was found in 17.97% of individuals. Knowledge of red‐cell antigen phenotype frequencies in a population is helpful for creating a phenotype database of blood donors which can provide antigen‐negative compatible blood to patients with multiple alloantibodies. Moreover, provision of antigen‐matched blood can prevent alloimmunization in multi‐transfused patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Phenotype frequencies of Rh (C, c, E, e), M, Mi^a and Kidd blood group systems among ethnic Thai blood donors from the north‐east of Thailand

Romphruk

Butryojantho

Jirasakonpat

et al. 2019

Int J Immunogenetics

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“…Anti‐E is the most common antibody in the Chinese population (26.4%‐41%) . Anti‐E can cause severe hemolytic transfusion reactions and HDN . E antigen and its antithetical antigen (e antigen) are produced by the RHCE gene located on Chromosome 1.…”

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confidence: 99%

“…6,7 Anti-E can cause severe hemolytic transfusion reactions and HDN. 8,9 E antigen and its antithetical antigen (e antigen) are produced by the RHCE gene located on Chromosome 1. The E/e polymorphism results from a Pro226Ala substitution in the fourth extracellular loop.…”

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confidence: 99%

HLA‐DRB109:01* allele is associated with anti‐E immunization in a Chinese population

Tian

Wang³

et al. 2018

Transfusion

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This study indicated that HLA-DRB1*09:01 phenotype was significantly more prevalent in E-immunized patients than the control group. It suggested that HLA-DRB1*09:01 molecule might represent a susceptibility phenotype enhancing formation of anti-E alloantibody. Further study would be necessary to identify the anchor peptide responsible for E alloimmunization by stimulation of specific T cells by peptide originating from E antigen.

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“…However in developed countries, 1:300 to 1:600 pregnancies are at risk for hemolytic disease of the fetus and newborn (HDFN) due to RBC alloimmunization [1,2,3,4,5]. Approximately 30% of affected fetuses may require in utero or postnatal interventions with an estimated overall morbidity of 0.1% and a mortality rate of 0.002% [6]. While alloimmunization to RBCs has been reduced during the last five decades because of the administration of anti-D immunoprophylaxis to RhD-negative women and by Rhesus and Kell antigen-matched blood transfusion in women of childbearing age [7], prenatal loss due to uncontrolled immunization still represents a severe complication in perinatal health.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Antenatal Intravenous Immunoglobulin Treatment in Pregnancies at High Risk due to Alloimmunization to Red Blood Cells

Mayer

Hinkson

Hillebrand

et al. 2018

Transfus Med Hemother

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Background: Alloimmunization to red blood cells (RBCs) may result in fetal anemia prior to 20 weeks gestation. The question as to whether early commencement of antenatal treatment with high-dose intravenous immunoglobulins (IVIG) may prevent or at least delay the development of fetal anemia in the presence of alloantibodies to RBCs is highly relevant. Patients and Results: Here we describe a patient with high-titer anti-K and two other severely affected pregnant women with a history of recurrent pregnancy loss due to high-titer anti-D or anti-D plus anti-C. Early commencement of treatment with IVIG (1 g/kg/week) resulted in prevention of intrauterine transfusion (IUT) in the former two cases, and in a significant delay of development of fetal anemia in the remaining case (26 weeks gestation). Conclusion: Based on our findings and of previously published cases, early initiation of treatment of severely alloimmunized women with IVIG (1 g/kg/week) could potentially improve the outcome of fetuses at risk.

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A descriptive single‐centre experience of the management and outcome of maternal alloantibodies in pregnancy

Abstract: This study demonstrates that morbidity and mortality caused by HDFN is minimal. These results are reassuring for women at risk of HDFN as even severely affected cases are successfully managed in most instances. Further studies are needed to identify predictors of disease severity.

Cited by 15 publications

References 31 publications

Phenotype frequencies of Rh (C, c, E, e), M, Mi^a and Kidd blood group systems among ethnic Thai blood donors from the north‐east of Thailand

Phenotype frequencies of Rh (C, c, E, e), M, Mi^a and Kidd blood group systems among ethnic Thai blood donors from the north‐east of Thailand

HLA‐DRB109:01* allele is associated with anti‐E immunization in a Chinese population

Efficacy of Antenatal Intravenous Immunoglobulin Treatment in Pregnancies at High Risk due to Alloimmunization to Red Blood Cells

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A descriptive single‐centre experience of the management and outcome of maternal alloantibodies in pregnancy

Abstract: This study demonstrates that morbidity and mortality caused by HDFN is minimal. These results are reassuring for women at risk of HDFN as even severely affected cases are successfully managed in most instances. Further studies are needed to identify predictors of disease severity.

Cited by 15 publications

References 31 publications

Phenotype frequencies of Rh (C, c, E, e), M, Mia and Kidd blood group systems among ethnic Thai blood donors from the north‐east of Thailand

Phenotype frequencies of Rh (C, c, E, e), M, Mia and Kidd blood group systems among ethnic Thai blood donors from the north‐east of Thailand

HLA‐DRB1*09:01 allele is associated with anti‐E immunization in a Chinese population

Efficacy of Antenatal Intravenous Immunoglobulin Treatment in Pregnancies at High Risk due to Alloimmunization to Red Blood Cells

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Resources

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Phenotype frequencies of Rh (C, c, E, e), M, Mi^a and Kidd blood group systems among ethnic Thai blood donors from the north‐east of Thailand

Phenotype frequencies of Rh (C, c, E, e), M, Mi^a and Kidd blood group systems among ethnic Thai blood donors from the north‐east of Thailand

HLA‐DRB109:01* allele is associated with anti‐E immunization in a Chinese population