Relationship between maternal antibody type and antenatal course following intrauterine transfusion for red cell alloimmunisation (original) (raw)
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Archives of Disease in Childhood - Fetal and Neonatal Edition, 2013
Background Currently, maternal Rh-D antibody levels are primarily used to triage which alloimmunized women warrant enhanced surveillance with middle cerebral artery Doppler. Traditionally, maternal Rh-D antibody levels ≤15 IU/ml have indicated, at worst, mild anaemia and provided reassurance. This threshold has not been widely studied. Methods A prospective cohort study of all intrauterine fetal transfusions (IUT) for Rh-D alloimmunization performed at our tertiary fetal medicine unit from 1996-2011. Fetal haemoglobin (Hb) levels at the time of IUT were adjusted for gestational age (multiples of median [MoM]) and correlated with the maternal serum Rh-D antibody level taken on the day of IUT, or ≤2 weeks prior to the transfusion. Results 260 IUTs were performed, of which 195 were for Rh-D alloimmunzation in 82 pregnancies. No significant correlation was demonstrated between fetal Hb and serum antibody levels (Spearman r = 0.08; p = 0.35). Rates of mild (0.65-0.84 MoM), moderate (0.55-0.64 MoM) and severe (<0.55 MoM) fetal anaemia were 32%, 22% and 31% respectively. The sensitivity, specificity, PPV and NPV of a maternal antibody threshold of >15 IU/ml for detecting any fetal anaemia (<0.84 MoM) were 88%, 14%, 85% and 18%. The equivalent results for a threshold of >15 IU/ml detecting moderatesevere anaemia (<0.65 MoM) were 88%, 12%, 52% and 47%. Using a lower antibody threshold of >8 IU/ml, the sensitivity, specificity, PPV and NPV of maternal serum antibody levels detecting any fetal anaemia were 96%, 5%, 85% and 17% respectively. Conclusion The widely used Rh-D threshold of >15 IU/ml may miss a substantial proportion of cases of fetal anaemia.
Transfusion, 2009
The objective was to determine clinical consequences of various specificities for the infant/fetus. The population was patients referred between 1998 and 2005 to the tertiary center because of detected red blood cell (RBC) alloimmunization. Altogether 455 infants were delivered by 390 alloimmunized women. This was a retrospective cohort study. Data were obtained from the blood bank register and the obstetric and neonatal database. As indicators of hemolytic activity of the antibodies, the frequency of the therapeutic interventions intrauterine transfusion, exchange transfusion, and simple transfusion was used. Anti-D was the most common antibody (46.6%), followed by anti-K (15.4%). A combination of antibodies was detected in 27%. All three types of therapeutic intervention were significantly more frequent in women with anti-D plus an additional antibody than in women with anti-D as the sole antibody. The anti-D titer closely paralleled the clinical importance of the antibody. One case of anti-s with a titer of 512 required all three types of transfusion. Anti-D was the single most frequent and harmful specificity closely followed by anti-K. Combinations of antibody specificities were more harmful than single specificities, and a potentially synergistic effect should be considered.
Indian Journal of Hematology and Blood Transfusion, 2013
Intrauterine blood transfusion is the mainstay of managing foetuses with severe anemia. It may however result in fetomaternal hemorrhage, which in cases of Rh isoimmunisation may increase the severity of the disease by enhancing the maternal immunological response to fetal antigens. This study was conducted to determine the frequency, specificity and origin of additional red cell antibodies which developed after IUT. The change in the titre of allo anti-D following IUT was also determined. Antibody detection and titration was done on the blood samples of all the patients before and after intrauterine blood transfusion to check for the development of additional antibody and change in the titre of existing anti-D. Severe anemia was found in 17 (58.6 %) fetuses who received a total of 42 ultrasound-guided IUTs. Development of antibodies additional to anti-D in maternal serum was seen in 5 (29.4 %) cases. The specificity of additional alloantibodies was anti-C in four cases whereas it was anti-E in one case. Four fold or greater increase in existing allo-anti D titre was seen in 6 (35.3 %) cases after IUT. Enhancement of maternal sensitisation leading to an increase in maternal antibody titre is particularly seen after the first IUT. Matching of the donor RBCs particularly for Rh antigens might prevent the induction of additional alloantibodies against these antigens. IUT as a treatment modality should be given judiciously and only when the need is inevitable.
British journal of haematology, 2015
Red blood cell (RBC) antibodies can persist for decades or decrease quickly to undetectable levels. Antibody persistence has not been systematically studied. Women whose children are treated with intrauterine transfusions (IUT) for haemolytic disease of the fetus (HDFN) often produce additional antibodies, which can be evoked by the intrauterine transfusion or by fetomaternal haemorrhage during the procedure. Factors associated with persistence of both the antibodies responsible for HDFN and additional antibodies were studied in 260 women whose children were treated with IUT between 1988 and 2008. They possessed 499 (205 anti-D and 294 non-D) antibodies after the last IUT. After a median follow-up of 8·7 years, all 260 antibodies primarily responsible for HDFN had persisted. Additional antibodies directed against antigens of the children persisted in 70·6%, and in 32·3% if they were not child-specific (P < 0·001). Antibodies induced by irradiated IUT persisted in only 7·1%. Multi...
International journal of epidemiology, 2014
Although the risks of adverse pregnancy outcomes associated with anti-D antibodies are well-recognized, much less is known concerning alloimmunization with other red blood cell antibodies detected during routine maternal screening. To date, most reports of adverse pregnancy outcomes associated with non-anti-D antibodies have been from small case studies. The aim of this study was to examine the associations of maternal alloimmunization with specific red blood cell antibodies and the risks of preterm birth and stillbirth in the Swedish population. All antibody screening, outcome and covariate data were obtained through linkages of Swedish national health and data registers. Follow-up in these population-based registers was available up to 31 December 2002. The final study sample consisted of 1,022,569 singleton births from 668,952 mothers during 1987-2002. In total, 1.3% of the 1,022,569 study pregnancies were alloimmunized. In adjusted logistic regression models, compared with havin...
ARC Journal of Gynecology and Obstetrics, 2017
Background: Hemolytic disease of the newborn is still a matter of concern, due to the morbidity and mortality that can produce in the fetuses and newborns affected. Many different RBC alloantibodies can produce the disease, being anti-D the most frequently implicated followed by anti-c, anti-K and anti-E. Our objective was to analyse the prevalence of RBC significant alloantibodies in pregnant women of our area. In addition, follow-up of deliveries and newborns was performed in order to evaluate the hemolytic potential of the different alloantibodies. Materials and methods: We retrospectively reviewed pregnancies that were positive screened for RBC antibodies for a five-year period. Data was collected at la Fe University Hospital in Valencia. Obstetric and immunohematologic data from pregnant women controlled in the Obstetrics Department from January 2011 to January 2016 were reviewed. Follow-up of newborns affected was also collected. Results: During the study period, 27609 pregnant women (23215 Rh (D) positive and 4394 Rh (D) negative) were controlled in the obstetric service of the hospital. Of these, 176 (0.63 %) had some clinically significant RBC alloantibody and 30 women (0.1 %) had more than 1 alloantibody. The antigens most often found were anti-D for Rh (D) negative women, and anti-E for Rh (D) positive women. In thirteen patients requiring IUT, the antibody pattern was as follows: 7 patients with anti-D, 4 anti-D combined with anti-C, 1 anti-K, 1 anti-c combined with anti-E. Plasmapheresis was also performed to one patient. Discussion: Anti-D remains the most frequent antibody in pregnant women and produces the most severe HDN in our area. Since it is the only alloimmunization that can be prevented, an effort to administrate prophylaxis to all RhD negative pregnant women population is mandatory. Plasmapheresis can be useful, as adjuvant treatment in those cases of severe HDN to reduce the alloantibody titer and consequently ITU needs