Third trimester screening for alloimmunisation in <scp>R</scp>hc‐negative pregnant women: evaluation of the <scp>D</scp>utch national screening programme

Slootweg, Yolentha Maria; Koelewijn, JM; Kamp, IL van; Bom, Johanna G. van der; Oepkes, Dick; Haas, Masja de

doi:10.1111/1471-0528.13816

Cited by 18 publications

(10 citation statements)

References 27 publications

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“…Our study had similar findings, with two of 15 cases receiving treatment for anemia, and both receiving intravenous immunoglobulin (500 mg/kg IV, then repeated 12 hours later). However, there have also been studies and a case report suggesting anti‐c can cause more severe HDFN.…”

Section: Discussionmentioning

confidence: 99%

How clinically important are non‐D Rh antibodies?

Healsmith

Savoia

Kane

2019

Acta Obstet Gynecol Scand

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Introduction The advent of RhD immunoglobulin prophylaxis to prevent maternal RhD alloimmunization has reduced the incidence of this condition and its associated poor outcomes. Consequently, non‐D Rh antibodies now account for a greater proportion of alloimmunized pregnancies. These antibodies have been the subject of comparatively little research. This study investigated the incidence and clinical outcome of pregnancies affected by non‐D Rh alloimmunization at an Australian tertiary maternity service. Material and methods This was a retrospective study of all pregnancies with non‐D Rh antibodies (namely anti‐C, ‐E, ‐c, ‐e, ‐Cw as well as the compound antibodies anti‐CD, ‐cE and ‐ce) managed at the Royal Women's Hospital, Victoria, Australia, from 2009 to 2013 inclusive. Information collected included maternal demographics, details of the antibodies, course of the pregnancy and neonatal outcomes. Results During the study period, 115 non‐D Rh alloimmunized pregnancies were identified in 102 mothers. Forty‐nine pregnancies reached the critical titer (> 16) from non‐D Rh alone and 11 fetuses received intrauterine red blood cell transfusion. Labor was induced or cesarean section performed in 38 cases. Forty‐three neonates were admitted to the special care nursery and 59 received phototherapy. Nine received treatment for anemia and 10 neonates received intravenous immunoglobulin. Conclusions Non‐D Rh alloimmunization is a relatively uncommon complication of pregnancy, occurring in only .33% of pregnancies in the study period. It can lead to significant fetal/neonatal morbidity (and may lead to mortality). The most severe outcomes (including perinatal deaths) were mostly associated with the compound antibodies anti‐CD and anti‐cE, or a non‐D Rh antibody in conjunction with anti‐D.

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Section: Discussionmentioning

confidence: 99%

How clinically important are non‐D Rh antibodies?

Healsmith

Savoia

Kane

2019

Acta Obstet Gynecol Scand

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“…Studies have also shown that additional antibody screening in the third trimester of pregnancy increases the number of detected late alloimmunizations in RhD-negative pregnant women, thus enabling early treatment of HDFN [13]. Blood transfusion, multiparity and chorionic villus sampling/ amniocentesis are a known risk factor for alloimmunization.…”

Section: Methodsmentioning

confidence: 99%

“…The routine testing includes ABO grouping and RhD typing as well as a direct antiglobulin test (DAT). These tests provide the information on indications for the use of anti-D Immunoglobulin to RhD-negative women [12][13][14]. In the DAT positive cases, antibody can be obtained by removing the bound antibody of the neonatal RBC (elution).…”

Section: Introductionmentioning

confidence: 99%

Red blood cell alloimmunization in pregnancy: A 10-year single-center study

2022

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Background/Aim. Pregnancy-induced red blood cell (RBC) alloimmunization is important not only because of the possible negative effects on subsequent pregnancy outcomes, in case the fetus carries the antigen, but also because of the optimal transfusion management in cases of obstetric haemorrhage. Timely detection of RBC antibodies is part of a testing, prevention and treatment strategy aimed at achieving better outcomes for alloimmunized mothers with an affected fetus. The aim was to determine the frequency and specificity of alloantibodies among pregnant women from the South Backa District, with special attention to the incidence of anti-D alloantibody. Methods. A retrospective study was conducted from January 1, 2010 to December 31, 2019 in the Blood Transfusion Institute of Vojvodina. Screening and antibody identification were performed by an indirect antiglobulin test in gel-microcards (ID-Card Liss/Coombs) with two test RBC (ID-DiaCell I-II screening cells, Bio-Rad, Cressier, Switzerland), on an automated system (IH-500, Bio-Rad). Results. Among 25694 tested pregnant women 1.38% were actively immunized, while 1.12% antibodies was identified in the current pregnancy. Among 3622 (14.09%) RhD-negative women 1.77% with anti-D produced during the ongoing pregnancy were found. Distribution of antibody specificity was: anti-D 23.34%, anti-M 11.85%, anti-E 9.41%, anti-K 9.41%, anti-C 5.92%, anti-Fyb 5.92%, anti-c 3.13%, anti-S 3.13%, anti-Lea 3.13%, anti-Leb 3.13%, anti-Cw 1.75%, anti-Jka 1.40%, anti-P 1.05%, anti-Lub 0.70%, anti-Fya 0.35%, autoantibody of undetermined specificity 0.70%, and irregular antibodies of undetermined specificity 15.68%. Conclusion. Immune globulin prophylaxis has led to a significant reduction in the frequency of D alloimmunization among pregnant women in the South Backa District over the last ten years, but the incidence of anti-D is still significantly higher than in published data for developed countries. We also identified the other, less commonly present, clinically significant antibodies. There is a need to introduce uniform recommendations for immunohematological testing in pregnancy on the territory of the Republic of Serbia, in accordance with modern requirements.

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“…Many developed nations have implemented regular screening of all pregnant women and even have national screening programs (Table 2) (5,14,(16)(17)(18)(19)(20)(21). Although universal screening seems justified, the cost and infrastructure required would be immense.…”

Section: Casementioning

confidence: 99%