1
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Bahr TM, Ohls RK, Ilstrup SJ, Christensen RD. Neonatal Intensive Care Unit Patients Receiving More Than 25 Platelet Transfusions. Am J Perinatol 2024; 41:e1769-e1774. [PMID: 37054977 DOI: 10.1055/a-2073-3848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
OBJECTIVE A few patients in neonatal intensive care units (NICU) receive numerous platelet transfusions. These patients can become refractory, defined as transfusions of ≥10 mL/kg failing to increase the platelet count by at least 5,000/µL. Causes of, and best treatments for, platelet transfusion refractoriness in neonates have not been defined. STUDY DESIGN Multi-NICU multiyear retrospective analysis of neonates receiving >25 platelet transfusions. RESULTS Eight neonates received 29 to 52 platelet transfusions. All eight were blood group O. Five had sepsis, four were very small for gestational age, four had bowel resections, two Noonan syndrome, two had cytomegalovirus infection. All eight had some (19-73%) refractory transfusions. Many (2-69%) of the transfusions were ordered when the platelet count was >50,000/µL. Higher posttransfusion counts occurred after ABO-identical transfusions (p = 0.026). Three of the eight had late NICU deaths related to respiratory failure; all five survivors had severe bronchopulmonary dysplasia requiring tracheostomy for prolonged ventilator management. CONCLUSION Neonates who are high users of platelet transfusions appear to be at high risk for poor outcomes, especially respiratory failure. Future studies will examine whether group O neonates are more likely to develop refractoriness and whether certain neonates would have a higher magnitude of posttransfusion rise if they received ABO-identical donor platelets. KEY POINTS · Many of the platelet transfusions given in the NICU are given to a small subset of patients.. · Refractoriness to platelet transfusions is common among these very high recipients.. · Neonates who are high users of platelet transfusions appear to be at high risk for poor outcomes..
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Affiliation(s)
- Timothy M Bahr
- Obstetric and Neonatal Operations, Intermountain Healthcare, Murray, Utah
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah
| | - Robin K Ohls
- Obstetric and Neonatal Operations, Intermountain Healthcare, Murray, Utah
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah
| | - Sarah J Ilstrup
- Intermountain Healthcare Transfusion Services and Department of Pathology, Intermountain Medical Center, Murray, Utah
| | - Robert D Christensen
- Obstetric and Neonatal Operations, Intermountain Healthcare, Murray, Utah
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah
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2
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Sharma KA, Pandey H, Singh N, Garg D, P S, Dadhwal V, Rana A, Chaudhary P. Medical, Administrative, Financial, and Social Challenges in the Management of a Case of Hemolytic Disease of the Fetus Caused by a Rare Alloantibody in a Low-Resource Setting. Cureus 2024; 16:e59676. [PMID: 38836139 PMCID: PMC11149682 DOI: 10.7759/cureus.59676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/06/2024] Open
Abstract
Antibodies to high-frequency antigens are rarely implicated in cases of hemolytic disease of the fetus and newborn (HDFN), yet they pose a challenge to both clinical staff and transfusion medicine, especially with the identification of the implicating antibody and the arrangement of compatible blood for intrauterine transfusion. Here we report one such interesting case of HDFN caused by an alloantibody to a high-frequency antigen belonging to the Rhesus (Rh) blood group system. The patient presented at the 19th week with Rh-isoimmunized pregnancy. She received six intrauterine transfusions (IUTs) at different intervals during the antenatal period. Arranging the blood of this rare blood group required great efforts from hospital administration, clinicians, and social workers. At 31 weeks, the fetus developed a non-reassuring non-stress test (NST). Hence, the baby was delivered by cesarean section. The baby fared well in the neonatal period. With great efforts and support from social health workers, the Japanese Red Cross society, the administration, and non-government organizations, the impossible became possible.
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Affiliation(s)
- K Aparna Sharma
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Hem Pandey
- Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Nilanchali Singh
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Deepali Garg
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Shainy P
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Vatsla Dadhwal
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Anubhuti Rana
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Priyanka Chaudhary
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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3
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Hirani R, Powley T, Mondy P, Irving DO. The prevalence of selected clinically significant red blood cell antigens among Australian blood donors. Pathology 2024; 56:398-403. [PMID: 38142183 DOI: 10.1016/j.pathol.2023.10.008] [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: 05/17/2023] [Revised: 08/31/2023] [Accepted: 10/06/2023] [Indexed: 12/25/2023]
Abstract
Red blood cell (RBC) transfusion can cause some patients to form antibodies to RBC antigens when RBC phenotypes do not match that of the blood donor. Transfusion practitioners can order phenotyped RBC units for patients with known RBC antibodies or those who are at risk of forming them. However, with increasing demand for phenotyped RBC units, contemporary data on antigen prevalence is required to manage the changing supply. A total of 490,491 blood donors, including 103,798 (21.2%) first-time blood donors, from 2019 were analysed for the prevalence of selected clinically relevant blood group antigens. Prevalence of the phenotype R1R1 (D+ C+ E- c- e+) increased from the previous estimate of 17.3% to 24.0% in first-time blood donors. The prevalence of R1r (D+ C+ E- c+ e+) decreased from 35.3% to 30.8%. R1R1 was more common in blood donors born in Asia or the Middle East. The prevalence of Fy(a-b-) in donors where Fy antigens were tested was 0.2%. Of these, 71.8% stated their region of birth as Africa. The prevalence of Jk(a-b-) is 0.01% in donors where the Jk antigens were tested with region of birth stated as either Oceania or Asia. The increasing prevalence of the c-negative phenotype in R1R1 individuals is associated with the changing demographics of the Australian community. For R1R1 individuals with childbearing potential, the transfusion of RhD negative blood, which is usually c-positive, may increase the possibility of haemolytic disease of the fetus and newborn during pregnancy. Continued diversification of the Australian blood donor panel will support having the appropriate phenotyped RBC units available.
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Affiliation(s)
- Rena Hirani
- Australian Red Cross Lifeblood, Sydney, NSW, Australia; Macquarie University, Sydney, NSW, Australia.
| | - Tanya Powley
- Australian Red Cross Lifeblood, Brisbane, Qld, Australia
| | - Phillip Mondy
- Australian Red Cross Lifeblood, Sydney, NSW, Australia
| | - David O Irving
- Australian Red Cross Lifeblood, Sydney, NSW, Australia; University of Technology Sydney, Sydney, NSW, Australia
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4
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Hyvärinen K, Haimila K, Moslemi C, Biobank BS, Olsson ML, Ostrowski SR, Pedersen OB, Erikstrup C, Partanen J, Ritari J. A machine-learning method for biobank-scale genetic prediction of blood group antigens. PLoS Comput Biol 2024; 20:e1011977. [PMID: 38512997 PMCID: PMC10986993 DOI: 10.1371/journal.pcbi.1011977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/02/2024] [Accepted: 03/07/2024] [Indexed: 03/23/2024] Open
Abstract
A key element for successful blood transfusion is compatibility of the patient and donor red blood cell (RBC) antigens. Precise antigen matching reduces the risk for immunization and other adverse transfusion outcomes. RBC antigens are encoded by specific genes, which allows developing computational methods for determining antigens from genomic data. We describe here a classification method for determining RBC antigens from genotyping array data. Random forest models for 39 RBC antigens in 14 blood group systems and for human platelet antigen (HPA)-1 were trained and tested using genotype and RBC antigen and HPA-1 typing data available for 1,192 blood donors in the Finnish Blood Service Biobank. The algorithm and models were further evaluated using a validation cohort of 111,667 Danish blood donors. In the Finnish test data set, the median (interquartile range [IQR]) balanced accuracy for 39 models was 99.9 (98.9-100)%. We were able to replicate 34 out of 39 Finnish models in the Danish cohort and the median (IQR) balanced accuracy for classifications was 97.1 (90.1-99.4)%. When applying models trained with the Danish cohort, the median (IQR) balanced accuracy for the 40 Danish models in the Danish test data set was 99.3 (95.1-99.8)%. The RBC antigen and HPA-1 prediction models demonstrated high overall accuracies suitable for probabilistic determination of blood groups and HPA-1 at biobank-scale. Furthermore, population-specific training cohort increased the accuracies of the models. This stand-alone and freely available method is applicable for research and screening for antigen-negative blood donors.
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Affiliation(s)
- Kati Hyvärinen
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Katri Haimila
- Blood Group Unit, Finnish Red Cross Blood Service, Vantaa, Finland
| | - Camous Moslemi
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Martin L. Olsson
- Department of Laboratory Medicine, Lund University, Lund, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Office for Medical Services, Region Skåne, Sweden
| | - Sisse R. Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole B. Pedersen
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Skejby, Denmark
| | - Jukka Partanen
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Jarmo Ritari
- Research and Development, Finnish Red Cross Blood Service, Helsinki, Finland
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5
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Bodnar M, Lieberman L, Arsenault V, Berardi P, Duncan J, Lane D, Lavoie M, McCarthy J, Morrison D, Robitaille N, Shehata N, Wilson A, Clarke G. The selection and preparation of red cell components for intrauterine transfusion: A national survey. Vox Sang 2024; 119:265-271. [PMID: 38141176 DOI: 10.1111/vox.13575] [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: 08/01/2023] [Revised: 11/13/2023] [Accepted: 12/01/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND AND OBJECTIVES The practice regarding the selection and preparation of red blood cells (RBCs) for intrauterine transfusion (IUT) is variable reflecting historical practice and expert opinion rather than evidence-based recommendations. The aim of this survey was to assess Canadian hospital blood bank practice with respect to red cell IUT. MATERIALS AND METHODS A survey was sent to nine hospital laboratories known to perform red cell IUT. Questions regarding component selection, processing, foetal pre-transfusion testing, transfusion administration, documentation and traceability were assessed. RESULTS The median annual number of IUTs performed in Canada was 109 (interquartile range, 103-118). RBC selection criteria included allogeneic, Cytomegalovirus seronegative, irradiated, fresh units with most sites preferentially providing HbS negative, group O, RhD negative, Kell negative and units lacking the corresponding maternal antibody without extended matching to the maternal phenotype. Red cell processing varied with respect to target haematocrit, use of saline reconstitution (n = 4), use of an automated procedure for red cell concentration (n = 1) and incorporation of a wash step (n = 2). Foetal pre-transfusion testing uniformly included haemoglobin measurement, but additional serologic testing varied. A variety of strategies were used to link the IUT event to the neonate post-delivery, including the creation of a unique foetal blood bank identifier at three sites. CONCLUSION This survey reviews current practice and highlights the need for standardized national guidelines regarding the selection and preparation of RBCs for IUT. This study has prompted a re-examination of priorities for RBC selection for IUT and highlighted strategies for transfusion traceability in this unique setting.
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Affiliation(s)
- Melanie Bodnar
- Canadian Blood Services, Medical Laboratory and Stem Cell Services, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Lani Lieberman
- Department of Clinical Pathology, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Valerie Arsenault
- Centre Hospitalier Universitaire Sainte Justine, Montréal, Quebec, Canada
| | | | | | - Debra Lane
- Health Sciences Centre Winnipeg, Winnipeg, Manitoba, Canada
| | - Marianne Lavoie
- Centre Hospitalier Universitaire de Quebec (Université Laval), Québec City, Québec, Canada
| | | | - Douglas Morrison
- BC Children's and Women's Hospital, Vancouver, British Columbia, Canada
| | - Nancy Robitaille
- Centre Hospitalier Universitaire Sainte Justine, Montréal, Quebec, Canada
- Héma-Québec, Transfusion Medicine, Montréal, Québec, Canada
| | | | - Ann Wilson
- McGill University Health Centre, Montréal, Québec, Canada
| | - Gwen Clarke
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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6
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Cruz-Leal Y, Norris PAA, Gil Gonzalez L, Marjoram D, Wabnitz H, Shan Y, Lazarus AH. Trogocytosis drives red blood cell antigen loss in association with antibody-mediated immune suppression. Blood 2024; 143:807-821. [PMID: 37946269 DOI: 10.1182/blood.2023020860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/27/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023] Open
Abstract
ABSTRACT Red blood cell (RBC) alloimmunization to paternal antigens during pregnancy can cause hemolytic disease of the fetus and newborn (HDFN). This severe and potentially fatal neonatal disorder can be prevented by the administration of polyclonal anti-D through a mechanism referred to as antibody-mediated immune suppression (AMIS). Although anti-D prophylaxis effectively prevents HDFN, a lack of mechanistic clarity has hampered its replacement with recombinant agents. The major theories behind AMIS induction in the hematologic literature have classically centered around RBC clearance; however, antigen modulation/loss has recently been proposed as a potential mechanism of AMIS. To explore the primary mechanisms of AMIS, we studied the ability of 11 different antibodies to induce AMIS, RBC clearance, antigen loss, and RBC membrane loss in the HOD (hen egg lysozyme-ovalbumin-human Duffy) murine model. Antibodies targeting different portions of the HOD molecule could induce AMIS independent of their ability to clear RBCs; however, all antibodies capable of inducing a strong AMIS effect also caused significant in vivo loss of the HOD antigen in conjunction with RBC membrane loss. In vitro studies of AMIS-inducing antibodies demonstrated simultaneous RBC antigen and membrane loss, which was mediated by macrophages. Confocal live-cell microscopy revealed that AMIS-inducing antibodies triggered RBC membrane transfer to macrophages, consistent with trogocytosis. Furthermore, anti-D itself can induce trogocytosis even at low concentrations, when phagocytosis is minimal or absent. In view of these findings, we propose trogocytosis as a mechanism of AMIS induction.
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Affiliation(s)
- Yoelys Cruz-Leal
- Innovation and Portfolio Management, Canadian Blood Services, Ottawa, ON, Canada
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Peter A A Norris
- Innovation and Portfolio Management, Canadian Blood Services, Ottawa, ON, Canada
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Medicine Huddinge, Center for Hematology and Regenerative Medicine, Karolinska Institute, Stockholm, Sweden
| | - Lazaro Gil Gonzalez
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Danielle Marjoram
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Hanna Wabnitz
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Yuexin Shan
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Alan H Lazarus
- Innovation and Portfolio Management, Canadian Blood Services, Ottawa, ON, Canada
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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7
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Carpenter MC, Souter SC, Zipkin RJ, Ackerman ME. Current Insights Into K-associated Fetal Anemia and Potential Treatment Strategies for Sensitized Pregnancies. Transfus Med Rev 2024; 38:150779. [PMID: 37926651 PMCID: PMC10856777 DOI: 10.1016/j.tmrv.2023.150779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023]
Abstract
K-associated anemic disease of the fetus and newborn (K-ADFN) is a rare but life-threatening disease in which maternal alloantibodies cross the placenta and can mediate an immune attack on fetal red blood cells expressing the K antigen. A considerably more common disease, D-associated hemolytic disease of the fetus and newborn (D-HDFN), can be prophylactically treated using polyclonal α-D antibody preparations. Currently, no such prophylactic treatment exists for K-associated fetal anemia, and disease is usually treated with intrauterine blood transfusions. Here we review current understanding of the biology of K-associated fetal anemia, how the maternal immune system is sensitized to fetal red blood cells, and what is understood about potential mechanisms of prophylactic HDFN interventions. Given the apparent challenges associated with preventing alloimmunization, we highlight novel strategies for treating sensitized mothers to prevent fetal anemia that may hold promise not only for K-mediated disease, but also for other pathogenic alloantibody responses.
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Affiliation(s)
| | | | | | - Margaret E Ackerman
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA; Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
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8
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Gao C, Chen Q, Hao X, Wang Q. Immunomodulation of Antibody Glycosylation through the Placental Transfer. Int J Mol Sci 2023; 24:16772. [PMID: 38069094 PMCID: PMC10705935 DOI: 10.3390/ijms242316772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Establishing an immune balance between the mother and fetus during gestation is crucial, with the placenta acting as the epicenter of immune tolerance. The placental transfer of antibodies, mainly immunoglobulin G (IgG), is critical in protecting the developing fetus from infections. This review looks at how immunomodulation of antibody glycosylation occurs during placental transfer and how it affects fetal health. The passage of maternal IgG antibodies through the placental layers, including the syncytiotrophoblast, stroma, and fetal endothelium, is discussed. The effect of IgG subclass, glycosylation, concentration, maternal infections, and antigen specificity on antibody transfer efficiency is investigated. FcRn-mediated IgG transport, influenced by pH-dependent binding, is essential for placental transfer. Additionally, this review delves into the impact of glycosylation patterns on antibody functionality, considering both protective and pathological effects. Factors affecting the transfer of protective antibodies, such as maternal vaccination, are discussed along with reducing harmful antibodies. This in-depth examination of placental antibody transfer and glycosylation provides insights into improving neonatal immunity and mitigating the effects of maternal autoimmune and alloimmune conditions.
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Affiliation(s)
| | | | | | - Qiushi Wang
- Department of Blood Transfusion, Shengjing Hospital of China Medical University, Shenyang 110004, China
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9
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Duan H, Li J, Jiang Z, Shi X, Hu Y. Noninvasive screening of fetal RHD genotype in Chinese pregnant women with serologic RhD-negative phenotype. Transfusion 2023; 63:2152-2158. [PMID: 37698267 DOI: 10.1111/trf.17545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Noninvasive fetal RHD genotyping has been provided to nonimmunized RhD-negative pregnant women to guide anti-D prophylaxis. Among the Chinese, more than 30% of the RhD-negative phenotype is associated with variant RHD alleles, which would limit the accuracy of fetal RHD status prediction; thus, more targeting and proper programs need to be developed. STUDY DESIGN AND METHODS Fluorescence quantitative polymerase chain reaction PCR (qPCR) or Sanger sequencing on all RHD exons was used to detect maternal RHD genotypes. For pregnant women with RHD*01N.01 or RHD*01N.03 alleles, the presence of RHD exons 5 and 10 in cell-free DNA was determined by qPCR. For pregnant women with the RHD(1227G>A) allele, high-throughput sequencing on exon 9 of the RHD gene and RHCE gene was used to predict fetal RhD phenotype. RESULTS Among 65 cases of Chinese pregnant women with the serologic RhD-negative phenotype, three major genotypes were identified: RHD*01N.01/RHD*01N.01 (61.5%), RHD*01N.01/RHD(1227G>A) or RHD*01N.03/RHD(1227G>A) (20%), and RHD*01N.01/RHD*01N.03 (13.8%), along with three cases of minor genotypes (4.6%). For 43 pregnant women with the RHD*01N.01 or RHD*01N.03 alleles, qPCR on maternal cell-free DNA yielded a 98.5% (42/43) accuracy rate and 100% successful prediction rate. High-throughput sequencing was successfully used to predict fetal RhD phenotypes for 13 pregnant women with RHD(1227G>A). CONCLUSION On the basis of maternal RHD genotyping, fetal genotyping through qPCR or high-throughput sequencing can improve the accuracy and success rate of prenatal fetal RhD phenotype prediction among Chinese pregnant women. It plays a potential role in guiding anti-D prophylaxis and pregnancy management in Chinese pregnant women.
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Affiliation(s)
- Honglei Duan
- Center for Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jie Li
- Center for Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zihan Jiang
- Center for Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiaohong Shi
- Center for Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yali Hu
- Center for Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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10
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Quraishy N, Sapatnekar S. Immunohematological testing and transfusion management of the prenatal patient. Adv Clin Chem 2023; 117:163-208. [PMID: 37973319 DOI: 10.1016/bs.acc.2023.08.002] [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] [Indexed: 11/19/2023]
Abstract
The primary indication for immunohematological testing in the prenatal patient is to detect and identify maternal red cell antibodies. If there are antibodies that are expected to hemolyze the fetus' red cells, their strength of reactivity must be tested, and the fetus' antigen status determined. After delivery, testing is performed to assess the extent of fetomaternal hemorrhage, as a large hemorrhage may require other therapeutic interventions. Another major role for immunohematological testing is to select blood components appropriately when intrauterine transfusion is required for fetal anemia resulting from maternal alloimmunization or some other cause. Supplementation with molecular methods has transformed the practice of immunohematology, particularly as it applies to typing for the D antigen of the Rh blood group system. Notwithstanding the advances in testing, close coordination and communication between the transfusion service and the obstetrics service are the foundation for ensuring the finest care for prenatal patients, and for new mothers and their infants. This review describes testing and transfusion practices for prenatal patients, using case presentations to highlight the management of selected immunohematological findings. It also includes a discussion of key patient management topics that are currently unresolved.
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Affiliation(s)
- NurJehan Quraishy
- Section of Transfusion Medicine, Department of Laboratory Medicine, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Suneeti Sapatnekar
- Section of Transfusion Medicine, Department of Laboratory Medicine, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, United States.
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11
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van 't Oever RM, Zwiers C, de Winter D, de Haas M, Oepkes D, Lopriore E, Verweij EJJ. Identification and management of fetal anemia due to hemolytic disease. Expert Rev Hematol 2022; 15:987-998. [PMID: 36264850 DOI: 10.1080/17474086.2022.2138853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Hemolytic disease of the fetus and newborn (HDFN) is a condition caused by maternal alloantibodies against fetal red blood cells (RBCs) that can cause severe morbidity and mortality in the fetus and newborn. Adequate screening programs allow for timely prevention and intervention resulting in significant reduction of the disease over the last decades. Nevertheless, HDFN still occurs and with current treatment having reached an optimum, focus shifts toward noninvasive therapy options. AREAS COVERED This review focusses on the timely identification of high risk cases and antenatal management. Furthermore, we elaborate on future perspectives including improvement of screening, identification of high risk cases and promising treatment options. EXPERT OPINION In high-income countries mortality and morbidity rates due to HDFN have drastically been reduced over the last decades, yet worldwide anti-D mediated HDFN still accounts for 160,000 perinatal deaths and 100,000 patients with disabilities every year. Much of these deaths and disabilities could have been avoided with proper identification and prophylaxis. By implementing sustainable prevention, screening, and disease treatment measures in all countries this will systemically reduce unnecessary perinatal deaths. There is a common responsibility to engage in this cause.
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Affiliation(s)
- Renske M van 't Oever
- Department of Obstetrics and Gynecology, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands.,Department of Immunohematology Diagnostics, Sanquin,Amsterdam, The Netherlands
| | - Carolien Zwiers
- Department of Obstetrics and Gynecology, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Derek de Winter
- Department of Immunohematology Diagnostics, Sanquin,Amsterdam, The Netherlands.,Willem-Alexander Children's Hospital, department of Pediatrics, division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Masja de Haas
- Department of Immunohematology Diagnostics, Sanquin,Amsterdam, The Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Dick Oepkes
- Department of Obstetrics and Gynecology, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Willem-Alexander Children's Hospital, department of Pediatrics, division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - E J Joanne Verweij
- Department of Obstetrics and Gynecology, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
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12
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Abstract
The World Health Organization estimates that approximately a quarter of the world's population suffers from anemia, including almost half of preschool-age children. Globally, iron deficiency anemia is the most common cause of anemia. Other important causes of anemia in children are hemoglobinopathies, infection, and other chronic diseases. Anemia is associated with increased morbidity, including neurologic complications, increased risk of low birth weight, infection, and heart failure, as well as increased mortality. When approaching a child with anemia, detailed historical information, particularly diet, environmental exposures, and family history, often yield important clues to the diagnosis. Dysmorphic features on physical examination may indicate syndromic causes of anemia. Diagnostic testing involves a stepwise approach utilizing various laboratory techniques. The increasing availability of genetic testing is providing new mechanistic insights into inherited anemias and allowing diagnosis in many previously undiagnosed cases. Population-based approaches are being taken to address nutritional anemias. Novel pharmacologic agents and advances in gene therapy-based therapeutics have the potential to ameliorate anemia-associated disease and provide treatment strategies even in the most difficult and complex cases.
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Affiliation(s)
- Patrick G Gallagher
- Departments of Pediatrics, Pathology, and Genetics, Yale University School of Medicine, New Haven, CT
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13
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Li W, Jiang M, Lu R. The impact of shared governance on the adverse mood of parturients with gestational hypertension and perinatal indicators of newborns. J OBSTET GYNAECOL 2022; 42:1823-1828. [PMID: 35465804 DOI: 10.1080/01443615.2022.2039909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Wenyan Li
- Nursing Department, Ganzhou Maternal and Child Health Hospital, Ganzhou, China
| | - Manxiang Jiang
- Trauma Center, Ganzhou People's Hospital, Ganzhou, China
| | - Ruiying Lu
- Department of Obstetrics, Ganzhou Maternal and Child Health Hospital, Ganzhou, China
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14
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Walhof ML, Leon J, Greiner AL, Scott JR, Knudson CM. Hemolytic disease of the fetus and newborn in the sensitizing pregnancy where anti-D was incorrectly identified as RhIG. J Clin Lab Anal 2022; 36:e24323. [PMID: 35243688 PMCID: PMC8993642 DOI: 10.1002/jcla.24323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 01/12/2022] [Accepted: 02/05/2022] [Indexed: 12/02/2022] Open
Abstract
Background Hemolytic disease of the fetus and newborn (HDFN) is a potentially fatal complication in Rh‐incompatible pregnancies and rarely occurs in the sensitizing pregnancy. Distinguishing RhIG from true anti‐D identified is challenging. A case of severe HDFN in which a sample drawn at 28 weeks showed anti‐D antibody (3+ strength) attributed to RhIG is described. RBC antibody testing early in pregnancy was negative. At birth, the infant was severely anemic and maternal anti‐D titer was 1:256. This case represents a clinically significant anti‐D in the sensitizing pregnancy that was missed due to confusion with RhIG. Methods To determine if agglutination strength could be helpful, a retrospective chart‐review using both electronic and paper medical records was performed on 348 samples identified as RhIG and 52 true anti‐D samples. The agglutination strength of antibody was recorded for each sample. Results For RhIG, there was an even distribution between the weak to moderate agglutination strength (w+, 1+, and 2+) results (35%, 26%, and 33%, respectively) and just 6% had a 3+ strength. Agglutination strength in patients with high titer (≥1:16) anti‐D showed they often (44.4%) have 1+ or 2+ agglutination reactivity. Conclusions These results show that agglutination strength alone does not provide reliable evidence to distinguish RhIG from high titer anti‐D antibodies. We recommend that in cases where there is any uncertainty about whether the anti‐D reactivity is due to RhIG, titers should be performed to rule out clinically significant anti‐D antibody.
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Affiliation(s)
- Mackenzie L Walhof
- DeGowin Blood Center, Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Judith Leon
- DeGowin Blood Center, Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Andrea L Greiner
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - James R Scott
- Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Charles Michael Knudson
- DeGowin Blood Center, Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
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15
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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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16
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Rahmati A, Farhat AS, Boroumand-Noughabi S, Soleymani F, Keramati M. Retrospective analysis of direct antiglobulin test positivity at tertiary academic hospital over 10 years. Transfus Apher Sci 2022; 61:103358. [DOI: 10.1016/j.transci.2022.103358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/16/2021] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
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17
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van Sambeeck JHJ, van der Schoot CE, van Dijk NM, Schonewille H, Janssen MP. Extended red blood cell matching for all transfusion recipients is feasible. Transfus Med 2021; 32:221-228. [PMID: 34845765 DOI: 10.1111/tme.12831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/08/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To demonstrate the feasibility and effectiveness of extended matching of red blood cells (RBC) in practice. BACKGROUND At present, alloimmunisation preventing matching strategies are only applied for specific transfusion recipient groups and include a limited number of RBC antigens. The general assumption is that providing fully matched RBC units to all transfusion recipients is not feasible. In this article we refute this assumption and compute the proportion of alloimmunisation that can be prevented, when all donors and transfusion recipients are typed for A, B, D plus twelve minor blood group antigens (C, c, E, e, K, Fya , Fyb , Jka , Jkb , M, S and s). METHODS We developed a mathematical model that determines the optimal sequence for antigen matching. The model allows for various matching strategies, issuing policies and inventory sizes. RESULTS For a dynamic inventory composition (accounting for randomness in the phenotypes supplied and requested) and an antigen identical issuing policy 97% and 94% of alloimmunisation events can be prevented, when respectively one and two RBC units per recipient are requested from an inventory of 1000 units. Although this proportion decreases with smaller inventory sizes, even for an inventory of 60 units almost 50% of all alloimmunisation events can be prevented. CONCLUSION In case antigen of both donors and recipients are comprehensively typed, extended preventive matching is feasible for all transfusion recipients in practice and will significantly reduce transfusion-induced alloimmunisation and (alloantibody-induced) haemolytic transfusion reactions.
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Affiliation(s)
- Joost H J van Sambeeck
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Center for Healthcare Operations Improvement and Research, University of Twente, Enschede, The Netherlands.,Department of Stochastic Operations Research, University of Twente, Enschede, The Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nico M van Dijk
- Center for Healthcare Operations Improvement and Research, University of Twente, Enschede, The Netherlands.,Department of Stochastic Operations Research, University of Twente, Enschede, The Netherlands
| | - Henk Schonewille
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
| | - Mart P Janssen
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
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18
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Dziegiel MH, Krog GR, Hansen AT, Olsen M, Lausen B, Nørgaard LN, Bergholt T, Rieneck K, Clausen FB. Laboratory Monitoring of Mother, Fetus, and Newborn in Hemolytic Disease of Fetus and Newborn. Transfus Med Hemother 2021; 48:306-315. [PMID: 34803574 DOI: 10.1159/000518782] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/27/2021] [Indexed: 01/12/2023] Open
Abstract
Background Laboratory monitoring of mother, fetus, and newborn in hemolytic disease of fetus and newborn (HDFN) aims to guide clinicians and the immunized women to focus on the most serious problems of alloimmunization and thus minimize the consequences of HDFN in general and of anti-D in particular. Here, we present the current approach of laboratory screening and testing for prevention and monitoring of HDFN at the Copenhagen University Hospital in Denmark. Summary All pregnant women are typed and screened in the 1st trimester. This serves to identify the RhD-negative pregnant women who at gestational age (GA) of 25 weeks are offered a second screen test and a non-invasive fetal RhD prediction. At GA 29 weeks, and again after delivery, non-immunized RhD-negative women carrying an RhD-positive fetus are offered Rh immunoglobulin. If the 1st trimester screen reveals an alloantibody, antenatal investigation is initiated. This also includes RhD-positive women with alloantibodies. Specificity and titer are determined, the fetal phenotype is predicted by non-invasive genotyping based on cell-free DNA (RhD, K, Rhc, RhC, RhE, ABO), and serial monitoring of titer commences. Based on titers and specificity, monitoring with serial peak systolic velocity measurements in the fetal middle cerebral artery to detect anemia will take place. Intrauterine transfusion is given when fetal anemia is suspected. Monitoring of the newborn by titer and survival of fetal red blood cells by flow cytometry will help predict the length of the recovery of the newborn.
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Affiliation(s)
- Morten Hanefeld Dziegiel
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Grethe Risum Krog
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anne Todsen Hansen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Olsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Birgitte Lausen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lone Nikoline Nørgaard
- Department of Obstetrics, Center of Fetal Medicine and Ultrasound, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Bergholt
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Klaus Rieneck
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik Banch Clausen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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19
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Myle AK, Al-Khattabi GH. Hemolytic Disease of the Newborn: A Review of Current Trends and Prospects. Pediatric Health Med Ther 2021; 12:491-498. [PMID: 34675752 PMCID: PMC8504549 DOI: 10.2147/phmt.s327032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/02/2021] [Indexed: 11/23/2022] Open
Abstract
Hemolytic disease of the newborn (HDN), also known as Erythroblastosis fetalis, is a hemolytic condition that predominantly affects rhesus-positive fetuses and infants born to rhesus-negative mothers. The pathophysiology of HDN begins with maternal antibodies attacking fetal red blood cells following alloimmunization due to rhesus or ABO incompatibility between the maternal and fetal blood. Previously, HDN was known to cause fetal death in 1% of all pregnancies, but with the advent of immunoprophylactic therapies, the condition can be currently fairly well managed with fewer complications if diagnosed early. Diagnosis calls for extensive history taking, physical examination, serological studies, and imaging modalities such as pelvic ultrasound scans. To prevent the disease, earlier intravenous immunoglobulin (IVIG) should be given to pregnant Rh- women who have not been sensitized. It is also vital to understand prospective complications such as severe hyperbilirubinemia and develop appropriate remedies. Because of its great incidence and nature, HDN has been thoroughly explored, and more studies are being conducted each year, revealing new insights about the condition. This review covers the disorder's etiology, diagnosis, and management, including the most current findings as of 2021, as well as trends and prospects, to help in future research and evidence-based medical practice.
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Affiliation(s)
- Akshay Kiran Myle
- Department of Clinical Research, General Medicine, Pharmacology, Integrative Medicine, Clinical Researcher. National Institute of Medicine Sciences, Poduru Mandalam City, Andhra Pradesh State, India
- Preventive Medicine and Public Health, Ministry of Health, Makkah City, Kingdom of Saudi-Arabia
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20
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Núñez Ahumada MA, Arancibia Aros CE, Villalobos Pavez CE, Pontigo Gonzalez FM, Abarca Arce V, Sandoval Medrano M, Reyes Jorquera S. A mild case of hemolytic disease of the fetus and newborn due to anti-Sc2. Immunohematology 2021; 37:122-125. [PMID: 34591375 DOI: 10.21307/immunohematology-2021-018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report the case of a newborn girl with jaundice due to increased indirect bilirubin with a positive direct antiglobulin test (DAT) and compensated hemolysis. The result of the newborn's DAT was discrepant with the negative result of the mother's indirect antiglobulin test. The multiparous mother had a previous history of fetal hydrops miscarriage, with no known cause, and no record of the cause was found at the hospital where she was treated. After referring samples from the mother and newborn to a reference laboratory, the rare alloanti-Sc2 was identified in the mother's plasma and in the newborn's eluate. HEA BeadChip genotyping of the newborn's DNA sample predicted the SC:1,2 phenotype. We report the case of a newborn girl with jaundice due to increased indirect bilirubin with a positive direct antiglobulin test (DAT) and compensated hemolysis. The result of the newborn’s DAT was discrepant with the negative result of the mother’s indirect antiglobulin test. The multiparous mother had a previous history of fetal hydrops miscarriage, with no known cause, and no record of the cause was found at the hospital where she was treated. After referring samples from the mother and newborn to a reference laboratory, the rare alloanti-Sc2 was identified in the mother’s plasma and in the newborn’s eluate. HEA BeadChip genotyping of the newborn’s DNA sample predicted the SC:1,2 phenotype.
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Affiliation(s)
- M A Núñez Ahumada
- Clínica Santa María , 0500 Santa María Avenue, Providencia, Santiago , Chile 7520378
| | | | - C E Villalobos Pavez
- Transfusion Medicine Service, Blood Bank, Clínica Santa María , Santiago , Chile
| | - F M Pontigo Gonzalez
- Clínica Santa María, Molecular Biology Laboratory of Blood Groups, Blood Bank, Clínica Santa María , Santiago , Chile
| | - V Abarca Arce
- Blood Bank, Clínica Alemana de Temuco , Temuco , Chile
| | | | - S Reyes Jorquera
- Blood Bank Medical Chief, Clínica Alemana de Temuco , Temuco , Chile
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21
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Oud JA, Evers D, de Haas M, de Vooght KMK, van de Kerkhof D, Som N, Péquériaux NCV, Hudig F, Albersen A, van der Bom JG, Zwaginga JJ. The effect of extended c, E and K matching in females under 45 years of age on the incidence of transfusion-induced red blood cell alloimmunisation. Br J Haematol 2021; 195:604-611. [PMID: 34346067 PMCID: PMC9290146 DOI: 10.1111/bjh.17697] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
Maternal alloantibodies directed against fetal red blood cell (RBC) antigens may cause potentially life‐threatening haemolytic disease of the fetus and newborn (HDFN). Dutch transfusion guidelines therefore prescribe preventive cEK matching for all (pre‐)fertile females. To quantify the impact of cEK matching, we compared overall and antigen‐specific cumulative RBC alloimmunisation incidences in females and males aged <45 years. Among a multicentre cohort comprised of patients who received their first and subsequent RBC unit between 2005 and 2019, first‐formed RBC alloantibodies were detected in 47 of 2998 (1·6%) females and 49 of 2507 (2·0%) males. Comparing females and males, overall alloimmunisation incidences were comparable (3·1% [95% confidence interval (CI) 2·1–4·4] versus 3·5% (95% CI 2·4–4·9, P = 0·853) after 10 units transfused). However, cEK alloimmunisation incidences were significantly lower among females (0·6% (95% CI 0·3–1.5) versus 2·2% (95% CI 1·5–3·4, P = 0·001) after 10 units transfused). Yet, despite cEK‐matching guidelines being in effect, 6·5%, 3·6% and 0·2% of all RBC units remained mismatched for c, E or K antigens respectively. Most of these mismatches were almost always due to emergency settings. Even though cEK alloimmunisation was not prevented completely, implementation of cEK matching resulted in an alloantigen‐exposure risk reduction of up to 98%.
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Affiliation(s)
- Josine A Oud
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Haematology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Dorothea Evers
- Department of Haematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Masja de Haas
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Haematology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Immunohaematology Diagnostics, Sanquin, Amsterdam, the Netherlands
| | - Karen M K de Vooght
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daan van de Kerkhof
- Department of Clinical Chemistry and Haematology, Catharina Hospital, Eindhoven, the Netherlands
| | - Nel Som
- Department of Clinical Chemistry, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
| | - Nathalie C V Péquériaux
- Department of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | | | - Arjan Albersen
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Haematology, Leiden University Medical Center, Leiden, the Netherlands
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22
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Jernman R, Isaksson C, Haimila K, Kuosmanen M, Mäkikallio-Anttila K, Toivonen S, Ordén MR, Sulin K, Tihtonen K, Vääräsmäki M, Sainio S. Time points and risk factors for RhD immunizations after the implementation of targeted routine antenatal anti-D prophylaxis: A retrospective nationwide cohort study. Acta Obstet Gynecol Scand 2021; 100:1868-1875. [PMID: 34157128 DOI: 10.1111/aogs.14216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Targeted routine antenatal anti-D prophylaxis was introduced to the national prophylaxis program in Finland in late 2013. The aim of this study was to assess the incidence, time-points, and risk factors for Rhesus D immunization after the implementation of routine antenatal anti-D prophylaxis, in all women in Finland with antenatal anti-D antibodies detected in 2014-2017. MATERIAL AND METHODS In a nationwide population-based retrospective cohort study, the incidence, time-points, and risk factors of anti-D immunizations were analyzed. Information on antenatal screening was obtained from the Finnish Red Cross Blood Service database, and obstetric data from hospital records and the Finnish Medical Birth Register. RESULTS The study included a total of 228 women (197 with complete data for all pregnancies). After the implementation of routine antenatal anti-D prophylaxis, the prevalence of pregnancies with anti-D antibodies decreased from 1.52% in 2014 to 0.88% in 2017, and the corresponding incidence of new immunizations decreased from 0.33% to 0.10%. Time-points for detection of new anti-D antibodies before and after 2014 were the first screening sample at 8-12 weeks of gestation in 52% versus 19%, the second sample at 24-26 weeks in 20% versus 50%, and the third screening at 36 weeks in 28% versus 32%. CONCLUSIONS The incidence of new anti-D immunizations decreased as expected after the implementation of routine antenatal anti-D prophylaxis. True failures are rare and they mainly occur when the prophylaxis is not given appropriately, suggesting a need for constant education of healthcare professionals on the subject.
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Affiliation(s)
- Riina Jernman
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Camilla Isaksson
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | | | | | - Maija-Riitta Ordén
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
| | - Kati Sulin
- Finnish Red Cross Blood Service, Helsinki, Finland
| | - Kati Tihtonen
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Marja Vääräsmäki
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
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23
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Association between ABO and Duffy blood types and circulating chemokines and cytokines. Genes Immun 2021; 22:161-171. [PMID: 34103707 PMCID: PMC8185309 DOI: 10.1038/s41435-021-00137-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/30/2021] [Accepted: 05/17/2021] [Indexed: 02/08/2023]
Abstract
Blood group antigens are inherited traits that may play a role in immune and inflammatory processes. We investigated associations between blood groups and circulating inflammation-related molecules in 3537 non-Hispanic white participants selected from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Whole-genome scans were used to infer blood types for 12 common antigen systems based on well-characterized single-nucleotide polymorphisms. Serum levels of 96 biomarkers were measured on multiplex fluorescent bead-based panels. We estimated marker associations with blood type using weighted linear or logistic regression models adjusted for age, sex, smoking status, and principal components of population substructure. Bonferroni correction was used to control for multiple comparisons, with two-sided p values < 0.05 considered statistically significant. Among the 1152 associations tested, 10 were statistically significant. Duffy blood type was associated with levels of CXCL6/GCP2, CXCL5/ENA78, CCL11/EOTAXIN, CXCL1/GRO, CCL2/MCP1, CCL13/MCP4, and CCL17/TARC, whereas ABO blood type was associated with levels of sVEGFR2, sVEGFR3, and sGP130. Post hoc pairwise t-tests showed that individuals with type Fy(a+b−) had the lowest mean levels of all Duffy-associated markers, while individuals with type A blood had the lowest mean levels of all ABO-associated markers. Additional work is warranted to explore potential clinical implications of these differences.
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24
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Maternal Blood Group and Routine Direct Antiglobulin Testing in Neonates: Is There a Role for Selective Neonatal Testing? CHILDREN-BASEL 2021; 8:children8050426. [PMID: 34065534 PMCID: PMC8161132 DOI: 10.3390/children8050426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/11/2021] [Accepted: 05/19/2021] [Indexed: 12/01/2022]
Abstract
Recommendations for the screening of hemolytic disease of the newborn (HDN) advise taking a selective approach in using the direct antiglobulin test (DAT) for mothers with blood group O or RhD-negative. This study assessed the relation of DAT results to maternal and neonatal blood groups and evaluated the risk of HDN. A retrospective analysis of all healthy newborns admitted during 2018 was performed. Of 1463 newborns, 4.4% had a positive DAT. There were 541 (37%) maternal–neonatal pairs with ABO incompatibility, most commonly born to mothers with blood group O. The cohort of neonates born to mothers with blood group O was divided into three groups: the O-A and O-B groups and the O-O group as a control. The DAT was positive in 59 (8.3%) neonates; most were in the O-B group (49.2%), whereas 13.6% were in the control group (p < 0.01). While the neonates in the O-B group were more likely to require phototherapy (p = 0.03), this finding was not related to DAT results. We found that selective testing of mothers with blood group O, mothers with blood group O or RhD-negative, neonates with blood group B, and neonates with blood group B born to mothers with blood group O or RhD-negative was ineffective in detecting phototherapy requirements. Our results indicate no difference regarding the need for phototherapy in neonates born to mothers with different blood types regardless of the DAT results.
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25
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Vodicka R, Bohmova J, Holuskova I, Krejcirikova E, Prochazka M, Vrtel R. Risk Minimization of Hemolytic Disease of the Fetus and Newborn Using Droplet Digital PCR Method for Accurate Fetal Genotype Assessment of RHD, KEL, and RHCE from Cell-Free Fetal DNA of Maternal Plasma. Diagnostics (Basel) 2021; 11:diagnostics11050803. [PMID: 33925253 PMCID: PMC8146004 DOI: 10.3390/diagnostics11050803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/19/2022] Open
Abstract
The molecular pathology of hemolytic disease of the fetus and newborn (HDFN) is determined by different RHD, RHCE, and KEL genotypes and by blood group incompatibility between the mother and fetus that is caused by erythrocyte antigen presence/absence on the cell surface. In the Czech Republic, clinically significant antierythrocyte alloantibodies include anti-D, anti-K, anti C/c, and anti-E. Deletion of the RHD gene and then three single nucleotide polymorphisms in the RHCE and KEL genes (rs676785, rs609320, and rs8176058) are the most common. The aim of this study is to develop effective and precise monitoring of fetal genotypes from maternal plasma of these polymorphisms using droplet digital (dd)PCR. Fifty-three plasma DNA samples (from 10 to 18 weeks of gestation) were analyzed (10 RHD, 33 RHCE, and 10 KEL). The ddPCR methodology was validated on the basis of the already elaborated and established method of minisequencing and real-time PCR and with newborn phenotype confirmation. The results of ddPCR were in 100% agreement with minisequencing and real-time PCR and also with newborn phenotype. ddPCR can fully replace the reliable but more time-consuming method of minisequencing and real-time PCR RHD examination. Accurate and rapid noninvasive fetal genotyping minimizes the possibility of HDFN developing.
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Affiliation(s)
- Radek Vodicka
- Department of Medical Genetics, University Hospital and Palacky University Olomouc, 775 20 Olomouc, Czech Republic; (R.V.); (E.K.); (M.P.); (R.V.)
| | - Jana Bohmova
- Department of Medical Genetics, University Hospital and Palacky University Olomouc, 775 20 Olomouc, Czech Republic; (R.V.); (E.K.); (M.P.); (R.V.)
- Correspondence: ; Tel.: +42-058-844-4636
| | - Iva Holuskova
- Department of Blood Transfusion, University Hospital and Palacky University Olomouc, 775 20 Olomouc, Czech Republic;
| | - Eva Krejcirikova
- Department of Medical Genetics, University Hospital and Palacky University Olomouc, 775 20 Olomouc, Czech Republic; (R.V.); (E.K.); (M.P.); (R.V.)
| | - Martin Prochazka
- Department of Medical Genetics, University Hospital and Palacky University Olomouc, 775 20 Olomouc, Czech Republic; (R.V.); (E.K.); (M.P.); (R.V.)
| | - Radek Vrtel
- Department of Medical Genetics, University Hospital and Palacky University Olomouc, 775 20 Olomouc, Czech Republic; (R.V.); (E.K.); (M.P.); (R.V.)
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Cruz-Leal Y, Lazarus AH. Could antigen loss be a potential mechanism to explain antibody-mediated immune suppression? Transfusion 2021; 61:1004-1006. [PMID: 33624837 DOI: 10.1111/trf.16309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Yoelys Cruz-Leal
- Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Laboratory Medicine, The Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Alan H Lazarus
- Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Laboratory Medicine, The Keenan Research Centre for Biomedical Science in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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AlKhater SA, Albalwi RA, Alomar SA, Alsultan AA, Almuhaidib HR, Almousa RA, Alanezi SM, Alghamdi RK, Shash HA. Value of the Direct Antiglobulin Test in Predicting the Need for Phototherapy in Newborns. J Blood Med 2021; 12:53-61. [PMID: 33542670 PMCID: PMC7853422 DOI: 10.2147/jbm.s291606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Guidelines for managing neonatal hemolytic disease of the newborn (HDN) recommend a selective approach in the use of direct antiglobulin test (DAT). In Saudi Arabia, many hospitals still perform routine DAT for all newborns. This study assessed the need for phototherapy in relation to DAT results in full-term healthy newborns. Patients and Methods A retrospective analysis of all healthy newborns admitted during 2018 was performed. The primary outcome was the association of positive DAT results with phototherapy. Results There were 1463 newborns born during the study period. The DAT was positive at 4.4%. The 24-hour bilirubin levels were higher in DAT-positive cases (P=0.06); however, peak bilirubin levels were not correlated with the DAT results (P=0.717). Thirty-six neonates (2.46%) required phototherapy, and the need was similar among DAT-positive and DAT-negative cases (P=0.271). The most common indication for phototherapy was clinical jaundice in 22 neonates (61.1%), followed by DAT positivity in 12 (33.3%) and hospital protocol in 2 patients (5.6%) (P <0.01 by chi-square overall comparison). Conclusion Our results indicate that factors other than DAT positivity are important in assessing the need for phototherapy in newborns. Clinical signs of jaundice were indicators of high serum bilirubin levels and subsequent phototherapy, further indicating that the DAT test was overused in predicting the need for phototherapy.
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Affiliation(s)
- Suzan A AlKhater
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,Department of Pediatrics, King Fahad Hospital of the University, Al-Khobar, Saudi Arabia
| | - Rana A Albalwi
- Department of Pediatrics, King Fahad Hospital of the University, Al-Khobar, Saudi Arabia
| | - Sara A Alomar
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Anfal A Alsultan
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Halah R Almuhaidib
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rahaf A Almousa
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sarah M Alanezi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Raghad K Alghamdi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hwazen A Shash
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,Department of Pediatrics, King Fahad Hospital of the University, Al-Khobar, Saudi Arabia
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Sapatnekar S, Lu W, Bakdash S, Quraishy N. Implementation of a Standardized Prenatal Testing Protocol in an Integrated, Multihospital Health System. Am J Clin Pathol 2021; 155:133-140. [PMID: 32880652 DOI: 10.1093/ajcp/aqaa120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES When our institution grew into an integrated multihospital health system, we were faced with the need to standardize laboratory processes, including blood bank processes, across all locations. The purpose of this article is to describe our experience of standardizing the protocols for prenatal testing. METHODS For each hospital in the system, we established service tiers to define tests offered on site or referred to another location. For each prenatal test, we examined the related processes for ways to improve uniformity, efficiency, and reliability. Throughout this process of standardization, we collaborated with the clinical services to gain concurrence on the interpretation and reporting of results. RESULTS We created and implemented a uniform protocol for testing prenatal patients. The protocol standardized the definition of critical titer, instituted criteria to identify passively acquired anti-D, and established a process for the follow-up of women with inconsistent serologic results on Rh(D) typing. CONCLUSIONS Close collaboration with the clinical services ensured that our testing protocol is aligned with the needs of the integrated obstetrics service in the health system. The approach described in this article may provide a plan outline for pathologists facing similar challenges at other integrated health systems.
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Affiliation(s)
- Suneeti Sapatnekar
- Section of Transfusion Medicine, The Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Wen Lu
- Section of Transfusion Medicine, The Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Suzanne Bakdash
- Section of Transfusion Medicine, The Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - NurJehan Quraishy
- Section of Transfusion Medicine, The Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
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29
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Alsaleem M. Intravenous Immune Globulin Uses in the Fetus and Neonate: A Review. Antibodies (Basel) 2020; 9:E60. [PMID: 33158209 PMCID: PMC7709108 DOI: 10.3390/antib9040060] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/07/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023] Open
Abstract
Intravenous immune globulin (IVIG) is made after processing plasma from healthy donors. It is composed mainly of pooled immunoglobulin and has clinical evidence-based applications in adult and pediatric populations. Recently, several clinical applications have been proposed for managing conditions in the neonatal population, such as hemolytic disease of the newborn, treatment, and prophylaxis for sepsis in high-risk neonates, enterovirus parvovirus and COVID-19 related neonatal infections, fetal and neonatal immune-induced thrombocytopenia, neonatal hemochromatosis, neonatal Kawasaki disease, and some types of immunodeficiency. The dosing, mechanism of action, effectiveness, side effects, and adverse reactions of IVIG have been relatively well studied in adults but are not well described in the neonatal population. This review aims to provide the most recent evidence and consensus guidelines about the use of IVIG in the fetus and neonate.
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Affiliation(s)
- Mahdi Alsaleem
- Pediatrics Department, Neonatology, Children’s Mercy Hospital, Kansas City, MO 64108, USA;
- Pediatrics Department, University of Kansas, Wichita, KS 67208, USA
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30
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Osei-Tutu A, Oti-Boadi M, Akosua Affram A, Dzokoto VA, Asante PY, Agyei F, Kenin A. Premarital Counseling Practices among Christian and Muslim Lay Counselors in Ghana. THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2020; 74:203-211. [PMID: 32967548 DOI: 10.1177/1542305020916721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We examined premarital counseling services offered by Christian and Muslim lay counselors in Ghana. Participants including clergy, Islamic clerics, and laity practicing in four urban centers were interviewed. Thematic analysis showed that common issues covered include medical screening, beliefs and values, expectations, partner knowledge, roles and duties, sex, parenthood, financial management, communication, and conflicts. The findings offer important insight into religious premarital counseling in Ghana and contribute to the global literature on premarital counseling.
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Affiliation(s)
| | | | | | - Vivian A Dzokoto
- Department of African-American Studies, Virginia Commonwealth University, USA
| | | | - Francis Agyei
- Department of Psychology, University of Ghana, Ghana
| | - Abraham Kenin
- Department of Psychology, University of Ghana, Ghana
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31
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Hyland CA, O'Brien H, Flower RL, Gardener GJ. Non-invasive prenatal testing for management of haemolytic disease of the fetus and newborn induced by maternal alloimmunisation. Transfus Apher Sci 2020; 59:102947. [PMID: 33115620 DOI: 10.1016/j.transci.2020.102947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Anti-D immunoglobulin prophylaxis reduces the risk of RhD negative women becoming alloimmunised to the RhD antigen and is a major preventative strategy in reducing the burden of haemolytic disease of the fetus and newborn (HDFN). HDFN also arises from other maternal red cell antibodies, with the most clinically significant, after anti-D, being anti-K, anti-c and anti-E. Among the 39 human blood group systems advanced genomic technologies are still revealing novel or rare antigens involved in maternal alloimmunisation. Where clinically significant maternal antibodies are detected in pregnancy, non-invasive prenatal testing (NIPT) of cell-free fetal DNA provides a safe way to assess the fetal blood group antigen status. This provides information as to the risk for HDFN and thus guides management strategies. In many countries, NIPT fetal RHD genotyping as a diagnostic test using real-time PCR has already been integrated into routine clinical care for the management of women with allo-anti-D to assess the risk for HDFN. In addition, screening programs have been established to provide antenatal assessment of the fetal RHD genotype in non-alloimmunised RhD negative pregnant women to target anti-D prophylaxis to those predicted to be carrying an RhD positive baby. Both diagnostic and screening assays exhibit high accuracy (over 99 %). NIPT fetal genotyping for atypical (other than RhD) blood group antigens presents more challenges as most arise from a single nucleotide variant. Recent studies show potential for genomic and digital technologies to provide a personalised medicine approach with NIPT to assess fetal blood group status for women with other (non-D) red cell antibodies to manage the risk for HDFN.
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Affiliation(s)
- Catherine A Hyland
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia; School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Helen O'Brien
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
| | - Robert L Flower
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia; School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Abstract
The components of the immune system may be present in early stages of embryonic and then fetal, then they reach maturity at different stages of pregnancy. Just as the growth and development of the components of the embryonic and then fetal immune system progressively mature, functions are acquired sequentially during the course of pregnancy, both the ability to mount a cell-mediated or antibody-mediated immune response and the tolerance towards a certain group of antigens. The fetus is immunocompetent because during this development, it acquires the ability to generate an immune response. As development takes place, the fetus also generates specific tolerance as it is exposed to genetically foreign and non-inherited maternal antigens. Nonetheless, the fetal immune system does not attack nor harm maternal tissues. At birth, the immune system, although developed, is not mature enough yet. Furthermore, passive transfer of maternal antibodies creates a unique scenario of compatibility that cannot be seen in children or adults. Recent advances in knowledge of fetal and neonatal immunology make it possible to recognize the risks associated with transfusion and how to resolve them.
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Rahimi-Levene N, Chezar J, Yahalom V. Red blood cell alloimmunization prevalence and hemolytic disease of the fetus and newborn in Israel: A retrospective study. Transfusion 2020; 60:2684-2690. [PMID: 32770778 DOI: 10.1111/trf.15987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/16/2020] [Accepted: 06/20/2020] [Indexed: 11/28/2022]
Abstract
Hemolytic disease of the fetus and newborn (HDFN) is a severe form of anemia caused by maternal antibodies against fetal red blood cells (RBC) that can cause intrauterine and perinatal morbidity and mortality. The prevalence and specificities of alloantibodies among Israeli pregnant women and clinical outcomes for their fetuses and newborns are unknown. STUDY DESIGN AND METHODS A retrospective study of women who gave birth between January 1, 2011, and December 31, 2011, was performed. Data were obtained for obstetric admissions from 16 of 27 hospitals, which included results of maternal ABO, D, antibody screens, antibody identification, and requirements for intrauterine or newborn exchange transfusions. RESULTS Data on 90 948 women representing 70% of all births during 2011 were analyzed. Antibody screen was positive in 5245 (5.8%) women. Alloantibodies, excluding anti-D titer (<16) were identified in 900 (1.0%) women. Of 191 D- women, 75 (39.3%) had anti-D titer of 16 or greater. Other common clinically significant antibodies were anti-E (204, 23%), anti-K (145, 16%), and anti-c (97, 10.8%) alone or in antibody combinations. Multiple alloantibodies were observed in 132 of 900 (15%) of women. Severe HDFN developed in 6.8% (9/132) of these pregnancies. Seventeen fetuses and newborns (0.02% of births) including one set of twins required RBC transfusions. Two fetuses whose mothers had multiple alloantibodies received intrauterine transfusions; one of them was hydropic and died. CONCLUSION The prevalence of RBC alloantibodies was 1.0% among Israeli pregnant women. Transfusion was required in 0.02% of the fetuses and newborns. Severe HDFN developed in 6.8% of pregnancies with multiple maternal alloantibodies.
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Affiliation(s)
- Naomi Rahimi-Levene
- Blood Bank, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Judith Chezar
- Blood Bank, Galilee Medical Center, Nahariya, Israel
| | - Vered Yahalom
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Blood Services and Apheresis Institute, Rabin Medical Center, Petach Tikva, Israel.,National Blood Group Reference Laboratory, Magen David Adom, National Blood Services, Ramat Gan, Israel
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34
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Pegoraro V, Urbinati D, Visser GHA, Di Renzo GC, Zipursky A, Stotler BA, Spitalnik SL. Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children. PLoS One 2020; 15:e0235807. [PMID: 32687543 PMCID: PMC7371205 DOI: 10.1371/journal.pone.0235807] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/24/2020] [Indexed: 11/29/2022] Open
Abstract
In the mid-20th century, Hemolytic Disease of the Fetus and Newborn, caused by maternal alloimmunization to the Rh(D) blood group antigen expressed by fetal red blood cells (i.e., "Rh disease"), was a major cause of fetal and neonatal morbidity and mortality. However, with the regulatory approval, in 1968, of IgG anti-Rh(D) immunoprophylaxis to prevent maternal sensitization, the prospect of eradicating Rh disease was at hand. Indeed, the combination of antenatal and post-partum immunoprophylaxis is ~99% effective at preventing maternal sensitization to Rh(D). To investigate global compliance with this therapeutic intervention, we used an epidemiological approach to estimate the current annual number of pregnancies worldwide involving an Rh(D)-negative mother and an Rh(D)-positive fetus. The annual number of doses of anti-Rh(D) IgG required for successful immunoprophylaxis for these cases was then calculated and compared with an estimate of the annual number of doses of anti-Rh(D) produced and provided worldwide. Our results suggest that ~50% of the women around the world who require this type of immunoprophylaxis do not receive it, presumably due to a lack of awareness, availability, and/or affordability, thereby putting hundreds of thousands of fetuses and neonates at risk for Rh disease each year. The global failure to provide this generally acknowledged standard-of-care to prevent Rh disease, even 50 years after its availability, contributes to an enormous, continuing burden of fetal and neonatal disease and provides a critically important challenge to the international health care system.
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Affiliation(s)
| | | | - Gerard H. A. Visser
- Departments of Obstetrics, University Medical Center, Utrecht, the Netherlands
| | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
- Department of Obstetrics and Gynecology, I.M. Sechenov First State University of Moscow, Moscow, Russia
| | | | - Brie A. Stotler
- Department of Pathology and Cell Biology, Columbia University, New York, NY, United States of America
| | - Steven L. Spitalnik
- Department of Pathology and Cell Biology, Columbia University, New York, NY, United States of America
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35
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Castleman JS, Kilby MD. Red cell alloimmunization: A 2020 update. Prenat Diagn 2020; 40:1099-1108. [PMID: 32108353 DOI: 10.1002/pd.5674] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 12/27/2022]
Abstract
Management of maternal red cell alloimmunization has been revolutionized over the last 60 years. Advances in the prevention, screening, diagnosis, and treatment of alloimmune-induced fetal anemia make this condition an exemplar for contemporary practice in fetal therapy. Since survival is now an expectation, attention has turned to optimization of long-term outcomes following an alloimmunized pregnancy. In this review, the current management of red cell alloimmunization is described. Current research and future directions are discussed with particular emphasis on later life outcomes after alloimmune fetal anemia.
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Affiliation(s)
- James S Castleman
- West Midlands Fetal Medicine Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Mark D Kilby
- West Midlands Fetal Medicine Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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36
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Poston JN, Sugalski J, Gernsheimer TB, Marc Stewart F, Pagano MB. Mitigation strategies for anti-D alloimmunization by platelet transfusion in haematopoietic stem cell transplant patients: a survey of NCCN ® centres. Vox Sang 2020; 115:334-338. [PMID: 32080868 DOI: 10.1111/vox.12899] [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: 11/11/2019] [Revised: 01/23/2020] [Accepted: 02/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES D-negative patients are at risk of developing an alloantibody to D (anti-D) if exposed to D during transfusion. The presence of anti-D can lead to haemolytic transfusion reactions and haemolytic disease of the newborn. Anti-D alloimmunization can also complicate allogeneic haematopoietic stem cell transplantation (HSCT) with haemolysis and increased transfusion requirements. The goal of this study was to determine whether cancer centres have transfusion practices intended to prevent anti-D alloimmunization with special attention in patients considered for HSCT. METHODS AND MATERIALS To understand transfusion practices regarding D-positive platelets in D-negative patients with large transfusion needs, we surveyed the 28 cancer centres that are members of the National Comprehensive Cancer Network® (NCCN® ). RESULTS Nineteen centres responded (68%). Most centres (79%) avoid transfusing D-positive platelets to RhD-negative patients when possible. Four centres (21%) avoid D-positive platelets only in D-negative women of childbearing age. If a D-negative patient receives a D-positive platelet transfusion, 53% of centres would consider treating with Rh immune globulin (RhIg) to prevent alloimmunization in women of childbearing age. Only one centre also gives RhIg to all D-negative patients who are HSCT candidates including adult men and women of no childbearing age. CONCLUSION There is wide variation in platelet transfusion practices for supporting D-negative patients. The majority of centres do not have D-positive platelet transfusion policies focused on preventing anti-D alloimmunization specifically in patients undergoing HSCT. Multicentre, longitudinal studies are needed to understand the clinical implications of anti-D alloimmunization in HSCT patients.
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Affiliation(s)
- Jacqueline N Poston
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,BloodworksNW Research Institute, Seattle, WA, USA
| | - Jessica Sugalski
- National Comprehensive Cancer Network, Plymouth Meeting, PA, USA
| | - Terry B Gernsheimer
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - F Marc Stewart
- Seattle Cancer Care Alliance, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Monica B Pagano
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.,Department of Laboratory Medicine, Transfusion Medicine Division, University of Washington, Seattle, WA, USA
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Kjær M, Geisen C, Akkök ÇA, Wikman A, Sachs U, Bussel JB, Nielsen K, Walles K, Curtis BR, Vidarsson G, Järås K, Skogen B. Strategies to develop a prophylaxis for the prevention of HPA-1a immunization and fetal and neonatal alloimmune thrombocytopenia. Transfus Apher Sci 2019; 59:102712. [PMID: 31948915 DOI: 10.1016/j.transci.2019.102712] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Indexed: 01/20/2023]
Abstract
Anti-HPA-1a-antibodies are the main cause of fetal and neonatal alloimmune thrombocytopenia (FNAIT) which may result in intracranial hemorrhage (ICH) and death among fetuses and newborns. Advances in understanding the pathogenesis of FNAIT and proof of concept for prophylaxis to prevent immunization suggest that development of hyperimmune anti-HPA-1a IgG aimed at preventing immunization against HPA-1a and FNAIT is feasible. Anti-HPA-1a IgG can be obtained either by isolating immunoglobulin from already-immunized women or by development of monoclonal anti-HPA-1a antibodies. Here we discuss recent advances that may lead to the development of a prenatal and postnatal prophylactic treatment for the prevention of HPA-1a-associated FNAIT and life-threatening FNAIT-induced complications.
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Affiliation(s)
- Mette Kjær
- Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway; Finnmark Hospital Trust, Hammerfest, Norway.
| | | | | | | | | | - James B Bussel
- Dept of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | | | | | | | | | | | - Bjørn Skogen
- Department of Medical Biology, UiT- The Artic University of Norway, Tromsø, Norway
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Vats K, Watchko JF. Coordinating Care Across the Perinatal Continuum in Hemolytic Disease of the Fetus and Newborn: The Timely Handoff of a Positive Maternal Anti-Erythrocyte Antibody Screen. J Pediatr 2019; 214:212-216. [PMID: 31451186 DOI: 10.1016/j.jpeds.2019.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/22/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Kalyani Vats
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jon F Watchko
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Abstract
PURPOSE OF REVIEW To summarize recent advances in red blood cell (RBC) blood group genotyping, with an emphasis on advances in the use of NGS next generation sequencing (NGS) to detect clinically relevant blood group gene variation. RECENT FINDINGS Genetic information is useful in predicting RBC blood group antigen expression in several clinical contexts, particularly, for patients at high-risk for allosensitization, such as multiple transfused patients. Blood group antigen expression is directed by DNA variants affecting multiply genes. With over 300 known antigens, NGS offers the attractive prospect of comprehensive blood group genotyping. Recent studies from several groups show that NGS reliably detects blood group gene single nucleotide variants (SNVs) with good correlation with other genetic methods and serology. Additionally, new custom NGS methods accurately detect complex DNA variants, including hybrid RH alleles. Thus, recent work shows that NGS detects known and novel blood group gene variants in patients, solves challenging clinical cases, and detects relevant blood group variation in donors. SUMMARY New work shows that NGS is particularly robust in identifying SNVs in blood group genes, whereas custom genomic tools can be used to identify known and novel complex structural variants, including in the RH system.
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40
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Shin KH, Lee HJ, Song D, Lee SM, Kim IS, Kim H, Yang EJ, Park KH. Characteristics of Bilirubin According to the Results of the Direct Antiglobulin Test and Its Impact in Hemolytic Disease of the Newborn. Lab Med 2019; 50:138-144. [PMID: 30192966 DOI: 10.1093/labmed/lmy050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hyperbilirubinemia, which is a sign of hemolytic disease of the newborn (HDN), can irreversibly damage the central nervous system. OBJECTIVES To determine the etiology of HDN in affected patients and characterize the changing pattern of bilirubin using direct antiglobulin testing (DAT). METHODS We collected clinical data from newborns who underwent perinatal DAT and from their mothers, between August 2008 and July 2017. RESULTS Among 303 neonates, 37 (12.2%) showed positive DAT results. The positive predictive values (PPVs) and negative predictive values (NPVs) based on DAT results were 75.7% and 28.9%, respectively, for starting phototherapy. Bilirubin levels increased more rapidly in the DAT-positive group, compared with the DAT-negative group. The initial bilirubin level differed significantly according to the etiology of hyperbilirubinemia. Further, neonates with anti-D showed higher delta bilirubin per day than neonates with other antibodies. CONCLUSION Our results may help to determine the measurement period for bilirubin according to DAT results and etiology.
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Affiliation(s)
- Kyung-Hwa Shin
- Department of Laboratory Medicine, Pusan National University Hospital, Busan, South Korea
| | - Hyun-Ji Lee
- Department of Laboratory Medicine, Biomedical Research Institute Pusan National University Yangsan Hospital, Busan, South Korea
| | - Duyeal Song
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital
| | - Sun-Min Lee
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital
| | - In Suk Kim
- Department of Laboratory Medicine, Pusan National University Hospital, Busan, South Korea
| | - Hyunghoi Kim
- Department of Laboratory Medicine, Pusan National University Hospital, Busan, South Korea
| | - Eu Jeen Yang
- Department of Pediatrics, Pusan National University Hospital
| | - Kyung-Hee Park
- Department of Pediatrics, Pusan National University Hospital
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Chang MR, Chon AH, Baskin J, Nael A, Chmait RH. Case 1: Cardiac Arrest in a 2-month-old Boy with a Prenatal Course Complicated by Alloimmunization. Pediatr Rev 2019; 40:243-246. [PMID: 31043443 DOI: 10.1542/pir.2018-0004] [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: 11/24/2022]
Affiliation(s)
| | - Andrew H Chon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology
| | - Jacquelyn Baskin
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.,Children's Center for Cancer and Blood Disease
| | - Ali Nael
- Department of Pediatrics.,Department of Pathology, Children's Hospital Los Angeles, Los Angeles, CA
| | - Ramen H Chmait
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology
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42
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Transfusion-related red blood cell alloantibodies: induction and consequences. Blood 2019; 133:1821-1830. [PMID: 30808636 DOI: 10.1182/blood-2018-08-833962] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/01/2018] [Indexed: 01/19/2023] Open
Abstract
Blood transfusion is the most common procedure completed during a given hospitalization in the United States. Although often life-saving, transfusions are not risk-free. One sequela that occurs in a subset of red blood cell (RBC) transfusion recipients is the development of alloantibodies. It is estimated that only 30% of induced RBC alloantibodies are detected, given alloantibody induction and evanescence patterns, missed opportunities for alloantibody detection, and record fragmentation. Alloantibodies may be clinically significant in future transfusion scenarios, potentially resulting in acute or delayed hemolytic transfusion reactions or in difficulty locating compatible RBC units for future transfusion. Alloantibodies can also be clinically significant in future pregnancies, potentially resulting in hemolytic disease of the fetus and newborn. A better understanding of factors that impact RBC alloantibody formation may allow general or targeted preventative strategies to be developed. Animal and human studies suggest that blood donor, blood product, and transfusion recipient variables potentially influence which transfusion recipients will become alloimmunized, with genetic as well as innate/adaptive immune factors also playing a role. At present, judicious transfusion of RBCs is the primary strategy invoked in alloimmunization prevention. Other mitigation strategies include matching RBC antigens of blood donors to those of transfusion recipients or providing immunomodulatory therapies prior to blood product exposure in select recipients with a history of life-threatening alloimmunization. Multidisciplinary collaborations between providers with expertise in transfusion medicine, hematology, oncology, transplantation, obstetrics, and immunology, among other areas, are needed to better understand RBC alloimmunization and refine preventative strategies.
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Orzińska A, Guz K, Mikula M, Kluska A, Balabas A, Ostrowski J, Uhrynowska M, Kopeć I, Dębska M, Luterek K, Brojer E. Prediction of fetal blood group and platelet antigens from maternal plasma using next-generation sequencing. Transfusion 2019; 59:1102-1107. [PMID: 30620409 DOI: 10.1111/trf.15116] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/29/2018] [Accepted: 11/09/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fetuses whose mothers have produced antibodies to red blood cell (RBC) or platelet antigens are at risk of being affected by hemolytic disease or alloimmune thrombocytopenia, respectively, only if they inherit the incompatible antigen. Noninvasive diagnosis of the fetal antigen is employed for management of immunized pregnancies, but the specific detection of SNPs, encoding the majority of antigens, in maternal plasma is still a challenge. We applied targeted next-generation sequencing (NGS) to predict the fetal antigen based on the detection of fetomaternal chimerism. METHODS AND MATERIALS The DNA of 13 pregnant women (with anti-K [3] anti-k [1], anti-Fya [1], anti-D + C + Jka [1], anti-D + E + K [1], anti-HPA-1a [1], anti-HPA-3b [1], anti-HPA-5b [1], and nonimmunized [3]) was sequenced using primers for regions encoding RhD, RhC, Rhc, RhE/e, K/k, Fya/b, Jka/b, MN, Ss, and HPA-1, 2, 3, 5, 15, 4 X-polymorphisms on the Ion Torrent Personal Genome Machine (PGM) System (Thermo Fisher Scientific, Inc., Waltham, MA, USA). RESULTS NGS results were in agreement with the phenotype/genotype of women and their neonates (except for the unsuccessful detection of MN and RhC). NGS determined fetal allele chimerism for K, k, Fya, Fyb, Jka, Jkb, S, RhE (from 0.42% to 6.08%); RhD, Rhc (100%); HPA-1a, -2b, -3a, 3b, -5b, -15a, 15b (from 0.23% to 4.11%). NGS revealed fetal chimerism for incompatible antigens (from 0.7% to 4.8%) in 7 immunized cases, excluded in 3 (with anti-K, anti-Fya , anti-HPA-3b). CONCLUSION The designed NGS predicts the fetal RBC and platelet antigen status universally in cases with various clinically significant antibodies as well as providing confirmation of the presence of fetal DNA. However, some improvement of the unsuccessful primers is required.
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Affiliation(s)
- Agnieszka Orzińska
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Katarzyna Guz
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Michal Mikula
- Department of Genetics, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Anna Kluska
- Department of Genetics, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Aneta Balabas
- Department of Genetics, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Jerzy Ostrowski
- Department of Genetics, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.,Medical Centre of Postgraduate Education, Department of Gastroenterology, Hepatology and Clinical Oncology, Warsaw, Poland
| | - Małgorzata Uhrynowska
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Izabella Kopeć
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Marzena Dębska
- Department of Obstetrics and Gynaecology, Medical Centre of Postgraduate Education, Warsaw, Poland
| | - Katarzyna Luterek
- 1th Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Brojer
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
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44
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Szittner Z, Bentlage AE, Donk E, Ligthart PC, Lissenberg‐Thunnissen S, Schoot CE, Vidarsson G. Multiplex blood group typing by cellular surface plasmon resonance imaging. Transfusion 2018; 59:754-761. [DOI: 10.1111/trf.15071] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/21/2018] [Accepted: 10/16/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Zoltan Szittner
- Department of Experimental ImmunohematologySanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Arthur E.H. Bentlage
- Department of Experimental ImmunohematologySanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Eric Donk
- Department of ReagentsSanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Peter C. Ligthart
- Department of Diagnostics, Sanquin Research and Landsteiner LaboratoryAcademic Medical Centre, University of Amsterdam Amsterdam The Netherlands
| | - Suzanne Lissenberg‐Thunnissen
- Department of Experimental ImmunohematologySanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - C. Ellen Schoot
- Department of Experimental ImmunohematologySanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Gestur Vidarsson
- Department of Experimental ImmunohematologySanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
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45
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Karafin MS, Tan S, Tormey CA, Spencer BR, Hauser RG, Norris PJ, Roubinian NH, Wu Y, Triulzi DJ, Kleinman S, Gottschall JL, Hendrickson JE. Prevalence and risk factors for RBC alloantibodies in blood donors in the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III). Transfusion 2018; 59:217-225. [PMID: 30427537 DOI: 10.1111/trf.15004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/31/2018] [Accepted: 09/04/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Little information exists on red blood cell (RBC) alloimmunization in healthy US blood donors, despite the potential significance for donors themselves, blood recipients, and the blood center. STUDY DESIGN AND METHODS Donor/donation data were sourced from the Recipient Epidemiology and Donor Evaluation Study-III, which contains information from four US blood centers during 2012 through 2016. Multivariable logistic regression was used to assess prevalence of positive antibody screen by donor demographics, blood type, parity, and transfusion history. RESULTS More than 2 million units were collected from 632,378 donors, with 0.51% of donations antibody screen positive and 0.77% of donors having at least one positive antibody screen. The most common antibody specificities were D (26.4%), E (23.8%), and K (21.6%). Regression analysis indicated that increasing age, female sex, D-negative status, and history of transfusion and pregnancy were positively associated with a positive antibody screen. Prior transfusion history was most strongly associated with a positive antibody screen, with donors reporting a prior transfusion having a higher adjusted odds ratio (3.9) of having a positive antibody screen compared to donors reporting prior pregnancy (adjusted odds ratio, 2.0). Though transfusion was a more potent immune stimulus for RBC alloantibody formation than pregnancy, the sheer number of previously pregnant donors contributed to pregnancy being a risk factor for the majority of clinically significant RBC alloantibodies detected in females. CONCLUSION These findings on prevalence of and risk factors for RBC antibodies may have implications for future medical care of donors and for operations at blood centers.
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Affiliation(s)
- Matthew S Karafin
- Blood Center of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Christopher A Tormey
- Department of Laboratory Medicine, Yale University, New Haven, Connecticut.,VA CT, West Haven, Connecticut
| | - Bryan R Spencer
- Department of Laboratory Medicine, Yale University, New Haven, Connecticut.,American Red Cross, Dedham, Massachusetts
| | - Ronald G Hauser
- Department of Laboratory Medicine, Yale University, New Haven, Connecticut.,VA CT, West Haven, Connecticut
| | - Philip J Norris
- University of California, San Francisco, California.,Blood Systems Research Institute, San Francisco, California
| | - Nareg H Roubinian
- University of California, San Francisco, California.,Blood Systems Research Institute, San Francisco, California
| | - Yanyun Wu
- Department of Laboratory Medicine, Yale University, New Haven, Connecticut.,Bloodworks Northwest, Seattle, Washington
| | - Darrell J Triulzi
- University of Pittsburgh and Institute of Transfusion Medicine, Pittsburgh, Pennsylvania
| | - Steve Kleinman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jerome L Gottschall
- Blood Center of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale University, New Haven, Connecticut.,Department of Pediatrics, Yale University, New Haven, Connecticut
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46
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Maier CL, Mener A, Patel SR, Jajosky RP, Bennett AL, Arthur CM, Hendrickson JE, Stowell SR. Antibody-mediated immune suppression by antigen modulation is antigen-specific. Blood Adv 2018; 2:2986-3000. [PMID: 30413434 PMCID: PMC6234375 DOI: 10.1182/bloodadvances.2018018408] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 09/16/2018] [Indexed: 01/22/2023] Open
Abstract
Alloantibodies developing after exposure to red blood cell (RBC) alloantigens can complicate pregnancy and transfusion therapy. The only method currently available to actively inhibit RBC alloantibody formation is administration of antigen-specific antibodies, a phenomenon termed antibody-mediated immune suppression (AMIS). A well-known example of AMIS is RhD immune globulin prophylaxis to prevent anti-D formation in RhD- individuals. However, whether AMIS is specific or impacts alloimmunization to other antigens on the same RBC remains unclear. To evaluate the specificity of AMIS, we passively immunized antigen-negative recipients with anti-KEL or anti-hen egg lysozyme (HEL) antibodies, followed by transfusion of murine RBC expressing both the HEL-ovalbumin-Duffy (HOD) and human KEL antigens (HOD × KEL RBC). Significant immunoglobulin G deposition on transfused HOD × KEL RBC occurred in all passively immunized recipients. Complement deposition and antigen modulation of the KEL antigen occurred on transfused RBC only in anti-KEL-treated recipients, whereas HEL antigen levels decreased only in the presence of anti-HEL antibodies. Western blot analysis confirmed the specificity of antigen loss, which was not attributable to RBC endocytosis and appears distinct for the 2 antigens. Specifically, removal of KEL was attenuated by clodronate treatment, whereas loss of HEL was unaffected by clodronate in vivo but sensitive to protease treatment in vitro. Antigen-specific modulation correlated with antigen-specific AMIS, with anti-KEL treated recipients forming antibodies to the HOD antigen and anti-HEL-treated recipients developing antibodies to the KEL antigen. Together, these results demonstrate that passively administered antibodies can selectively inhibit the immune response to a specific antigen.
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Affiliation(s)
- Cheryl L Maier
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA; and
| | - Amanda Mener
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA; and
| | - Seema R Patel
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA; and
| | - Ryan P Jajosky
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA; and
| | - Ashley L Bennett
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA; and
| | - Connie M Arthur
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA; and
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
| | - Sean R Stowell
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA; and
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47
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Webb J, Delaney M. Red Blood Cell Alloimmunization in the Pregnant Patient. Transfus Med Rev 2018; 32:213-219. [PMID: 30097223 DOI: 10.1016/j.tmrv.2018.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/22/2018] [Accepted: 07/05/2018] [Indexed: 12/13/2022]
Abstract
Alloimmunization to red blood cell (RBC) antigens represents a challenge for physicians caring for women of child bearing potential. Exposure to non-self RBC antigens may occur during transfusion or pregnancy leading to the development of antibodies. If a subsequent fetus bears that antigen, maternal antibodies may attack the fetal red blood cells causing red cell destruction and clinically significant hemolytic disease of the fetus and newborn (HDFN). In the most severe cases, HDFN may result in intrauterine fetal demise due to high output cardiac failure, effusions and ascites, known as "hydrops fetalis". This article reviews strategies for management and prevention of RBC alloimmunization in women of child bearing potential.
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Affiliation(s)
- Jennifer Webb
- Children's National Health System, Washington, D.C., USA; The George Washington University, Departments of Pediatrics & Pathology, Washington, DC, USA.
| | - Meghan Delaney
- Children's National Health System, Washington, D.C., USA; The George Washington University, Departments of Pediatrics & Pathology, Washington, DC, USA
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48
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Levitt RN, Gourri E, Gassner C, Banez-Sese G, Salam A, Denomme GA, Yang E. Molecular characterization and multidisciplinary management of Gerbich hemolytic disease of the newborn. Pediatr Blood Cancer 2018; 65:e27014. [PMID: 29469208 DOI: 10.1002/pbc.27014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/30/2017] [Accepted: 01/22/2018] [Indexed: 01/17/2023]
Abstract
Gerbich (Ge) antigens are high frequency red cell antigens expressed on glycophorin C (GYPC) and glycophorin D. Hemolytic disease of the fetus and newborn (HDFN) due to Gerbich antibody is rare and presents a clinical challenge, as Gerbich negative blood is scarce. We report a case of HDFN due to maternal Ge3 negative phenotype and anti-Ge3 alloimmunization, successfully managed by transfusion of maternal blood. Molecular testing revealed that the mother has homozygous deletion of exon 3 of GYPC, the father is homozygous wildtype for GYPC, and the infant is obligate heterozygote expressing Ge3.
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Affiliation(s)
- Rebecca N Levitt
- Department of Pediatrics, Inova Children's Hospital, Falls Church, Virginia
| | - Elise Gourri
- Blood Transfusion Service Zurich, Swiss Red Cross (SRC), Zürich-Schlieren, Switzerland
| | - Christoph Gassner
- Blood Transfusion Service Zurich, Swiss Red Cross (SRC), Zürich-Schlieren, Switzerland
| | - Grace Banez-Sese
- Inova Schar Cancer Institute Apheresis Service, Inova Blood Donor Services, Inova Donor Services, Sterling, Virginia
| | - Abdus Salam
- Blood Bank and Transfusion Service, Inova Fairfax Hospital, Falls Church, Virginia
| | - Gregory A Denomme
- Diagnostic laboratories, BloodCenter of Wisconsin, Milwaukee, Wisconsin
| | - Elizabeth Yang
- Department of Hematology-Oncology, Pediatric Specialists of Virginia, Falls Church, Virginia
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia
- Virginia Commonwealth University School of Medicine-Inova Campus, Falls Church, Virginia
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49
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Karafin MS, Westlake M, Hauser RG, Tormey CA, Norris PJ, Roubinian NH, Wu Y, Triulzi DJ, Kleinman S, Hendrickson JE. Risk factors for red blood cell alloimmunization in the Recipient Epidemiology and Donor Evaluation Study (REDS-III) database. Br J Haematol 2018; 181:672-681. [PMID: 29675950 DOI: 10.1111/bjh.15182] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/29/2018] [Indexed: 12/22/2022]
Abstract
Despite the significance of red blood cell (RBC) alloimmunization, the lack of standardized registries in the US has prevented the completion of large studies. Data from 3·5 years of the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) recipient database, containing information from 12 hospitals, were studied. A RBC alloantibody responder had an antibody identified at any point during the study, and a non-responder had a negative antibody screen at least 15 days post-RBC transfusion. Demographics, blood type, ICD9/10 codes, and other potential correlates were evaluated. Of 319 177 (2·07%) screened patients, 6597 had a total of 8892 clinically significant RBC alloantibodies identified, with 75% being in the Rh or Kell families. Alloimmunization was more common in females (2·38%) than males (1·68%), and in RhD negative (2·82%) than RhD positive (1·94%) patients. Age, sex, RhD status and race were associated with being a responder, and certain diagnoses (including sickle cell disease or trait, systemic lupus erythematosus, rheumatoid arthritis and myelodysplastic syndrome) were more common among responders than non-responders. Data collected in this multi-centre recipient database provide the largest RBC alloimmunized patient cohort studied in the US, with previously known demographic and disease associations of responder status confirmed, and new associations identified.
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Affiliation(s)
| | | | - Ronald G Hauser
- Department of Laboratory Medicine, Yale University, New Haven, CT, USA.,VA CT, West Haven, CT, USA
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale University, New Haven, CT, USA.,VA CT, West Haven, CT, USA
| | - Philip J Norris
- University of California, San Francisco, CA, USA.,Blood Systems Research Institute, San Francisco, CA, USA
| | - Nareg H Roubinian
- University of California, San Francisco, CA, USA.,Blood Systems Research Institute, San Francisco, CA, USA
| | - Yanyun Wu
- Department of Laboratory Medicine, Yale University, New Haven, CT, USA.,Bloodworks Northwest, Seattle, WA, USA
| | - Darrell J Triulzi
- University of Pittsburgh and Institute of Transfusion Medicine, Pittsburgh, PA, USA
| | - Steve Kleinman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale University, New Haven, CT, USA.,Department of Pediatrics, Yale University, New Haven, CT, USA
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50
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Gunasekera D, Zimring JC, Pratt KP. A unique major histocompatibility complex Class II-binding register correlates with HLA-DR11-associated immunogenicity of the major K blood group antigen. Transfusion 2018; 58:1171-1181. [PMID: 29464723 DOI: 10.1111/trf.14525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/29/2017] [Accepted: 01/02/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Kell is a glycoprotein expressed on red blood cells (RBCs). Its K and k variants contain either Met (K antigen) or Thr (k antigen) at Position 193, respectively. Development of anti-K after K-mismatched antigen exposure via blood transfusions or pregnancy can destroy RBCs, leading to hemolytic transfusion reactions and hemolytic disease of the fetus and newborn. The immunogenicity of overlapping 15-mer Kell peptides with M193 or T193 at every possible position was investigated previously. Interestingly, Peptide W179 to M193, with the polymorphic M193T residue at the peptide's C-terminus, was the most effective at stimulating CD4 T cells from a series of K-immunized women. STUDY DESIGN AND METHODS This study investigates the basis for HLA restriction of anti-K immune responses. Major histocompatibility complex Class II (MHCII)-binding prediction algorithms and quantitative peptide-MHCII-binding assays were employed to determine the binding registers; anchor residues; and affinities of wild-type, truncated, and sequence-modified K and k peptides. Predictions were generated using Immune Epitope Database and ProPred algorithms. Competitive peptide-MHCII-binding assays utilized 12 recombinant HLA-DR proteins, K and k peptides, and high-affinity MHCII-restricted reference peptides. RESULTS The peptide-MHCII-binding assays identified a unique K peptide-binding register (W179-S187) restricted to HLA-DRB1*11:01, in addition to partially overlapping binding registers that included the K/k M193T polymorphic site and that bound promiscuously to multiple HLA-DR proteins. CONCLUSION Three partially overlapping MHCII-binding motifs for HLA-DRB1*11:01 result in high-avidity K-peptide binding, which may contribute to HLA-DR11-restricted immunogenicity associated with the K allele.
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Affiliation(s)
- Devi Gunasekera
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Kathleen P Pratt
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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