Prevention of RhD Alloimmunization: A Comparison of Four National Guidelines

Sperling, Jeffrey D.; Dahlke, Joshua D.; Sutton, Desmond; González, Juan M.; Chauhan, Suneet P.

doi:10.1055/s-0037-1606609

Cited by 22 publications

(31 citation statements)

References 57 publications

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“…Anti-D immunoglobulin (anti-D) administration was introduced in the early 1970s to reduce the incidence of alloimmunization (sensitization) of pregnant women to the D antigen and subsequently the incidence of HDFN, which has since decreased dramatically [2]. In many countries, the current policy is to administer anti-D to non-sensitized RhD-negative pregnant women in the 28th week of gestation [3]. After birth, the cord blood is phenotyped and postnatal anti-D prophylaxis is offered only if the newborn is RhD-positive.…”

Section: Introductionmentioning

confidence: 99%

Targeted antenatal anti-D prophylaxis for RhD-negative pregnant women: a systematic review

Runkel

Bein

Sieben

et al. 2020

BMC Pregnancy Childbirth

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Background: All non-sensitized Rhesus D (RhD)-negative pregnant women in Germany receive antenatal anti-D prophylaxis without knowledge of fetal RhD status. Non-invasive prenatal testing (NIPT) of cell-free fetal DNA in maternal plasma could avoid unnecessary anti-D administration. In this paper, we systematically reviewed the evidence on the benefit of NIPT for fetal RhD status in RhD-negative pregnant women. Methods: We systematically searched several bibliographic databases, trial registries, and other sources (up to October 2019) for controlled intervention studies investigating NIPT for fetal RhD versus conventional anti-D prophylaxis. The focus was on the impact on fetal and maternal morbidity. We primarily considered direct evidence (from randomized controlled trials) or if unavailable, linked evidence (from diagnostic accuracy studies and from controlled intervention studies investigating the administration or withholding of anti-D prophylaxis). The results of diagnostic accuracy studies were pooled in bivariate meta-analyses. Results: Neither direct evidence nor sufficient data for linked evidence were identified. Meta-analysis of data from about 60,000 participants showed high sensitivity (99.9%; 95% CI [99.5%; 100%] and specificity (99.2%; 95% CI [98.5%; 99.5%]). Conclusions: NIPT for fetal RhD status is equivalent to conventional serologic testing using the newborn's blood. Studies investigating patient-relevant outcomes are still lacking.

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Section: Introductionmentioning

confidence: 99%

Targeted antenatal anti-D prophylaxis for RhD-negative pregnant women: a systematic review

Runkel

Bein

Sieben

et al. 2020

BMC Pregnancy Childbirth

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“…RAADP is now recommended for all non‐sensitised Rh(D)‐negative pregnant women and for those not predicted to be carrying Rh(D)‐negative fetuses by non‐invasive cell‐free fetal DNA RHD genotyping . RAADP regimens vary between countries, ranging from two doses of anti‐D of at least 500 IU each at 28 and 34 weeks of pregnancy to a single 1500 IU dose at 28 weeks . The current Australian recommendation is two 625 IU doses at 28 and 34 weeks…”

mentioning

confidence: 99%

“…14 RAADP regimens vary between countries, ranging from two doses of anti-D of at least 500 IU each at 28 and 34 weeks of pregnancy to a single 1500 IU dose at 28 weeks. 15 The current Australian recommendation is two 625 IU doses at 28 and 34 weeks. 12 In contrast to the two-dose regimen, single dose regimens have been associated with lower rates of anti-D detectability in maternal blood at the time of delivery (22% v 61%).…”

mentioning

confidence: 99%

Single dose v two‐dose antenatal anti‐D prophylaxis: a randomised controlled trial

White

Cheng

Penova-Veselinovic

et al. 2019

Medical Journal of Australia

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Objective To compare rates of detectability of circulating Rh(D)‐immunoglobulin (anti‐D) at delivery with single and two‐dose antenatal anti‐D prophylaxis (RAADP) regimens; to compare compliance with the two regimens. Design Open label, randomised controlled trial between May 2013 and November 2015. Setting, participants 277 women who attended a tertiary obstetric referral hospital in Perth for antenatal care and were at least 18 years of age, less than 30 weeks pregnant and yet to receive RAADP, Rh(D)‐negative (negative antibody screen), and who intended to deliver their baby at the hospital. Exclusion criteria were prior anti‐D sensitisation, any contraindication of anti‐D administration, and a history of isolated IgA deficiency. Interventions One 1500 IU anti‐D dose at 28 weeks of pregnancy (single dose regimen); two doses of 625 IU each at 28 and 34 weeks of pregnancy (two‐dose regimen). Main outcome measures The primary outcome was the proportion of women with detectable anti‐D levels at delivery; the secondary outcome was compliance with the allocated RAADP regimen. Results Circulating anti‐D was detectable at delivery in a greater proportion of women in the two‐dose group (111 of 129, 86%) than in the single dose group (70 of 125, 56%; P < 0.001). Compliance was not significantly different between the single dose (86 of 138, 61%) and two‐dose groups (70 of 139, 50%; P = 0.06). Conclusions The two‐dose RAADP schedule currently recommended in Australia provides better protection against Rh(D) sensitisation than a one‐dose regimen. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12613000661774).

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“…It is known that anti-idiotypic antibodies bind and neutralize pathogenic antibodies and interfere with their interaction with the autoantigen. Fragments (F)ab(2) contained in IVIG reduce functional activity or block the binding of autoantibodies to the corresponding autoantigens, such as antibodies to D-antigen [6,7]. The suppressive effects of IVIG may also be due to its effect on B-lymphocyte receptors, which leads to a decrease in immunoglobulin production [1,4,6].…”

Section: акушерство та гінекологіяmentioning

confidence: 99%

Clinical Effects of Human Immunoglobulin Administration in Women With Rhesus Sensitization at the Pre-Gravid Stage

Chernievskaya

Рожковська

Марічереда

et al. 2020

АПП

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The aim of the study – to evaluate changes in cellular immunity in rhesus-sensitized women in response to IVIG administration and the prognostic effectiveness of a method for the prevention of isoimmunization in the next pregnancy. Materials and Methods. The study was performed on the basis of City Maternity Hospital No. 7" (Odesa) in 2014–2019. 37 rhesus-sensitized women were randomly splited in two clinical groups: main clinical group (n=19) where patients received human immunoglobulin for intravenous administration, and control group (n=18) where patients did not receive IVIG. Results and Discussion. The state of cellular immunity in rhesus-sensitized women is characterized by a moderate decrease in the absolute and relative indices of T-lymphocytes while increasing the number of B-lymphocytes. The NK cell population did not differ from the control group. When analyzing subpopulations of T-lymphocytes, it can be concluded that the number of T-helper cells is increased and the number of T-suppressors is proportionally reduced. These changes explain the increase in the number of B-lymphocytes as a result of increasing antigenic load on cell receptors. In the group of women who received IVIG therapy, the ratio of chances of normalization of cellular immunity was 18.41 (95 % CI 2.62–166.74), T-helper – 14.93 (95 % CI) 2.45–107.8), T-suppressors – 14.57 (95 % CI 2.13 –127.57) and B-lymphocytes – 31.87 (95 % CI 4.1–333.41). According to the ROC analysis, the quality of the statistical model of IVIG application corresponds to AUC = 0.843 (95 % CI 0.689–0.941) According to the ROC analysis, the level of β-lymphocytes in the compared AUC groups = 0.58 (95 % CI 0.405–0.742).

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Prevention of RhD Alloimmunization: A Comparison of Four National Guidelines

Cited by 22 publications

References 57 publications

Targeted antenatal anti-D prophylaxis for RhD-negative pregnant women: a systematic review

Targeted antenatal anti-D prophylaxis for RhD-negative pregnant women: a systematic review

Single dose v two‐dose antenatal anti‐D prophylaxis: a randomised controlled trial

Clinical Effects of Human Immunoglobulin Administration in Women With Rhesus Sensitization at the Pre-Gravid Stage

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