Deaths from rhesus haemolytic disease in England and Wales in 1982 and 1983.

Clarke, C. A.; Mollison, P L; Whitfield, A. G. W.

doi:10.1136/bmj.291.6487.17

Cited by 19 publications

(6 citation statements)

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“…Although the number of affected pregnancies in this survey was small, it compares reasonably with other studies. Leggat et al found 16 affected pregnancies, over a much longer period 6 and Bowman et al 2 studying 31 affected pregnancies presenting over 47 years, from 1944–1990. Our study, although including a relatively large number of Kell pregnancies, suffers from the weakness that practice and practitioners will have altered over the thirteen year period.…”

Section: Discussionmentioning

confidence: 99%

“…This often results in prolonged intensive neonatal care and sometimes culminates in perinatal death. The incidence of anti‐D sensitisation has decreased due to the administration of anti‐D immunoglobulin, while the importance of other antibodies has increased 1,2 . Anti‐Kell antibodies appear to cause significant suppression of erythropoiesis rather than red cell destruction 3,4 and, unlike Rhesus disease, the outcome is not affected by previous obstetric history 5 .…”

Section: Introductionmentioning

confidence: 99%

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The outcome of pregnancy in Kell alloimmunisation

Grant

Kilby

Meer

et al. 2000

BJOG

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Objective To assess management and outcome of pregnancies with anti-Kell in the West Midlands in Design A retrospective review of casenotes.Setting A regional referral clinic for red cell alloimmune disease and fetal medicine unit at a university hospital.Population Sixty-five pregnancies were identified in 52 Kell-sensitised women with Kell positive partners from the records of the Birmingham Blood Transfusion Centre.Methods Information from the casenotes was entered on a database and comparisons were made using the SPSS for Windows statistics package. Main outcome measuresMode of sensitisation, degree of fetal or neonatal anaemia, need for transfusion, gestation at delivery, birthweight and pregnancy outcome.Results Alloimmunisation was transfusion-related in 29 pregnancies and pregnancy-induced in 33. The cause could not be identified in three cases. There were 22 proven Kell positive fetuses, of which 18 were affected, in which alloimmunisation was pregnancy-related in 12 cases and transfusion-related in five. Antibody titres and amniotic fluid OD,,, were not helpful in management. Severe or very severe disease occurred in 50% of the affected pregnancies (9/18). There was no difference in pregnancy outcome between transfusion or pregnancy induced sensitisation.Conclusions Anti-Kell alloimmunisation is an uncommon cause of serious anaemia in a significant proportion of affected pregnancies. There appears to be no difference between that caused by pregnancy or transfusion. Estimation of fetal haemoglobin concentration by cordocentesis is recommended, as antibody titres and amniocentesis are not helpful.the UK over 13 years.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The outcome of pregnancy in Kell alloimmunisation

Grant

Kilby

Meer

et al. 2000

BJOG

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“…Haemolytic disease of the newborn (HDN) is an isoimmune haemolytic jaundice which prior to modern interventions had a perinatal mortality rate of 50% that has now decreased to 7 per 100 000 births 1. The mainstay of treatment is intensive phototherapy with exchange transfusion recommended if, in spite of phototherapy, the total serum bilirubin (TSB) approaches a level considered to cause a risk of bilirubin encephalopathy 2.…”

Section: Commentarymentioning

confidence: 99%

Question 2

Walsh

Molloy²

2009

Archives of Disease in Childhood

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17. Cheng YW, Wong SN. Diagnosing symptomatic urinary tract infections in infants by catheter urine culture. J Paediatr Child Health 2005;41:437-40. 18. Dayan PS, Chamberlain JM, Boenning D, et al. A comparison of the initial to the later stream urine in children catheterized to evaluate for a urinary tract infection. Pediatr Emerg Care 2000;16:88-90. 19. Vaillancourt S, McGillivray D, Zhang X, et al. To clean or not to clean: effect on contamination rates in midstream urine collections in toilet-trained children. Pediatrics 2007;119:e1288-93. 20. Kass EH. Pyelonephritis and bacteriuria. A major problem in preventive medicine.

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“…However, the immune response leading to sensitization in Rh-ve mother is much less. Incidence of antepartum sensitization is 1-2 %, and of postpartum sensitization, it is only 10-15 % of women having Rh?ve babies [1]. The discovery, introduction, and utilization of Rh-D immunoglobulin (anti-D) for prophylaxis against Rh immunization is one of the major medical achievements and successful application of preventive obstetric medicine in the last century.…”

Section: Introductionmentioning

confidence: 99%

Intrauterine Transfusion

Deka

2016

Journal of Fetal Medicine

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The mainstay of management of an Rh isoimmunized pregnancy is the early identification of fetal anemia. Ultrasound middle cerebral artery-peak systolic velocity (MCA-PSV) Doppler measurements are very useful to diagnose severe disease, to time delivery/serial intrauterine transfusions, and eliminate need of amniocentesis/cordocentesis. Fetal blood sampling is done if the fetus is hydropic or MCA-PSV is >1.5 MoM. Blood is kept ready for transfusion if fetal anemia is detected (hematocrit <30 %). Intravascular transfusion is preferred, especially in hydropic fetuses. Rarely, intraperitoneal transfusion is performed in certain situations when the approach to cord is difficult—posterior placenta, obesity, and very early gestation. Blood is absorbed through the lymphatics. Ultrasound and color Doppler is done for fetal heart activity, placental site, cord insertion, and accessible site. The needle path is mapped and decision is taken on where to enter the cord—cord insertion/free loop/intrahepatic portion site. A 20 gauge long needle is inserted under continuous ultrasound guidance into the umbilical vein, 2–3 mL blood aspirated for hemoglobin, packed cell volume, and blood group. Necessary volume of packed O-ve, irradiated red blood cell (hematocrit of 75–80 %) is then transfused. Fetal monitoring is done by serial ultrasound for anemia, MCA-PSV to time next transfusion, and fetal wellbeing—daily kick counts, ultrasound, and electronic biophysical profile. Neonatal management is by intensive fetal anemia and jaundice monitoring, use of intravenous immunoglobulin, exchange transfusion, and phototherapy. The improvement in outcome of Rh immunized fetuses is primarily due to improved expertise, better ultrasound machines, intrauterine blood transfusion, and improved neonatal care. From July 1997 to September 2015, there were 1022 transfusions performed in one Unit at AIIMS, with an overall successful outcome of 90–94 %. Fetal survival is low if hydropic or with first transfusion at 20 weeks or less. Care during the procedure will help to further improve safety. In conclusion, treatment of fetal anemia in Rh isoimmunization by ultrasound-guided fetal blood transfusions is relatively safe in experienced hands, permits a near-term delivery in majority of cases of this potentially life-threatening fetal disease.

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Deaths from rhesus haemolytic disease in England and Wales in 1982 and 1983.

Abstract: Examination of death certificates and the clinical notes of the patients concerned showed that the number of deaths from rhesus (D) haemolytic disease in England and Wales was

Cited by 19 publications

References 4 publications

The outcome of pregnancy in Kell alloimmunisation

The outcome of pregnancy in Kell alloimmunisation

Question 2

Intrauterine Transfusion

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