Two hundred intrauterine exchange transfusions in severe blood incompatibilities

Poissonnier, Marie-Hélène; Brossard, Y.; Demedeiros, Nicole; Vassileva, Juliana; Parnet, F; Larsen, M.; Gosset, Monique; Chavinié, J; Huchet, J.

doi:10.1016/0002-9378(89)90386-4

Cited by 83 publications

(35 citation statements)

References 16 publications

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“…5,6 In alloimmunised women, early knowledge of the fetal Rh blood group status is of advantage for prediction and management of the clinical course. 7 However, fetal blood sampling and amniocentesis or chorionic villus sampling for DNA testing are invasive procedures that all involve a risk to the fetus. Therefore, invasive tests are usually avoided in alloimmunised pregnancy unless ultrasonography, including determination of the peak systolic velocity of the fetal middle cerebral artery, reveals fetal anaemia and intrauterine blood transfusion is considered.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of noninvasive polymerase chain reaction testing for the determination of fetal rhesus C, c and E status in early pregnancy

Gutensohn¹,

Müller

Thomann

et al. 2010

BJOG

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Objective The aim of the study was to determine the sensitivity, specificity and accuracy of noninvasive tests for the fetal rhesus CcEc (RHCE) alleles C, c and E in early pregnancy.Design A prospective clinical trial was carried out to evaluate diagnostic accuracy.Setting Women were recruited at four centres specialising in prenatal diagnosis. Peripheral blood and amniotic fluid samples were obtained and sent to a single laboratory for analysis.Sample A total of 233 tests (46 for C, 87 for c and 100 for E) were performed on 181 specimens obtained from pregnant women at weeks 12 to 28 (median week 16) of gestation.Methods Following automated extraction of fetal DNA from maternal plasma, two different real-time polymerase chain reaction (PCR) protocols were used for the detection of the C, c and E alleles of RHCE. The results of the PCR were compared with genotyping results for the amniotic fluid.Main outcome measures Failure rate, sensitivity, specificity and accuracy were the main outcome measures.Results Unequivocal results were obtained for all specimens. With the first PCR protocol, the sensitivity was 100% for C, 38% for c and 59% for E. In contrast, with the second protocol, the sensitivity for C, c and E was 100%. The specificity for all assays was found to be between 99% and 100%.Conclusions A highly accurate protocol has been identified for the detection of fetal RHCE alleles in maternal plasma in early pregnancy. This noninvasive approach can be considered as a useful test in the management of pregnancies with anti-c, anti-E or anti-C alloimmunisation.

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Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of noninvasive polymerase chain reaction testing for the determination of fetal rhesus C, c and E status in early pregnancy

Gutensohn¹,

Müller

Thomann

et al. 2010

BJOG

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“…Simple vs. exchange. Intrauterine exchange transfusion (IUET) has been proposed as an alternative to simple IUT as exchange transfusions may result in a more stable hematocrit [59], potentially decrease the risks of (temporary) volume overload and increase the interval between procedures. However, the risk of procedure-related complications associated with IUETs may be higher, due to longer duration and needle movements [60].…”

Section: Intravascular Intrauterine Blood Transfusion (Iut)mentioning

confidence: 99%

Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn – review on current management and outcome

Zwiers

Kamp

Oepkes

et al. 2017

Expert Review of Hematology

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Introduction: Hemolytic disease of the fetus and newborn (HDFN) remains a serious pregnancy complication which can lead to severe fetal anemia, hydrops and perinatal death. Areas covered: This review focusses on the current prenatal management, treatment with intrauterine transfusion (IUT) and promising non-invasive treatment options for HDFN. Expert commentary: IUTs are the cornerstone in prenatal management of HDFN and have significantly improved perinatal outcome in the past decades. IUT is now a relatively safe procedure, however the risk of complications is still high when performed early in the second trimester. Non-invasive management using intravenous immunoglobulin may be a safe alternative and requires further investigation. ARTICLE HISTORY

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“…During the past 25 years, major progress has been made in the diagnosis and treatment of severe haemolytic disease of the newborn (HDN), the latest being ultrasound guided fetal transfusion by the intravascular route (Poissonnier et al, 1989). HDN has been preventable condition since the late 1960s due to the availability of Rh immunoglobulins which suppress primary RhD immunization when administered in appropriate circumstances to pregnant D-negative women (Mollison et al, 1987).…”

mentioning

confidence: 99%

Specificity and sensitivity of RHD genotyping methods by PCR‐based DNA amplification

Jt¹,

Kim

Mouro

et al. 1997

Br J Haematol

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Summary.We have compared the sensitivity and specificity of four PCR methods of RHD gene detection using different sets of primers located in the regions of highest divergence between the RHD and RHCE genes, notably exon 10 (method I), exon 7 (method II), exon 4 (method III) and intron 4 (method IV). Methods I-III were the most sensitive and gave a detectable signal with D-pos/D-neg mixtures containing only 0 . 001% D-positive cells. Moreover, method II could detect the equivalent DNA amount present in only three nucleated cells in the assay without hybridization of PCR products, whereas the sensitivity of the other methods was 10-50 times less. Investigation of D variants indicated that false-negative results were obtained with method II (D IVb variant), method III (D VI and DFR variants) and method IV (D VI variants), but not method I. Weak D (D u ) was correctly detected as D-positive by all methods, but most cases of Rh null appeared as false-positives, as they carry normal RH genes that are not phenotypically expressed. Some false-positive results were obtained with method I in a few Caucasian DNA samples serotyped as RhD-neg but carrying a C-or E-allele, whereas a high incidence of false-positives was found among non-Caucasian Rh-negative samples by all methods. In the Caucasian population, however, we found a full correlation between the predicted genotype and observed phenotype at birth of 92 infants. Although we routinely use the four methods for RHD genotyping, a PCR strategy based on at least two methods is recommended.

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Two hundred intrauterine exchange transfusions in severe blood incompatibilities

Cited by 83 publications

References 16 publications

Diagnostic accuracy of noninvasive polymerase chain reaction testing for the determination of fetal rhesus C, c and E status in early pregnancy

Diagnostic accuracy of noninvasive polymerase chain reaction testing for the determination of fetal rhesus C, c and E status in early pregnancy

Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn – review on current management and outcome

Specificity and sensitivity of RHD genotyping methods by PCR‐based DNA amplification

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