Risk factors for RhD immunisation despite antenatal and postnatal anti‐D prophylaxis

Koelewijn, Joke M.; Haas, Masja de; Vrijkotte, Tanja G. M.; Schoot, C. Ellen van der; Bonsel, Gouke J.

doi:10.1111/j.1471-0528.2009.02244.x

Cited by 52 publications

(71 citation statements)

References 35 publications

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“…This interpretation is supported by the results of a case-control study (42 cases, 339 controls) that found no association between weight and sensitisation. 20 Compliance with the allocated RAADP regimen was relatively low in both groups. The higher level among women in the single dose group (similar to the difference in an earlier study 17 ) was not significantly different from that of the two-dose group and was not associated with an improved rate of detectable anti-D at delivery.…”

Section: Consort Diagram Of the Selection Of Participants For Our Ranmentioning

confidence: 93%

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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Section: Consort Diagram Of the Selection Of Participants For Our Ranmentioning

confidence: 93%

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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“…Patient samples and clinical data from the prospective OPZI study (Detection and Prevention of Pregnancy Immunisation) were included after informed consent (Koelewijn et al, 2008a(Koelewijn et al, , 2009). The OPZI study included all Dutch pregnant women with clinically relevant non-D RBC antibodies, detected at first trimester screening, from 1 Sept 2002-1 June 2003 and from 1 Oct 2003-1 July 2004 (n = 230) and 964 controls and antigen-negative children (Koelewijn et al, 2008a(Koelewijn et al, , 2009). None of the affected cases received intravenous immunoglobulin therapy.…”

Section: Patient Samplesmentioning

confidence: 99%

Antigen specificity determines anti‐red blood cell IgG‐Fc alloantibody glycosylation and thereby severity of haemolytic disease of the fetus and newborn

et al. 2016

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Haemolytic disease of the fetus and newborn (HDFN) is a severe disease in which fetal red blood cells (RBC) are destroyed by maternal anti-RBC IgG alloantibodies. HDFN is most often caused by anti-D but may also occur due to anti-K, -c- or -E. We recently found N-linked glycosylation of anti-D to be skewed towards low fucosylation, thereby increasing the affinity to IgG-Fc receptor IIIa and IIIb, which correlated with HDFN disease severity. Here, we analysed 230 pregnant women with anti-c, -E or -K alloantibodies from a prospective screening cohort and investigated the type of Fc-tail glycosylation of these antibodies in relation to the trigger of immunisation and pregnancy outcome. Anti-c, -E and -K show - independent of the event that had led to immunisation - a different kind of Fc-glycosylation compared to that of the total IgG fraction, but with less pronounced differences compared to anti-D. High Fc-galactosylation and sialylation of anti-c correlated with HDFN disease severity, while low anti-K Fc-fucosylation correlated with severe fetal anaemia. IgG-Fc glycosylation of anti-RBC antibodies is shaped depending on the antigen. These features influence their clinical potency and may therefore be used to predict severity and identify those needing treatment.

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“…33 significance of different RhD genotypes in various ethnic backgrounds and the risk factors for RhIg failure. 40 Precise determination of fetal RhD typing has been widely accepted in Europe and improved the ability to guide RhIg therapy. 18 In conclusion, HDFN is a multifaceted disease that has distinct technical considerations over several critical time periods of fetal and neonatal development.…”

Section: Prevention (Transfusion Rhig)mentioning

confidence: 99%

Hemolytic disease of the fetus and newborn: managing the mother, fetus, and newborn

2015

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Hemolytic disease of the fetus and newborn (HDFN) affects 3/100 000 to 80/100 000 patients per year. It is due to maternal blood group antibodies that cause fetal red cell destruction and in some cases, marrow suppression. This process leads to fetal anemia, and in severe cases can progress to edema, ascites, heart failure, and death. Infants affected with HDFN can have hyperbilirubinemia in the acute phase and hyporegenerative anemia for weeks to months after birth. The diagnosis and management of pregnant women with HDFN is based on laboratory and radiographic monitoring. Fetuses with marked anemia may require intervention with intrauterine transfusion. HDFN due to RhD can be prevented by RhIg administration. Prevention for other causal blood group specificities is less studied. Learning Objectives• Explain the fetal and infant clinical findings associated with hemolytic disease of the fetus and newborn (HDFN) • Describe the approach to pregnancy management when a mother has red cell alloimmunization • Discuss the prevention strategies for HDFN Hemolytic disease of the fetus and newborn (HDFN) is rare condition that occurs when maternal red blood cell (RBC) or blood group antibodies cross the placenta during pregnancy and cause fetal red cell destruction. The fetal physiological consequences of severe anemia in the fetus can also lead to edema, ascites, hydrops, heart failure, and death. In less severe cases, the in utero red cell incompatibility can persist postnatally with neonatal anemia due to hemolysis, along with hyperbilirubinemia and erythropoietic suppression. Epidemiology and pathophysiologyThere are an estimated 3/100 000 to 80/100 000 cases of HDFN per year in the United States. 1 The maternal blood group antibodies that cause HDFN can be naturally occurring ABO antibodies (isohemagglutinins), or develop after exposure to foreign RBC; the latter are called blood group alloantibodies. For HDFN to occur, the fetus must be antigen positive (paternally inherited) and the mother must be antigen negative. Several studies have investigated the prevalence of red cell sensitization. In a large series of 22 102 females in the US, 254 (1.15%) of the women were found to have a red cell alloantibodies, of whom 18% had more than one alloantibody. 2 In the Netherlands, the prevalence of red cell alloantibodies detected in the first trimester was 1.2%. 3 The most common cause of blood group incompatibility results from the ABO blood group system, with incompatibility present in up to 20% of infants. 4 However, because anti-ABO antibodies are predominantly IgM class, most are not effectively transported across the placenta. In addition, the A and B antigens are not well developed on fetal red blood cells. Together, this results in a low rate of clinically severe HDFN due to ABO compatibility, although

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Risk factors for RhD immunisation despite antenatal and postnatal anti‐D prophylaxis

Cited by 52 publications

References 35 publications

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

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

Antigen specificity determines anti‐red blood cell IgG‐Fc alloantibody glycosylation and thereby severity of haemolytic disease of the fetus and newborn

Hemolytic disease of the fetus and newborn: managing the mother, fetus, and newborn

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