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Patris M, Holoye A, Goldman D, De Coninck C, Colard M. Successful management of severe Kell alloimmunization in pregnancy with intravenous immune globulin. Transfus Apher Sci 2024; 63:103868. [PMID: 38238203 DOI: 10.1016/j.transci.2023.103868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 04/07/2024]
Abstract
Hemolytic Disease of the Fetus and Newborn (HDFN) is a condition that affects 1 to 2 out of 1000 patients during pregnancy (1). When an alloantibody is present, it is essential to identify its nature in order to organize appropriate follow-up. Kell-mediated HDFN is rare; it occurs in about 5% of Kell alloimmunized pregnant women. It is important to note that in case of anti-Kell immunization, the severity of HDFN is not correlated with maternal antibody titers, and anemia tends to occur earlier and more severely. Therefore, early diagnosing and management of this condition is crucial. In the management of severe fetal anemia due to Kell immunization, available treatments include in utero transfusion (IUT), immunoglobulin therapy. Other alternative treatments exist, such as plasmapheresis. Intravenous immunoglobulin (IVIG), a noninvasive therapeutic approach, acts through multiple mechanisms. IVIG has been evaluated in cases of RhD immunization with high maternal antibody titers and a history of pregnancies involving early hydrops or intrauterine death. Regarding the potential benefits of intravenous IgG therapy, it may delay the need for early IUT, reduce the overall reliance on IUT, and have a positive impact on obstetric outcomes. This case of IV IgG therapy of anti-Kell immunization offers a thought-provoking avenue for future exploration.
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Ares SM, Nardozza LMM, Araujo Júnior E, Santana EFM. Non-RhD alloimmunization in pregnancy: an updated review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo22. [PMID: 38765509 PMCID: PMC11075387 DOI: 10.61622/rbgo/2024ao22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/28/2023] [Indexed: 05/22/2024] Open
Abstract
RhD alloimmunization in pregnancy is still the main cause of hemolytic disease of the fetus and neonate (HDFN). Nevertheless, there are other antigens that may be associated with the occurrence of this phenomenon and that have been growing in proportion, given that current prevention strategies focus only on anti-RhD antibodies. Although not widespread, the screening and diagnostic management of the disease caused by these antibodies has recommendations in the literature. For this reason, the following review was carried out with the objective of listing the main red blood cell antigen groups described - such as Rh, ABO, Kell, MNS, Duffy, Kidd, among others - addressing the clinical importance of each one, prevalence in different countries, and recommended management when detecting such antibodies during pregnancy.
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Affiliation(s)
- Sabrina Menes Ares
- Albert Einstein School of
MedicineDepartment of Maternal and
ChildSão PauloSPBrazilDepartment of Maternal and Child, Albert
Einstein School of Medicine, São Paulo, SP, Brazil.
| | - Luciano Marcondes Machado Nardozza
- Federal University of São
PauloPaulista School of MedicineDepartment of ObstetricsSão PauloSPBrazilDepartment of Obstetrics, Paulista School
of Medicine, Federal University of São Paulo, São Paulo, SP,
Brazil.
| | - Edward Araujo Júnior
- Federal University of São
PauloPaulista School of MedicineDepartment of ObstetricsSão PauloSPBrazilDepartment of Obstetrics, Paulista School
of Medicine, Federal University of São Paulo, São Paulo, SP,
Brazil.
- Municipal University of São Caetano do
SulMedical courseSão Caetano do SulSPBrazilMedical course, Municipal University of São
Caetano do Sul, São Caetano do Sul, SP, Brazil.
| | - Eduardo Félix Martins Santana
- Albert Einstein School of
MedicineDepartment of Maternal and
ChildSão PauloSPBrazilDepartment of Maternal and Child, Albert
Einstein School of Medicine, São Paulo, SP, Brazil.
- Federal University of São
PauloPaulista School of MedicineDepartment of ObstetricsSão PauloSPBrazilDepartment of Obstetrics, Paulista School
of Medicine, Federal University of São Paulo, São Paulo, SP,
Brazil.
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Tournier A, Ghesquiere L, Labreuche J, Drumez E, Storme L, Rakza T, Houfflin-Debarge V, Garabedian C. Effect of delayed cord clamping on red blood cell alloimmunization: a retrospective cohort study. Am J Obstet Gynecol MFM 2023; 5:101165. [PMID: 37734659 DOI: 10.1016/j.ajogmf.2023.101165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Although delayed cord clamping has well-known benefits for preterm and term neonates, it has been inadequately assessed in alloimmunized neonates. OBJECTIVE This study aimed to evaluate the benefits and risks of delayed cord clamping in alloimmunized neonates. STUDY DESIGN This was a retrospective comparative pre-post cohort study conducted from 2003 to 2018 in a tertiary care center in France. All living singleton neonates whose mothers were followed up for red blood cell alloimmunization during gestation and confirmed at birth (N=224) were included. Neonates were either exposed to immediate (n=125) or delayed cord clamping (n=99). Our main outcome was the time from birth to first exchange transfusions and/or transfusions. Secondary outcomes were hemoglobin level at birth, rate of exchange transfusion, number of postnatal transfusions, maximum bilirubin level, and number of phototherapy hours. RESULTS Hemoglobin at birth was significantly higher in case of delayed cord clamping (mean difference, 1.7 g/dL; 95% confidence interval, 0.7-2.8). Among infants treated with exchange transfusion or transfusion, the time to initial treatment was higher in case of delayed cord clamping (median difference, 8 days; rate ratio, 1.51; 95% confidence interval, 1.09-2.10). There were no significant differences in the need for exchange transfusion, the number of transfusions, the maximum total bilirubin level, nor the number of phototherapy hours. In the subgroup analysis of neonates needing intrauterine transfusion during pregnancy (ie, severe alloimmunization), neonates had a lower rate of exchange transfusion in case of delayed cord clamping (odds ratio, 0.36; 95% confidence interval, 0.15-0.82). CONCLUSION Our results indicate a benefit of delayed cord clamping in alloimmunization, regardless of pathology severity, without increased risk of jaundice.
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Affiliation(s)
- Alexane Tournier
- Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France (Drs Tournier, Ghesquiere, Houfflin-Debarge, and Garabedian)
| | - Louise Ghesquiere
- Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France (Drs Tournier, Ghesquiere, Houfflin-Debarge, and Garabedian); ULR 2694 METRICS, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France (Dr Ghesquiere, Mr Labreuche, Ms Drumez, and Drs Houfflin-Debarge and Garabedian)
| | - Julien Labreuche
- ULR 2694 METRICS, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France (Dr Ghesquiere, Mr Labreuche, Ms Drumez, and Drs Houfflin-Debarge and Garabedian); Department of Biostatistics, Centre Hospitalier Universitaire de Lille, Lille, France (Mr Labreuche and Ms Drumez)
| | - Elodie Drumez
- ULR 2694 METRICS, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France (Dr Ghesquiere, Mr Labreuche, Ms Drumez, and Drs Houfflin-Debarge and Garabedian); Department of Biostatistics, Centre Hospitalier Universitaire de Lille, Lille, France (Mr Labreuche and Ms Drumez)
| | - Laurent Storme
- Department of Neonatology, Centre Hospitalier Universitaire de Lille, Lille, France (Drs Storme and Rakza)
| | - Thameur Rakza
- Department of Neonatology, Centre Hospitalier Universitaire de Lille, Lille, France (Drs Storme and Rakza)
| | - Véronique Houfflin-Debarge
- Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France (Drs Tournier, Ghesquiere, Houfflin-Debarge, and Garabedian); ULR 2694 METRICS, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France (Dr Ghesquiere, Mr Labreuche, Ms Drumez, and Drs Houfflin-Debarge and Garabedian)
| | - Charles Garabedian
- Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France (Drs Tournier, Ghesquiere, Houfflin-Debarge, and Garabedian); ULR 2694 METRICS, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France (Dr Ghesquiere, Mr Labreuche, Ms Drumez, and Drs Houfflin-Debarge and Garabedian).
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Ghesquière L, Leroy J, Deken V, Tournier A, Vaast P, Subtil D, Delsalle A, Alluin G, Garabedian C, Houfflin-Debarge V. Anti-RH1 alloimmunization: At what maternal antibody threshold is there a risk of severe fetal anemia? Transfusion 2023; 63:629-637. [PMID: 36734370 DOI: 10.1111/trf.17264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/16/2022] [Accepted: 12/27/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND To define a threshold of maternal antibodies at risk of severe fetal anemia in patients followed for anti-RH1 alloimmunization (AI). STUDY, DESIGN, AND METHODS We conducted a retrospective study of patients followed for anti-RH1 AI at the Lille University Hospital. The first group, severe anemia, included patients who received one or more in utero transfusions (IUT) or who were induced before 37 weeks of pregnancy for suspected severe fetal anemia. The second group, absence of severe anemia, corresponded to patients without intervention during pregnancy related to AI. Sensitivities, specificities, and positive and negative predictive values for screening for severe fetal anemia were calculated for the antibody thresholds of 3.5 and 5 IU/ml for the quantification. RESULTS Between 2000 and 2018, 207 patients were included 135 in the severe anemia group and 72 in the no severe anemia group. No severe anemia was observed for an antibody titer below 16. For an antibody threshold of 3.5 IU/ml, the sensitivity was 98.2%, with 30.2% false positives. All severe anemias were detected in the second trimester; two cases of severe anemia were not detected in the third trimester. For an antibody threshold of 5 IU/ml, the sensitivity was lower at 95.6%, with five cases of severe anemia not detected. CONCLUSION The antibody threshold of 3.5 IU/ml for the quantification and 16 for the titration allow targeting patients requiring close monitoring by an experienced team in case of anti-RH1 AI.
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Affiliation(s)
- Louise Ghesquière
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS - Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Julie Leroy
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
| | - Valérie Deken
- Univ. Lille, CHU Lille, ULR 2694 - METRICS - Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- Department of Biostatistics, CHU Lille, Lille, France
| | - Alexane Tournier
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
| | - Pascal Vaast
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
| | - Damien Subtil
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS - Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Anne Delsalle
- French Blood Establishment, Nord Pas de Calais, France
| | | | - Charles Garabedian
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS - Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Véronique Houfflin-Debarge
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS - Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
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Pan W, Wu H, Chen J, Mo X, Wang H, Fang Q, Li Y, Huang Y. Fetal and neonatal outcome in severe alloimmunization managed with intrauterine transfusion: 18-year experience in a tertiary referral hospital in China. Front Pediatr 2023; 11:1157004. [PMID: 37124190 PMCID: PMC10130633 DOI: 10.3389/fped.2023.1157004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
Background Hemolytic disease of the fetus and newborn (HDFN) due to red cell alloimmunization, is an important cause of fetal and neonatal morbidity and mortality. However, fetal and neonatal outcome of HDFN managed with intrauterine transfusion (IUT) in China are unknown. In addition, fetal and neonatal outcomes according to the type of maternal red cell alloantibodies involved and outcomes of hydrops fetalis are also unclear. Objectives The objective of this study was to evaluate fetal and neonatal outcomes of severe red-cell alloimmunization treated by IUT, to compare the outcomes according to the type of antibody, and to investigate the perinatal and postnatal outcomes of hydrops fetalis due to red cell alloimmunization. Methods A retrospective study of pregnancies affected by HDFN and managed with IUT at a tertiary care university hospital in China between January 2001 and December 2018 was performed. Fetal and neonatal outcomes were investigated, and comparison of outcomes depending on the type of antibody and comparison of outcome between hydrops fetalis and fetuses without hydrops were also conducted. Results 244 IUTs were performed in 81 fetuses from 80 pregnancies. Anti-RhD was the major etiology of HDFN requiring IUT (71.6%). The fetal survival rate was 90.1%. The survival rate of the hydropic fetuses was significantly lower than those of the non hydropic fetuses (61.2% vs. 95.6%) (P = 0.002**). Compared with non hydropic fetuses, hydropic fetuses had significantly lower gestational age and lower hemoglobin level at first IUT. The neonatal survival rate was 98.6%. Exchange transfusions were required in 26% of the neonates. 30.1% of neonates had late anemia and required top-up transfusions, and hydropic fetuses required more late top-up transfusions than fetuses without hydrops. No significant difference in fetal and neonatal outcomes was found among the four subgroups stratified by the antibody involved. Conclusion Our study demonstrates that IUT is an effective and safe therapy for severe HDFN at our institution. Early detection and treatment of hydrops is critical for perinatal outcomes. Particular attention should be paid to late postnatal anemia in affected neonates and top-up transfusion is still commonly needed.
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Affiliation(s)
- Wenxu Pan
- Department of Pediatrics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haiyan Wu
- Department of Pediatrics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junlin Chen
- Department of Pediatrics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xinyue Mo
- Department of Pediatrics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongxin Wang
- Department of Pediatrics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qun Fang
- Fetal Medicine Centre, Department of Obstetrics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yijuan Li
- Department of Pediatrics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuefang Huang
- Department of Pediatrics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Correspondence: Yuefang Huang
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Bakhtary S, Panchalee T, Crowe EP, Schwab ME, Zakieh A, Josephson CD, Sobhani NC, Gonzalez-Velez JM, Goel R. Survey of intrauterine red blood cell (RBC) transfusion practices in the United States. Transfusion 2022; 62:2449-2453. [PMID: 36193867 DOI: 10.1111/trf.17134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/26/2022] [Accepted: 09/05/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND A paucity of data exists about the current practice of fetal red blood cell (RBC) transfusion in the United States (US). This investigation describes intrauterine transfusion (IUT) RBC product selection and processing practices at different US institutions. METHODS A transfusion medicine and maternal-fetal medicine (MFM) team designed a survey to interrogate and characterize RBCs utilized for IUT. This survey was distributed to seventy US institutions with fetal treatment centers (October 2020-April 2021) identified through the NAFTNet (North American Fetal Therapy Network). RESULTS Thirty-seven institutions responded (response rate 53%, 37/70), but five were excluded for not performing IUTs. Most (84%; 27/32) performed 1-24 IUTs annually; two performed >50 IUTs/year. Group O, Rh(D) negative RBC units were always used by 66% (21/32), and 75% (24/32) provided hemoconcentrated RBCs by washing (17/24) or dry packing (6/24). Overall, 66% (21/32) targeted a hematocrit ≥75%. Fifty percent provided both leukocyte-reduced and CMV-negative RBC units. Irradiation of RBC units was performed within 6 h of issue at 63% (20/32) of sites. Most (81%, 26/32) used RBC units at <7 days of age after collection, 56% (18/32) always provided washed RBC units, while 19% (6/32) issued washed RBC only if fresh units are unavailable. Implicated maternal RBC alloantibodies were matched for 78% (25/32) of the time. The transfused volume was universally determined by the MFMs. DISCUSSION Heterogeneity and lack of standardization exist in RBC product selection and special processing steps for IUTs in the US. Hence, the establishment of a consensus to standardize IUT protocols is needed.
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Affiliation(s)
- Sara Bakhtary
- Department of Laboratory Medicine, UCSF, San Francisco, California, USA
| | - Tachjaree Panchalee
- Department of Obstetrics and Gynecology, UCSF, San Francisco, California, USA
| | - Elizabeth P Crowe
- Division of Transfusion Medicine and Pediatric Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Abdulhafiz Zakieh
- Division of Transfusion Medicine and Pediatric Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Cassandra D Josephson
- Department of Oncology and Cancer and Blood Disorders Institute, Johns Hopkins Univ SOM, Baltimore MD and Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Nasim C Sobhani
- Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, California, USA
| | - Juan M Gonzalez-Velez
- Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, California, USA
| | - Ruchika Goel
- Division of Transfusion Medicine and Pediatric Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Mbalibulha Y, Natukunda B, Okwi AL, Kalyango JN, Isaac K, Ononge S. Alloimmunization to Rh Antigen (D, C, E, C, E) Among Pregnant Women Attending Antenatal Care in South Western Uganda. J Blood Med 2022; 13:747-752. [PMID: 36471679 PMCID: PMC9719281 DOI: 10.2147/jbm.s385737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/18/2022] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Maternal red cell alloimmunization to Rh antigen in pregnant women occurs when the immune system is sensitized by foreign red blood cell surface antigens, in this case fetal red blood cells, inducing an immune response. Various antigens of blood group systems may cause alloimmunization, especially the Rh, Kel, Fy, JK, and MNS systems. This study aimed to determine alloimmunization to the different frequencies of Rh antigen among pregnant women in South Western Uganda. METHODS A total of 1369 pregnant women consented and were recruited into a cross-sectional study during their regular antenatal visits during the period August 2020 to July 2021. Samples (4 mL) of anticoagulated and coagulated blood were obtained, and Rh blood grouping including Rh antigen and the indirect antiglobulin test (IAT) was carried out using the agglutination technology of the LISS ID-Card technique in the Ortho Biovue ID-Micro Typing System. RESULTS Out of 1369 participants recruited to the study, 78 (5.7%) were D-, 1291 were D+, and 134 (9.8%) had alloantibodies. Among those with alloantibodies, 115 (85.8%) were D+ and 19 (14.2%) D-. The percentage alloimmunization according to the Rh antigens was highest in e (9.72%), c (2.48%), C (2.34%) and E (0.94%) antigens. With the ABO system, alloimmunization was highest in blood group B (10.7%), followed by A (10.6%), O (9.2%) and then AB (7.1%). Alloimmunization was more prevalent in D- (24%) than in D+ participants (8.9%). Rhesus antigen e was the most prevalent antigen (99.8%), followed by c. The alloimmunization rate of 9.8% among these participants is high, and appears in both D+ and D- women. The other Rhesus antigens are seen to cause alloimmunization, with antigen e causing the highest prevalence. In conclusion, there is a need to identify antibodies and study the outcome for clinical significance, especially in D+ women, to facilitate proper pregnancy management.
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Affiliation(s)
- Yona Mbalibulha
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bernard Natukunda
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Andrew Livex Okwi
- Department of Pathology, College of Health Science, Makerere University, Kampala, Uganda
| | - Joan N Kalyango
- Director, Clinical and Epidemiology Unit, School of Medicine, College of Health Science, Makerere University, Kampala, Uganda
| | - Kajja Isaac
- Deputy Principal, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sam Ononge
- Department of Obstetrics & Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
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Mbalibulha Y, Natukunda B, Livex OA, Ononge S, Kalyango JN, Kajja I. ABO and Rh Antigen Distribution Among Pregnant Women in South Western Uganda. J Blood Med 2022; 13:351-355. [PMID: 35769868 PMCID: PMC9234189 DOI: 10.2147/jbm.s360769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/14/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction ABO and Rh are the major blood group systems in Transfusion Medicine, the ABO system based on two red cell antigens (A, B) while the Rh has about 50 antigens of which five are highly clinically significant (D, C, c, E, e). These vary among races and ethnic groups. Blood type phenotype incompatibility between mother and fetus may result in antigen mismatch, triggering alloimmunization, and thus causing hemolytic transfusion reaction (HTR), which results in hemolytic disease of fetus and newborn (HDFN). This study aimed to determine the frequencies of ABO and rhesus blood group antigen in the pregnant women in South Western Uganda. Methods A cross-sectional study was carried out on 1369 pregnant women who were recruited and provided consent to participate during their regular antenatal visits between August 2020 and July 2021. Four milliliters (4mL) of EDTA-anti-coagulated blood samples were collected and ABO and Rh-blood grouping including Rh antigen screening was done using the agglutination technology comprised of glass beads and reagent contained in a column of the Ortho Biovue ID Micro Typing System (Ortho Clinical Diagnostics, New Jersey, USA). The Rh antigen phenotypes and frequencies were then determined. Results There was percentage distribution of 99.8%, c 99.3%, D 94.3%, C 19.2% and E 15.9%, with Rh cDe/cDe (65.1%) being the most common phenotype followed by cDe/CDe (15%), cDe/cDE (10.8%) and cDE/cDE 0.1% least common. The ABO grouping frequency was obtained as O 49.4%, A 29.5%, B 17.0% and AB 4.1%, with D positivity at 94.3%. Discussion Population genetic variations result in varied expressions of red cell antigens that may have clinical complications. Knowledge of the presence of these Rh antigen distributions and phenotype frequencies during pregnancy help in rational management of the pregnancy, alloimmunization and better approach to safe blood transfusion.
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Affiliation(s)
- Yona Mbalibulha
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bernard Natukunda
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Okwi Andrew Livex
- Department of Pathology, College of Health Science, Makerere University, Kampala, Uganda
| | - Sam Ononge
- Department of Obstetrics & Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joan N Kalyango
- Director Clinical and Epidemiology Unit, School of Medicine, College of Health Science, Makerere University, Kampala, Uganda
| | - Isaac Kajja
- Deputy Principal College of Health Sciences, Makerere University, Kampala, Uganda
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Duete ÚR, Brunetta DM, Araujo Júnior E, Tonni G, Carvalho FHC. Maternal-fetal alloimmunization: perinatal outcomes in a reference hospital in Northeastern Brazil. REVISTA DA ASSOCIAÇÃO MÉDICA BRASILEIRA 2022; 68:670-674. [DOI: 10.1590/1806-9282.20220047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/01/2022] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Edward Araujo Júnior
- Universidade Federal de São Paulo, Brazil; Universidade Municipal de São Caetano do Sul, Brazil
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Martinaud C, Fleuriot E, Pasquier P. Implementation of Low Titer Whole Blood for French overseas operations: O positive or negative products in massive hemorrhage? Transfus Clin Biol 2022; 29:164-167. [DOI: 10.1016/j.tracli.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
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Redondo Villatoro A, Luque González P, Frías Sánchez Z, Castro Artero A, Corrales Gutiérrez I, Pantoja Garrido M. Enfermedad hemolítica perinatal en recién nacido por aloinmunización anti-E. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2022. [DOI: 10.1016/j.gine.2021.100705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Red blood cell alloimmunization in pregnancy: A 10-year single-center study. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp201124016b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
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 trans-fusion management in cases of obstetric hemorrhage. Timely detection of RBC antibodies is part of testing, prevention, and treatment strategy, aimed at achieving better outcomes for alloimmunized mothers with an affected fetus. The aim of the study was to determine the frequency and specificity of alloantibodies among pregnant women from the South Backa District, Serbia, with special attention to the incidence of anti-D alloantibodies. Methods. A retrospective study was conducted in the Blood Transfusion Institute of Vojvodina and covered the period from January 1, 2010, to December 31, 2019. 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 25,694 tested pregnant women, 1.38% were actively immunized, while 1.12% of women acquired antibodies in the current pregnancy. Among 3,622 (14.09%) RhD-negative women, 1.77% produced anti-D antibodies during the ongoing pregnancy. Distribution of anti-body 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. Immunoglobulin 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. However, the incidence of anti-D antibodies 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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Vlachodimitropoulou E, Garbowski M, Anne Solomon S, Abbasi N, Seaward G, Windrim R, Keunen J, Kelly E, Van Mieghem T, Shehata N, Ryan G. Outcome predictors for maternal red blood cell alloimmunisation with anti-K and anti-D managed with intrauterine blood transfusion. Br J Haematol 2021; 196:1096-1104. [PMID: 34862601 DOI: 10.1111/bjh.17956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/29/2022]
Abstract
Red blood cell (RBC) alloimmunisation with anti-D and anti-K comprise the majority of cases of fetal haemolytic disease requiring intrauterine red cell transfusion (IUT). Few studies have investigated which haematological parameters can predict adverse fetal or neonatal outcomes. The aim of the present study was to identify predictors of adverse outcome, including preterm birth, intrauterine fetal demise (IUFD), neonatal death (NND) and/or neonatal transfusion. We reviewed the records of all pregnancies alloimmunised with anti-K and anti-D, requiring IUT over 27 years at a quaternary fetal centre. We reviewed data for 128 pregnancies in 116 women undergoing 425 IUTs. The median gestational age (GA) at first IUT was significantly earlier for anti-K than for anti-D (24·3 vs. 28·7 weeks, P = 0·004). Women with anti-K required more IUTs than women with anti-D (3·84 vs. 3·12 mean IUTs, P = 0·036) and the fetal haemoglobin (Hb) at first IUT was significantly lower (51.0 vs. 70.5 g/l, P = 0·001). The mean estimated daily decrease in Hb did not differ between the two groups. A greater number of IUTs and a slower daily decrease in Hb (g/l/day) between first and second IUTs were predictive of a longer period in utero. Earlier GA at first IUT and a shorter interval from the first IUT until delivery predicted IUFD/NND. Earlier GA and lower Hb at first IUT significantly predicted need for phototherapy and/or blood product use in the neonate. In the anti-K group, a greater number of IUTs was required in women with a higher titre. Furthermore, the higher the titre, the earlier the GA at which an IUT was required in both groups. The rate of fall in fetal Hb between IUTs decreased, as the number of transfusions increased. Our present study identified pregnancies at considerable risk of an unfavourable outcome with anti-D and anti-K RBC alloimmunisation. Identifying such patients can guide pregnancy management, facilitates patient counselling, and can optimise resource use. Prospective studies can also incorporate these characteristics, in addition to laboratory markers, to further identify and improve the outcomes of these pregnancies.
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Affiliation(s)
- Evangelia Vlachodimitropoulou
- Fetal Medicine Unit, Ontario Fetal Center, Mount Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Maciej Garbowski
- Department of Haematology, University College London Hospital, London, UK
| | - Shelley Anne Solomon
- Fetal Medicine Unit, Ontario Fetal Center, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Nimrah Abbasi
- Fetal Medicine Unit, Ontario Fetal Center, Mount Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Gareth Seaward
- Fetal Medicine Unit, Ontario Fetal Center, Mount Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Rory Windrim
- Fetal Medicine Unit, Ontario Fetal Center, Mount Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Johannes Keunen
- Fetal Medicine Unit, Ontario Fetal Center, Mount Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Edmond Kelly
- Fetal Medicine Unit, Ontario Fetal Center, Mount Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Tim Van Mieghem
- Fetal Medicine Unit, Ontario Fetal Center, Mount Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Nadine Shehata
- Fetal Medicine Unit, Ontario Fetal Center, Mount Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Greg Ryan
- Fetal Medicine Unit, Ontario Fetal Center, Mount Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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Thomsen WC, Afify ZA. Late Hyporegenerative Anemia Following Successful Management of Rh-D Alloimmunization: Still an Underappreciated Entity. Clin Pediatr (Phila) 2021; 60:399-402. [PMID: 34098759 DOI: 10.1177/00099228211022156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- William C Thomsen
- University of Utah, Salt Lake City, UT, USA.,Primary Children's Hospital, Salt Lake City, UT, USA
| | - Zeinab A Afify
- University of Utah, Salt Lake City, UT, USA.,Primary Children's Hospital, Salt Lake City, UT, USA
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15
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Sharma D, Tsibizova VI. Current perspective and scope of fetal therapy: part 2. J Matern Fetal Neonatal Med 2020; 35:3812-3830. [PMID: 33135520 DOI: 10.1080/14767058.2020.1839881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Fetal therapy has been defined as any therapeutic intervention either invasive or noninvasive for correcting or treating any fetal malformation or condition. Invasive fetal therapy have its own set of maternal and fetal complications and invasive approach is not feasible in many of fetal conditions that are candidate for fetal therapy. Many such fetal conditions have been treated successfully by medical or noninvasive management. In medical fetal therapy, mothers are treated with medications which are transferred to fetus through placenta and exert positive effect on the fetus, thus avoiding complications that are seen secondary to invasive fetal therapy. The fetal conditions that have been managed with medical therapy includes fetal and neonatal alloimmune thrombocytopenia, neural tube defect, congenital adrenal hyperplasia, perinatal infections, respiratory distress syndrome, inborn error of metabolism, and congenital cystic adenomatoid malformation. This review will cover the medical or noninvasive aspect of fetal therapy and will highlight the progress made in the management of these fetal conditions.
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Affiliation(s)
- Deepak Sharma
- Department of Neonatology, National Institute of Medical Science, Jaipur, India
| | - Valentina I Tsibizova
- Almazov National Medical Research Centre, Health Ministry of Russian Federation, Saint Petersburg, Russia
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Ravenhill BJ, Kanjee U, Ahouidi A, Nobre L, Williamson J, Goldberg JM, Antrobus R, Dieye T, Duraisingh MT, Weekes MP. Quantitative comparative analysis of human erythrocyte surface proteins between individuals from two genetically distinct populations. Commun Biol 2019; 2:350. [PMID: 31552303 PMCID: PMC6754445 DOI: 10.1038/s42003-019-0596-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/23/2019] [Indexed: 12/30/2022] Open
Abstract
Red blood cells (RBCs) play a critical role in oxygen transport, and are the focus of important diseases including malaria and the haemoglobinopathies. Proteins at the RBC surface can determine susceptibility to disease, however previous studies classifying the RBC proteome have not used specific strategies directed at enriching cell surface proteins. Furthermore, there has been no systematic analysis of variation in abundance of RBC surface proteins between genetically disparate human populations. These questions are important to inform not only basic RBC biology but additionally to identify novel candidate receptors for malarial parasites. Here, we use 'plasma membrane profiling' and tandem mass tag-based mass spectrometry to enrich and quantify primary RBC cell surface proteins from two sets of nine donors from the UK or Senegal. We define a RBC surface proteome and identify potential Plasmodium receptors based on either diminished protein abundance, or increased variation in RBCs from West African individuals.
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Affiliation(s)
- Benjamin J. Ravenhill
- Cambridge Institute for Medical Research, University of Cambridge, Hills Road, Cambridge, CB2 0XY UK
| | - Usheer Kanjee
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Ambroise Ahouidi
- Laboratory of Bacteriology and Virology, Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Luis Nobre
- Cambridge Institute for Medical Research, University of Cambridge, Hills Road, Cambridge, CB2 0XY UK
| | - James Williamson
- Cambridge Institute for Medical Research, University of Cambridge, Hills Road, Cambridge, CB2 0XY UK
| | - Jonathan M. Goldberg
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Robin Antrobus
- Cambridge Institute for Medical Research, University of Cambridge, Hills Road, Cambridge, CB2 0XY UK
| | - Tandakha Dieye
- Laboratory of Bacteriology and Virology, Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Manoj T. Duraisingh
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Michael P. Weekes
- Cambridge Institute for Medical Research, University of Cambridge, Hills Road, Cambridge, CB2 0XY UK
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