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Ghesquière L, Leroy J, Deken V, Tournier A, Vaast P, Subtil D, Delsalle A, Alluin G, Garabedian C, Houfflin-Debarge V. Anti-RH1 alloimmunization: At what maternal antibody threshold is there a risk of severe fetal anemia? Transfusion 2023; 63:629-637. [PMID: 36734370 DOI: 10.1111/trf.17264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/16/2022] [Accepted: 12/27/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND To define a threshold of maternal antibodies at risk of severe fetal anemia in patients followed for anti-RH1 alloimmunization (AI). STUDY, DESIGN, AND METHODS We conducted a retrospective study of patients followed for anti-RH1 AI at the Lille University Hospital. The first group, severe anemia, included patients who received one or more in utero transfusions (IUT) or who were induced before 37 weeks of pregnancy for suspected severe fetal anemia. The second group, absence of severe anemia, corresponded to patients without intervention during pregnancy related to AI. Sensitivities, specificities, and positive and negative predictive values for screening for severe fetal anemia were calculated for the antibody thresholds of 3.5 and 5 IU/ml for the quantification. RESULTS Between 2000 and 2018, 207 patients were included 135 in the severe anemia group and 72 in the no severe anemia group. No severe anemia was observed for an antibody titer below 16. For an antibody threshold of 3.5 IU/ml, the sensitivity was 98.2%, with 30.2% false positives. All severe anemias were detected in the second trimester; two cases of severe anemia were not detected in the third trimester. For an antibody threshold of 5 IU/ml, the sensitivity was lower at 95.6%, with five cases of severe anemia not detected. CONCLUSION The antibody threshold of 3.5 IU/ml for the quantification and 16 for the titration allow targeting patients requiring close monitoring by an experienced team in case of anti-RH1 AI.
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Affiliation(s)
- Louise Ghesquière
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS - Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Julie Leroy
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
| | - Valérie Deken
- Univ. Lille, CHU Lille, ULR 2694 - METRICS - Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- Department of Biostatistics, CHU Lille, Lille, France
| | - Alexane Tournier
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
| | - Pascal Vaast
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
| | - Damien Subtil
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS - Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Anne Delsalle
- French Blood Establishment, Nord Pas de Calais, France
| | | | - Charles Garabedian
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS - Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Véronique Houfflin-Debarge
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS - Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
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Phung TV, Houfflin-Debarge V, Ramdane N, Ghesquière L, Delsalle A, Coulon C, Subtil D, Vaast P, Garabedian C. Maternal red blood cell alloimmunization requiring intrauterine transfusion: a comparative study on management and outcome depending on the type of antibody. Transfusion 2018; 58:1199-1205. [DOI: 10.1111/trf.14542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 01/11/2018] [Accepted: 01/13/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Thanh-Vy Phung
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille; Lille France
| | - Véronique Houfflin-Debarge
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille; Lille France
- Perinatal Environment and Growth; EA 4489, University of Lille North of France; Lille France
| | - Nassima Ramdane
- Department of Biostatistics; EA 2694, UDSL, CHU Lille; Lille France
| | - Louise Ghesquière
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille; Lille France
- Perinatal Environment and Growth; EA 4489, University of Lille North of France; Lille France
| | - Anne Delsalle
- Etablissement français du Sang, Nord Pas de Calais; France
| | - Capucine Coulon
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille; Lille France
| | - Damien Subtil
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille; Lille France
- Perinatal Environment and Growth; EA 4489, University of Lille North of France; Lille France
| | - Pascal Vaast
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille; Lille France
| | - Charles Garabedian
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille; Lille France
- Perinatal Environment and Growth; EA 4489, University of Lille North of France; Lille France
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