Maternal red blood cell alloimmunization requiring intrauterine transfusion: a comparative study on management and outcome depending on the type of antibody

Phung, Thanh-Vy; Houfflin‐Debarge, V.; Ramdane, Nassima; Ghesquière, Louise; Delsalle, A; Coulon, C.; Subtil, D.; Vaast, P.; Garabédian, Charles

doi:10.1111/trf.14542

Cited by 21 publications

(21 citation statements)

References 42 publications

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“…The similar reticulocyte counts and percentages between these two groups indicated similar haematopoietic conditions. Some studies reported that neither the foetal anaemia severity nor the gestational age at first IUT was influenced by anti-D with other antibodies [10,27]. In the logistic regression analysis of anaemic foetuses affected by Rh(D) alloimmunization, anti-D combined with other antibodies was not a risk factor for severe HDF in either univariate analysis or multivariate analysis.…”

Section: Discussionmentioning

confidence: 89%

“…In addition, some women have multiple red cell antibodies, which might lead to a more complicated situation during pregnancy management than when a single red cell antibody is present. Some studies have found that foetuses affected by multiple antibodies need more interventions than those affected by only anti-D [10]. Thus, the objective of our study was to characterize the distribution of antibodies that cause HDF and to evaluate the effects of different antibodies on the severity of HDF in a Chinese population.…”

Section: Introductionmentioning

confidence: 99%

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Distribution of maternal red cell antibodies and the risk of severe alloimmune haemolytic disease of the foetus in a Chinese population: a cohort study on prenatal management

Luo

et al. 2020

BMC Pregnancy Childbirth

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Background Haemolytic disease of the foetus and newborn (HDFN) is the most common aetiology of haemolytic anaemia and hyperbilirubinaemia in foetuses and neonates. Studies on the distribution of antibodies that cause haemolytic disease of the foetus (HDF) in China are limited, and the effects of multiple antibodies on the severity of HDF need further evaluation. Methods An observational cohort study from January 2005 to December 2019 was conducted in two hospitals affiliated with Sun Yat-sen University. Maternal red cell alloimmunization was identified by the Guangzhou Blood Centre. In total, 268 pregnant woman-foetus pairs were divided into four groups according to the type of maternal alloantibodies: anti-D, anti-D combined with other antibodies, other single-antibody and other multiple antibodies. The obstetric history, antibody characteristics, incidence of severe HDF and foetal outcomes were collected and compared. Logistic regression analysis of the risk factors for HDF and survival analysis of the severe HDF-free interval were conducted. Results Anti-D was the most common cause of HDF, followed by anti-M. No anti-K- or isolated anti-c-associated HDF was found. The incidence of severe HDF was higher in the group with anti-D combined with other antibodies than in the group with anti-D alone (P = 0.025), but no significant difference was found in haemoglobin level and reticulocyte count in the anaemic foetuses between these two groups. Foetuses in the other single-antibody group had a lower reticulocyte count (P = 0.007), more IUTs (P = 0.007) and an earlier onset of severe HDF (P = 0.012). The maximum antibody titre was significantly lower in the other single-antibody group than in the anti-D group (P < 0.001). A high maternal antibody titre (P < 0.001), multiple affected pregnancies (P < 0.001) and other single-antibody (P = 0.042) were independent risk factors for HDF. A higher reticulocyte count (P = 0.041) was an independent risk factor for severe HDF in anaemia foetuses affected by Rh(D) alloimmunization. Conclusions The distribution of HDF-associated antibodies in China is different from that in Western countries. Other single non-Rh(D) antibodies could increase the risk of HDF, and anti-D combined with other antibodies would not influence the severity of foetal anaemia compared with anti-D alone.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Distribution of maternal red cell antibodies and the risk of severe alloimmune haemolytic disease of the foetus in a Chinese population: a cohort study on prenatal management

Luo

et al. 2020

BMC Pregnancy Childbirth

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“…The similar level of the reticulocyte count and percentage between these two groups indicated similar haematopoiesis conditions. Some studies reported that neither the foetal anaemia severity nor gestational age at first IUT was influenced by anti-D with addition antibodies [8,23]. In the logistics regression analysis of anaemia foetuses affected by Rh(D) alloimmunization, anti-D combined with other antibody was not a risk factor for severe HDF neither in univariant analysis nor multivariant analysis.…”

Section: Discussionmentioning

confidence: 89%

“…In addition, some women have multiple red cell antibodies, which might lead to more complicated situation than a single red cell antibody during pregnant management. Some studies have found that foetuses with multiple antibodies need a more interventions than those affected by only anti-D [8]. Thus, the objective of our study was to characterize the distribution of antibodies that cause HDF and to evaluate the effect of different antibodies on the severity of HDF in a Chinese population.…”

Section: Introductionmentioning

confidence: 99%

Different distribution of maternal red cell antibodies and risk on the severe alloimmune haemolytic disease of the foetus in a Chinese Population: a retrospective cohort study on prenatal management

Zhou

Luo

et al. 2020

Preprint

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BACKGROUND: The distribution of antibodies that cause haemolytic disease of the foetus (HDF) in China and the effects of multiple antibodies on the severity of HDF are needed to further evaluation. METHODS: A retrospective cohort study was conducted in two affiliated Hospitals of Sun Yat-sen University. Total 268 pregnant women and foetuses pairs were divided into four groups: anti-D, anti-D combined others, other single-antibody and other multiple-antibody. The obstetrics history, the incidence of severe HDF and foetal outcomes were collected and compared in each group. The logistics regression analysis and the survival analysis were conducted for analysis. RESULTS: Anti-D was the most common cause of HDF, followed by the anti-M of MNS system. No anti-K or isolate anti-c associated HDF was found. Upon the mothers with anti-D combined other antibodies, the incidence of severe HDF was increased than those with anti-D alone(P=0.046). Foetuses in the other single-antibody group had lower reticulocytes (P=0.007), more IUT times (P =0.007) and an earlier onset of severe HDF (P=0.003). High maternal antibody titer (P＜0.001), multiple affected pregnancies (P＜0.001) and other single-antibody (P=0.030) were the independent risk factor for HDF developing. And the lower foetal haematocrit (P =0.012) and higher reticulocyte counts (P =0.035) were the independent risk factors of severe HDF in the anaemia foetuses affected by RhD alloimmunization. CONCLUSION: The distribution of HDF-associated antibodies in China is different from that in western countries. Other single non-Rh(D) and multiple antibodies could both increase the risk of HDF but anti-D combined with other antibody would not influence the severity of the disease than anti-D alone.

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“…There were alloimmunized pregnancies with anti‐RhD plus anti‐RhC or anti‐RhE, while there were no pregnancies with anti‐RhD plus two other Rh antibody specificities in our study. Other authors have reported alloimmunized pregnancies by anti‐RhD plus anti‐RhC plus anti‐RhE [6, 7, 15, 16]. This is due to the low occurrence of the RhD‐negative ccee phenotype in Asians.…”

Section: Discussionmentioning

confidence: 99%

A comparative study on perinatal outcomes of red blood cell–alloimmunized pregnancies with anti‐RhD in combination and anti‐RhD alone in China

Tang

Zheng

et al. 2021

Vox Sanguinis

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Background and Objectives The advent of intrauterine transfusion (IUT) has improved the survival of severe foetal anaemia. The aim of this study was to compare the perinatal outcomes of red blood cell (RBC)–alloimmunized pregnancies with anti‐RhD in combination and anti‐RhD alone in China. Materials and Methods A retrospective study was conducted involving RBC–alloimmunized pregnancies with anti‐RhD in combination and anti‐RhD alone admitted to The First Affiliated Hospital, Sun Yat‐sen University, between January 2007 and December 2019. Obstetric data and neonatal outcomes were compared. Results A total of 165 alloimmunized pregnancies were identified, with 32 pregnancies in the anti‐RhD‐in‐combination group (25 pregnancies with anti‐RhD + anti‐RhC and 7 pregnancies with anti‐RhD + anti‐RhE) and 133 pregnancies in the anti‐RhD‐alone group. The anti‐RhD‐in‐combination group had significantly higher frequency of IUTs than the anti‐RhD‐alone group (59.4% [19/32] vs. 30.1% [40/133]; p < 0.01). The postnatal frequency of top‐up transfusions was significantly higher in the anti‐RhD in combination group than the anti‐RhD‐alone group (90.6% [29/32] vs. 70.7% [94/133]; p = 0.02). There was no significant difference in the frequency of exchange transfusions (ETs) between the two groups (15.6% [5/32] vs. 17.3% [23/133]; p = 0.82). Conclusions Compared to alloimmunized pregnancies with anti‐RhD alone, pregnancies with anti‐RhD in combination with anti‐RhC or anti‐RhE have an increased requirement for antenatal IUTs and postnatal top‐up transfusions but do not have an increased need for ETs.

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Maternal red blood cell alloimmunization requiring intrauterine transfusion: a comparative study on management and outcome depending on the type of antibody

Abstract: Anti-K1 alloimmunizations seem to cause more severe fetal anemia than anti-D alloimmunizations. Moreover, a decrease in hemoglobin appears to be more rapid when anti-D is associated with other antibodies.

Cited by 21 publications

References 42 publications

Distribution of maternal red cell antibodies and the risk of severe alloimmune haemolytic disease of the foetus in a Chinese population: a cohort study on prenatal management

Distribution of maternal red cell antibodies and the risk of severe alloimmune haemolytic disease of the foetus in a Chinese population: a cohort study on prenatal management

Different distribution of maternal red cell antibodies and risk on the severe alloimmune haemolytic disease of the foetus in a Chinese Population: a retrospective cohort study on prenatal management

A comparative study on perinatal outcomes of red blood cell–alloimmunized pregnancies with anti‐RhD in combination and anti‐RhD alone in China

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