Should we continue screening rhesus D positive women for the development of atypical antibodies in late pregnancy?

ArticleinJournal of Maternal-Fetal and Neonatal Medicine 20(1):59-61 · February 2007with14 Reads
DOI: 10.1080/14767050601123317 · Source: PubMed
Abstract
The purpose of this study was to calculate the incidence of the new development of atypical antibodies (other than anti-rhesus D) in women attending for antenatal care, and to assess the clinical impact and cost-effectiveness of a second test to detect these antibodies. A three-year retrospective analysis was undertaken to calculate the number of rhesus positive women who developed new antibodies in the last trimester of pregnancy. Of 13,143 rhesus positive women, 20 (0.15%) developed new antibodies; fetal outcome was not compromised in any of these cases. Repeat testing in late pregnancy would appear an unnecessary expense in our population.
    • "This variation can be explained by the heterogeneity of the screening protocols, by the absence of an unequivocal definition of 'the presence of clinically relevant alloantibodies' and, most importantly, by the use of preselected high-risk study populations with an unknown relation to the general population of pregnant women. Population data are available from three regional studies in Sweden, one in Croatia and our studies in the Netherlands [7, 12, 80, 90]. These latter studies show a prevalence of 0Á15–0Á25% of alloimmunized pregnancies with a risk for HDFN (partner antigen positive) caused by a red cell antibody other than anti-D (non-D mediated). "
    [Show abstract] [Hide abstract] ABSTRACT: Haemolytic Disease of the Fetus and Newborn (HDFN) is caused by maternal alloimmunization against red blood cell antigens. In severe cases, HDFN may lead to fetal anaemia with a risk for fetal death and to severe forms of neonatal hyperbilirubinaemia with a risk for kernicterus. Most severe cases are caused by anti-D, despite the introduction of antental and postnatal anti-D immunoglobulin prophylaxis. In general, red blood cell antibody screening programmes are aimed to detect maternal alloimmunization early in pregnancy to facilitate the identification of high-risk cases to timely start antenatal and postnatal treatment. In this review, an overview of the clinical relevance of red cell alloantibodies in relation to occurrence of HDFN and recent views on prevention, screening and treatment options of HDFN are provided. © 2015 International Society of Blood Transfusion.
    Full-text · Article · Apr 2015
    • "The overall incidence in our study is similar to 0·79% (213/26883) reported by Lee et al. and to 0·57% reported by Fibley et al. It is though, slight higher than The available data from other countries date back to 90s but it is interesting that the prevalence of maternal alloimmunisation in Greece in the past few years is still slightly higher than rates of alloimmunisation elsewhere in Europe and in North America over 15 years ago (Heddle et al., 1993; Filbey et al., 1995; Rothenberg et al., 1999; Lee et al., 2003; Adeniji et al., 2007). Of the 41 alloantibodies detected in 39 alloimmunised women, 37 alloantibodies (excluding 4 with anti-Lea specificity) were clinically significant and could cause HDFN. "
    [Show abstract] [Hide abstract] ABSTRACT: To access the incidence and specificity of maternal red blood cells alloimmunisation and its relevant clinical impact in Greece. The rate of alloimmunisation in pregnant women in Greece is unknown. We performed a 4-year study in two tertiary hospitals in Greece. Demographics, transfusion and obstetric history were analysed. Maternal alloimmunisation was detected with indirect anti-globulin test. We investigated 4368 pregnant women. Of which 3292 (75·37%) were Greek and 1076 (24·63%) were migrants. In 39 alloimmunised women, 41 alloantibodies were detected (0·89%). The incidence of alloimmunisation was 0·66% (22/3292) in Greeks and 1·76% (17/1076) in migrants (P = 0·01). Anti-D was the most frequent alloantibody (0·18%). Anti-D was more frequent in migrants; 5·76% compared to 0·56% in Greek RhD negative women (P = 0·002). Other antibody specificities in declining frequency rank were anti-K, anti-E, anti-Lea, anti-M, anti-c, anti-Ce, anti-Jka, anti-Jkb and anti-C. Primiparae vs para >2 and past history of blood transfusion were significantly associated with alloimmunisation during pregnancy (P = 0·0088, P < 0·0001, respectively). Our results depict differences in the delivery of health care between migrants and Greek women, as well as the heterogeneity in practices for the prevention of haemolytic disease of foetus and newborn in Greece and highlight the need for the implementation of nationwide guidelines.
    Full-text · Article · Jul 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Background. Neonatal jaundice is a clinical event frequently present in newborns. The causes most frequently involved in hemolytic disease of newborn (HDN) are still the incompatibilities to the ABO/Rh blood system. Direct Coombs test (or direct antiglobulin test, DAT) allows identification of the presence of red blood cell antibodies (IgG isotype) coming from the maternal serum on the surface of the fetus erythrocytes. The purpose of this study is to show the results and specificity of DAT as screening in newborn infants.
    Full-text · Article · Dec 2009
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