Le point sur le suivi des allo-immunisations érythrocytaires

Carbonne, Bruno; Castaigne, Vanina; Cynober, Evelyne; Levy, Richard J.; Cortey, A.; Mailloux, Agnès; Larsen, M.; Brossard, Y.

doi:10.1016/j.gyobfe.2010.01.012

Cited by 20 publications

(8 citation statements)

References 19 publications

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“…Regarding the quantification threshold, it is generally accepted in AI cases that the risk of severe fetal anemia is negligible at antibody levels <5 IU/ml. 5,22,23 In the literature, thresholds have ranged from 3.5-15 IU/ml, though with methodologies different from ours. The 4 IU/ml threshold was described by Bowell et al in 1982, with no cases of cord hemoglobin <10 g/dl among 78 newborns with anti-RH1 < 4 IU/ml.…”

Section: Discussionmentioning

confidence: 73%

Anti‐RH1 alloimmunization: At what maternal antibody threshold is there a risk of severe fetal anemia?

et al. 2023

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Background To define a threshold of maternal antibodies at risk of severe fetal anemia in patients followed for anti‐RH1 alloimmunization (AI). Study, Design, and Methods We conducted a retrospective study of patients followed for anti‐RH1 AI at the Lille University Hospital. The first group, severe anemia, included patients who received one or more in utero transfusions (IUT) or who were induced before 37 weeks of pregnancy for suspected severe fetal anemia. The second group, absence of severe anemia, corresponded to patients without intervention during pregnancy related to AI. Sensitivities, specificities, and positive and negative predictive values for screening for severe fetal anemia were calculated for the antibody thresholds of 3.5 and 5 IU/ml for the quantification. Results Between 2000 and 2018, 207 patients were included 135 in the severe anemia group and 72 in the no severe anemia group. No severe anemia was observed for an antibody titer below 16. For an antibody threshold of 3.5 IU/ml, the sensitivity was 98.2%, with 30.2% false positives. All severe anemias were detected in the second trimester; two cases of severe anemia were not detected in the third trimester. For an antibody threshold of 5 IU/ml, the sensitivity was lower at 95.6%, with five cases of severe anemia not detected. Conclusion The antibody threshold of 3.5 IU/ml for the quantification and 16 for the titration allow targeting patients requiring close monitoring by an experienced team in case of anti‐RH1 AI.

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Section: Discussionmentioning

confidence: 73%

Anti‐RH1 alloimmunization: At what maternal antibody threshold is there a risk of severe fetal anemia?

et al. 2023

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“…Cases of alloimmunization can be observed to women in obstetric situations. They involve low frequency antigens most often in the mother and high frequency antigens present on the surface of the baby's red blood cells [9][10][11][12][13][14]. Alloimmunization is a phenomen on very little studied in the African series.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Anti Erythocyte Alloimmunization to Sub-Saharan African Blood Donors

Mamadou¹,

Romuald²,

Anais³

et al. 2019

IJI

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A part from any incompatible blood transfusion, anti-erythrocyte alloimmunization is observed to pregnant women. It is the result of the passage of red blood cells carrying antigens different from those of the mother during pregnancy and delivery. The Rhesus D system is the most involved; but there are also other systems involved in this alloimmunization. Non-transfusion alloimmunization is an extremely rare event in the order of 1 of 4000 to women in Europe and in most cases concerns the Rhesus D. In sub-Saharan Africa, there are no statistics collected on foeto-maternal alloimmunization. As part of our postgraduate thesis on the sensitization status of red blood cells to acridine, we used the technique of looking for irregular agglutinins. The goal was to find anti-erythrocyte alloimmunization to blood donors in sub-Saharan Africa. We conducted a two-year multicenter prospective and descriptive study of 903 blood donors in Côte d'Ivoire, Benin and Cameroon. The samples were analyzed in the laboratories of the National Blood Transfusion Center of Côte D'Ivoire and Frankfurt according to the technique of the RAI gel card of the BIORAD company after centrifugation and incubation using test red cells treated with S-303. In the case of a positive reaction, identification is made by a panel of red blood cells in the different blood group systems. In our study population, there is a male predominance with a male/female ratio of 7.42. We found a very low prevalence of alloimmunization to non-transfused blood donors (0.9% or 8 cases out of 902). 4 anti-erythrocyte antibodies have been identified (1 Ac anti D and 3 AC anti S); 2 pan-agglutination, 2 unidentified Ac (insufficient serum) and suspicion of anti-glutathione. Anti-erythrocyte alloimmunization to sub-Saharan Africa blood donor is about 0.9% in our series. It remains high compared to European data. This alloimmunization is mainly observed to women with low frequency antigens to black peoples.

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“…Une surveillance bimensuelle au delà de 20 SA si l'immunisation est modérée. La surveillance est hebdomadaire si le risque d'anémie fœtale est plus important avec dosage bimensuel des anticorps [ 8 ].…”

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“…Avant la transfusion, l'anémie doit être confirmée par un dosage direct sur le sang fœtal. Ce procédé n'est pas dénué de risque, de mort fœtale in utéro ou d'accouchement prématuré évalué à 3% [ 8 ]. Il peut s'agir d'une transfusion in utéro simple (TIU) ou avec soustraction du sang fœtal.…”

Section: Discussionunclassified

“…Il peut s'agir d'une transfusion in utéro simple (TIU) ou avec soustraction du sang fœtal. L'exsanguino-transfusion in utéro (ETIU) à l'avantage de limiter la surcharge volémique fœtale mais elle expose à un risque fœtal plus important limitant son utilisation [ 8 ]. L'extraction fœtale,en cas d'atteinte sévère, est programmée dès que le risque de grande prématurité est écarté.…”

Section: Discussionunclassified

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Alloimmunisation fœto-maternelle Rhésus grave à propos d’un cas et revue de la littérature

Benkerroum¹,

Lachiri²,

Lazrak³

et al. 2015

Pan Afr Med J

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L'incompatibilité fœto-maternelle Rhésus peut être à l'origine d'un syndrome hémolytique dont l'expression clinique est l′anémie fœtale éventuellement compliquée par une anasarque fœto-placentaire ou à l'extrême une mort fœtale in utéro. Nous rapportons l'observation d'un cas d'allo immunisation Rhésus à 34 SA ayant aboutit un hydrops foetalis, l'extraction fœtale par césarienne en vue d'une exsanguino-transfusion a été réalisée, mais le nouveau né est décédé au cours de l'exsanguino-transfusion. Le dépistage des femmes à risque et l'utilisation d'Immunoglobulines anti D ont permis une réduction importante de l′incidence des accidents d'incompatibilité. La mesure du pic systolique de vélocité dans l'artère cérébrale moyenne a bouleversé la surveillance et la prise en charge prénatale des anémies fœtales secondaires à une allo-immunisation Rhésus. Son utilisation dans la surveillance des cas d'allo-immunisation Rhésus permettrait ainsi de réserver les procédures invasives (cordocentèse) comme geste thérapeutique qui permet la transfusion fœtale in utéro. Grâce à une collaboration multidisciplinaire cohérente, l'extraction fœtale peut être programmée, ce qui permet une prise en charge adéquate et rigoureuse, même des nouveaux nés avec atteinte sévère.

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Le point sur le suivi des allo-immunisations érythrocytaires

Cited by 20 publications

References 19 publications

Anti‐RH1 alloimmunization: At what maternal antibody threshold is there a risk of severe fetal anemia?

Anti‐RH1 alloimmunization: At what maternal antibody threshold is there a risk of severe fetal anemia?

Prevalence of Anti Erythocyte Alloimmunization to Sub-Saharan African Blood Donors

Alloimmunisation fœto-maternelle Rhésus grave à propos d’un cas et revue de la littérature

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