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Akkök ÇA. Why do RhD negative pregnant women still become anti-D immunized despite prophylaxis with anti-D immunoglobulin? Transfus Apher Sci 2024; 63:103969. [PMID: 38959811 DOI: 10.1016/j.transci.2024.103969] [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: 07/05/2024]
Abstract
Maternal allo-anti-D in RhD negative pregnant women may cause mild to severe hemolytic disease of the fetus and newborn. Although several other antibodies may also destroy red blood cells of the fetus and newborn, preventive measures with anti-D immunoglobulin are only available for D antigen. Targeted antenatal care together with postpartum prophylaxis with anti-D immunoglobulin has significantly reduced the D-alloimmunization risk. Potentially sensitizing events like trauma to the pregnant abdomen, vaginal bleeding, and amniocentesis may lead to fetomaternal hemorrhage and necessitate additional doses. Despite comprehensive programs with these targeted measures, allo-anti-D is still the most common reason for severe hemolytic disease of the fetus and newborn. Where do we fail then? Here, in this review, I would therefore like to discuss the reasons for D-alloimmunizations hoping that the greater focus will pave the way for further reduction in the number of pregnancy-related allo-anti-Ds.
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Affiliation(s)
- Çiğdem Akalın Akkök
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway.
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2
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Clausen FB. Antenatal RHD screening to guide antenatal anti-D immunoprophylaxis in non-immunized D- pregnant women. Immunohematology 2024; 40:15-27. [PMID: 38739027 DOI: 10.2478/immunohematology-2024-004] [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: 05/14/2024]
Abstract
In pregnancy, D- pregnant women may be at risk of becoming immunized against D when carrying a D+ fetus, which may eventually lead to hemolytic disease of the fetus and newborn. Administrating antenatal and postnatal anti-D immunoglobulin prophylaxis decreases the risk of immunization substantially. Noninvasive fetal RHD genotyping, based on testing cell-free DNA extracted from maternal plasma, offers a reliable tool to predict the fetal RhD phenotype during pregnancy. Used as a screening program, antenatal RHD screening can guide the administration of antenatal prophylaxis in non-immunized D- pregnant women so that unnecessary prophylaxis is avoided in those women who carry a D- fetus. In Europe, antenatal RHD screening programs have been running since 2009, demonstrating high test accuracies and program feasibility. In this review, an overview is provided of current state-of-the-art antenatal RHD screening, which includes discussions on the rationale for its implementation, methodology, detection strategies, and test performance. The performance of antenatal RHD screening in a routine setting is characterized by high accuracy, with a high diagnostic sensitivity of ≥99.9 percent. The result of using antenatal RHD screening is that 97-99 percent of the women who carry a D- fetus avoid unnecessary prophylaxis. As such, this activity contributes to avoiding unnecessary treatment and saves valuable anti-D immunoglobulin, which has a shortage worldwide. The main challenges for a reliable noninvasive fetal RHD genotyping assay are low cell-free DNA levels, the genetics of the Rh blood group system, and choosing an appropriate detection strategy for an admixed population. In many parts of the world, however, the main challenge is to improve the basic care for D- pregnant women.
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Affiliation(s)
- Frederik B Clausen
- Laboratory of Blood Genetics, Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
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3
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Isakson P, Pardi C. Evaluation of an automated platform for non-invasive single-exon fetal RHD genotyping early in pregnancy. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2023; 21:472-478. [PMID: 36795345 PMCID: PMC10645351 DOI: 10.2450/2023.0267-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/10/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND RhD immunization is still the major cause of hemolytic disease of the fetus and newborn. Fetal RHD genotyping during pregnancy followed by tailored anti-D prophylaxis for pregnant RhD-negative women carrying an RHD-positive fetus to prevent RhD immunization is a well-established practice in many countries. This study aimed to validate a platform for high-throughput, non-invasive, single-exon, fetal RHD genotyping consisting of automated DNA extraction and PCR set-up, and a novel system for electronic data transfer to the real-time PCR instrument. We also investigated the effect of storage conditions of fresh or frozen samples on the outcome of the assay. MATERIALS AND METHODS Blood samples from 261 RhD-negative pregnant women collected in Gothenburg, Sweden, between November 2018 and April 2020 during gestation week 10-14 were either tested as fresh after storage for 0-7 days at room temperature or as thawed plasma samples previously separated and stored for up to 13 months at -80°C. Extraction of cell-free fetal DNA and PCR set-up were performed in a closed automated system. Fetal RHD genotyping was determined by real-time PCR amplification of the RHD gene exon 4. RESULTS The outcome of RHD genotyping was compared with either the results obtained with serological RhD typing of newborns or with the results of RHD genotyping performed by other laboratories. No difference was observed in genotyping results when using fresh or frozen plasma during short- and long-term storage, revealing high stability of cell-free fetal DNA. The assay has shown high sensitivity (99.37%), specificity (100%), and accuracy (99.62%). DISCUSSION These data confirm that the proposed platform for non-invasive, single-exon, RHD genotyping early in pregnancy is accurate and robust. Importantly, we demonstrated the stability of cell-free fetal DNA in fresh and frozen samples after short- and long-term storage.
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Affiliation(s)
- Pauline Isakson
- Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Cecilia Pardi
- Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Maruta MB, Tesfaye K, Birhanu E, Yigazu N, Yuya M, Debella A, Mussa I. Prevalence and determinants of RH alloimmunization in Rh-negative women in teaching hospitals of Addis Ababa, Ethiopia: a hospital-based cross-sectional study. Front Glob Womens Health 2023; 4:1167736. [PMID: 37645591 PMCID: PMC10461565 DOI: 10.3389/fgwh.2023.1167736] [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: 02/16/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023] Open
Abstract
Background Despite the implementation of immunization with an anti-D antigen for pregnant women, adverse pregnancy outcomes continue to occur in Ethiopia and most Sub-Saharan African countries. Consequently, the woman's obstetric care is compromised, and there is an increase in perinatal morbidity and mortality. In Ethiopia, the burden of the disease is not well understood, and no research has been conducted in the study area. Therefore, this study aims to determine the prevalence and determinants of Rh alloimmunization in Rh-negative women receiving care at Addis Ababa teaching hospitals. Methods An institutional-based cross-sectional study was conducted from 5 October 2020 to 5 May 2021, among 328 Rh-negative pregnant women who received antenatal care and delivery services at Teaching Hospitals under Addis Ababa University. Face-to-face interviews were used to gather data using a pre-tested structured questionnaire, and a chart review was performed using a checklist. The data were entered into Epidata version 3.1 and analyzed using SPSS version 22. Multivariable analysis and logistic regression were used to evaluate the predictors, and the results were presented as an adjusted odds ratio (AOR) with a 95% confidence interval. Statistical significance was declared at a p-value < 0.05. Results Among Rh-D negative individuals, 56(17.1%) were alloimunized with 95% CI (15.1%, 19.23%). The prevalence of Rh-D negative was 2.1% with 95% CI (1.56%, 2.76%). Factors such as unemployment [AOR = 2.28, 95% CI: 1.21, 4.28], failure to use anti-D prophylaxis in previous pregnancy [AOR = 2.08, 95% CI: 1.10, 3.92), and the presence of sensitizing events [AOR = 0.52, 95% CI: 0.27, 0.84] were statistically significant with the outcome variables. Conclusions This study pointed out that the prevalence of Rh was relatively large and that almost one in every five pregnant women was alloimunized. Factors such as unemployment and failure to use anti-D prophylaxis in a previous pregnancy were found to be associated with outcome variables. Therefore, all stakeholders and concerned entities should prioritize enhancing access and affordability to anti-D prophylaxis to prevent the occurrence of Rh alloimmunization and its associated adverse outcomes.
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Affiliation(s)
- Melat B. Maruta
- Obstetrics and Gynecology, Menelik Comprehensive Specialized Hospital, Addis Ababa, Ethiopia
| | - Kiflom Tesfaye
- Obstetrics and Gynecology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Esayas Birhanu
- Obstetrics and Gynecology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Mohammed Yuya
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Ibsa Mussa
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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Elgun T, Musteri Oltulu Y, Yurttas Gok A, Agyuz U, Kilic U. DETERMINATION OF RH TYPE AND GENDER USING CIRCULATING CELL-FREE FETAL DNA IN EARLY PREGNANCY OF RH NEGATIVE WOMEN IN TURKEY. Transfus Clin Biol 2023:S1246-7820(23)00063-0. [PMID: 37116742 DOI: 10.1016/j.tracli.2023.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION Choosing the right clinical approach for early and reliable diagnosis/screening is becoming more important day by day. The aim of the study was to determine the early RhD type with cff-DNA obtained from maternal plasma, especially in the light of recent developments. In this way, it is aimed to apply Rh Ig only to mothers who are determined to have RhD (+) fetuses and to prevent unnecessary further tests that may possess a risk for RhD (-) fetuses. METHODS Prediction of fetal gender and RH genotype was performed by using RT-qPCR method. With simultaneous amplification of sequences of SRY, DYS14 and RH genes (exon 7 and exon 10). Fetal gender and RhD were determined in 30 RHD (-) pregnant women with cfDNA. RESULTS As a result of genotyping, the gender of 67% (20/30) fetuses was determined as male; the gender of 33% (10/30) fetuses was determined as female in a sample group of 30 pregnancies. It was determined that the DYS14 100% (20/20) gene was more sensitive than the SRY 97% (18/20) gene in gender determination after examining prenatal and postnatal results. As a result of the analysis, the presence of 17% (5/30) RhD (-) fetuses and 83% (25/30) RhD (+) fetuses were determined which is 100% compatible with postnatal results. DISCUSSION Detecting fetal RhD gene in maternal plasma made an important contribution to its use in non-invasive prenatal screening. This study shows that unnecessary intervention and cost can be avoided with successful genotyping analysis performed with RT-qPCR.
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Affiliation(s)
- Tugba Elgun
- Department of Medical Biology/Biruni University/Faculty of Medicine/ Istanbul, Turkey.
| | | | - Asiye Yurttas Gok
- Department of Biochemistry/ Istanbul Health and Technology University/Faculty of Pharmacy/Istanbul, Turkey.
| | | | - Ulkan Kilic
- Department of Medical Biology/University of Health Science/Hamidiye School of Medicine/Istanbul, Turkey.
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6
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Uzunel M, Tiblad E, Mörtberg A, Wikman A. Single-exon approach to non-invasive fetal RHD screening in early pregnancy: An update after 10 years' experience. Vox Sang 2022; 117:1296-1301. [PMID: 36102142 PMCID: PMC9826394 DOI: 10.1111/vox.13348] [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: 05/12/2022] [Revised: 06/29/2022] [Accepted: 08/05/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Anti-D prophylaxis, administered to RhD-negative women, has significantly reduced the incidence of RhD immunization. Non-invasive fetal RHD screening has been used in Stockholm for more than 10 years to identify women who will benefit from prophylaxis. The method is based on a single-exon approach and is used in early pregnancy. The aim of this study was to update the performance of the method. MATERIALS AND METHODS The single exon assay from Devyser AB is a multiplex kit detecting both exon 4 of the RHD gene and the housekeeping gene GAPDH. Cell-free DNA was extracted from 1 ml of plasma from EDTA blood taken during early pregnancy, weeks 10-12. The genetic RHD results were compared with serological typing of newborns for a determination of sensitivity and specificity. RESULTS In total, 4337 pregnancies were included in the study; 44 samples (1%) were inconclusive either due to maternal RHD gene variants (n = 34) or technical reasons (n = 10). Of the remaining 4293 pregnancies, a total number of nine discrepant results were found. False positive results (n = 7) were mainly (n = 4) due to RHD gene variants in the child. False-negative results were found in two cases, of which one was caused by a technical error. None of the false-negative cases was due to RHD gene variants. Overall, the sensitivity of the method was 99.93% and specificity 99.56%. CONCLUSION The single-exon assay used in this study is correlated with high sensitivity and specificity.
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Affiliation(s)
- Mehmet Uzunel
- Division of Therapeutic Immunology and Transfusion Medicine, Karolinska InstitutetSolnaSweden
| | - Eleonor Tiblad
- Department of Women's Health, Division of ObstetricsKarolinska University HospitalStockholmSweden,Clinical Epidemiology Division, Department of Medicine SolnaKarolinska InstitutetSolnaSweden
| | - Anette Mörtberg
- The Department of Clinical Immunology and Transfusion MedicineKarolinska University HospitalStockholmSweden
| | - Agneta Wikman
- The Department of Clinical Immunology and Transfusion MedicineKarolinska University HospitalStockholmSweden
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Liu S, Ajne G, Wikman A, Lindqvist C, Reilly M, Tiblad E. Management and clinical consequences of red blood cell antibodies in pregnancy: A population-based cohort study. Acta Obstet Gynecol Scand 2021; 100:2216-2225. [PMID: 34476807 DOI: 10.1111/aogs.14261] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Anti-D alloimmunization is the most common cause of severe hemolytic disease of the fetus and newborn (HDFN). The management of pregnancies affected by less frequent red blood cell (RBC) antibodies poses a challenge to clinicians, and perinatal outcomes are less well described. This study aimed to describe the frequency of clinically significant RBC antibodies in our pregnant population and analyze the risk of prenatal and postnatal treatment for HDFN in relation to our national risk classification system and management guidelines. MATERIAL AND METHODS A retrospective cohort study in the population of all alloimmunized singleton pregnancies in the Stockholm region 1990-2016. Descriptive summaries of different RBC antibodies and pregnancy outcomes were presented, the risks of intrauterine blood transfusion (IUT) and neonatal treatment for HDFN were estimated by type of antibodies. RESULTS Of the 1724 alloimmunized pregnancies, 1079 (63%) were at risk of HDFN and constituted our study cohort. Anti-D was detected in 492 (46%) pregnancies, followed by anti-E in 161 (15%), and anti-c in 128 (12%). Eighty-seven (8%) pregnancies had IUT, with the highest risk in pregnancies affected by anti-D combined with other antibodies. The maximum titer recorded before IUT was 64 or above, except for two pregnancies affected by anti-c, for which the maximum titers were 8 and 16. For the 942 (95%) live-born neonates from 992 alloimmunized pregnancies without IUT, the median gestational age at birth was 38+5 weeks compared with 35+5 weeks for those who had IUT. Neonatal treatment was most common in the anti-D alone and anti-D combined groups, with 136 (57%) and 21 (44%), respectively, treated with phototherapy and 35 (15%) and 9 (20%) receiving exchange transfusions, respectively. For pregnancies complicated by moderate- and low-risk antibodies, phototherapy was less frequent (32 [36%] and 21 [19%]) and exchange transfusion was rare (5 [6%] and 3 [3%]). CONCLUSIONS Anti-D, especially in combination with other antibodies, presents the highest risk of severe HDFN. The classification of less frequent and less well-known RBC antibodies into risk groups can help clinicians in assessing the risk of HDFN and counseling alloimmunized pregnant women regarding the risk of prenatal and postnatal treatments.
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Affiliation(s)
- Shengxin Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Gunilla Ajne
- Pregnancy Care and Delivery, Karolinska University Hospital, Stockholm, Sweden.,Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Solna, Sweden
| | - Agneta Wikman
- Division of Clinical Immunology & Transfusion Medicine, Department of Laboratory Medicine, Karolinska University Hospital, Stockholm, Sweden.,Division of Transplantation, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Solna, Sweden
| | - Caroline Lindqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Marie Reilly
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Eleonor Tiblad
- Center for Fetal Medicine, Pregnancy Care and Delivery, Karolinska University Hospital, Stockholm, Sweden.,Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Solna, Sweden
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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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Sørensen K, Baevre MS, Tomter G, Llohn AH, Hagen KG, Espinosa A, Jacobsen B, Arsenovic MG, Sørvoll IH, Ulvahaug AN, Sundic T, Akkök ÇA. The Norwegian experience with nationwide implementation of fetal RHD genotyping and targeted routine antenatal anti-D prophylaxis. Transfus Med 2021; 31:314-321. [PMID: 33821537 DOI: 10.1111/tme.12772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/04/2021] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To reduce the risk of RhD alloimmunization during the last trimester of pregnancy, a targeted routine antenatal anti-D prophylaxis (RAADP) programme was implemented in Norway in 2016. Here, we present and discuss our experience with the nationwide implementation of the programme, and report sample uptake and preliminary data of de novo anti-D in pregnancy. BACKGROUND The targeted RAADP was advised by the academic community and evaluated by the health authorities. A National Working Group has conducted the implementation in the transfusion services and contributed to organise the administration of the antenatal anti-D prophylaxis. Fetal RhD type is determined by non-invasive prenatal testing at gestational week 24, and anti-D prophylaxis is administrated at gestational week 28 only to women with RhD positive fetuses. METHODS We describe the implementation process of targeted RAADP in Norway. The sample uptake is calculated by comparing the number of fetal RHD screens with the expected number of samples. RESULTS The sample uptake shows regional variations: 88%-100% after 3 years. Promising decrease in de novo anti-D detected during pregnancy is observed. CONCLUSIONS Nationwide targeted RAADP is implemented and included in the Norwegian maternity care programme. Compliance to sample uptake should further improve in some regions. A remaining issue to fulfil is the documentation of the accuracy of the fetal RHD-typing at all sites. Post-natal prophylaxis will then be guided by the fetal RHD result. Dedicated registries will ensure data to evaluate the expected reduction in pregnancy-related RhD immunisations, which is the final success criterion of the programme.
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Affiliation(s)
- Kirsten Sørensen
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway
| | - Mette S Baevre
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway
| | - Geir Tomter
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway
| | - Abid Hussain Llohn
- Department of Immunology and Transfusion Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Kristin G Hagen
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Aurora Espinosa
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway
| | - Barbora Jacobsen
- Department of Immunology and Transfusion Medicine, St. Olav University Hospital, Trondheim, Norway
| | | | | | | | - Tatjana Sundic
- Department of Immunology and Transfusion Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Çiğdem Akalın Akkök
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway
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Wikman A, Mörtberg A, Jalkesten E, Jansson Y, Karlsson A, Tiblad E, Ajne G. Altered strategy of prophylactic anti-D administration in pregnancy to cover term and post-term - a pilot study. Vox Sang 2021; 116:1005-1011. [PMID: 33772800 DOI: 10.1111/vox.13092] [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: 10/09/2020] [Revised: 01/10/2021] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Routine antenatal anti-D prophylaxis (RAADP) to RhD-negative women is most often administered in gestational age (GA) 28-30 weeks with the next anti-D dose administered postpartum. The aim of this study was to analyse the proportion of RhD-negative women where RAADP is not detectable at term and in a pilot study to investigate whether RAADP administered in GA 28 and 38 results in detectable levels at term, post-term and post-delivery. MATERIALS AND METHODS In a retrospective analysis, 4280 RhD-negative women carrying an RHD positive fetus were included and the proportion with a negative antibody screen at delivery was determined. In the second part, 39 pregnancies were included prospectively, a second dose of RAADP was administered in GA 38 weeks, and anti-D was quantified before the second dose and then weekly for 5 weeks. RESULTS In the retrospective analysis, 20·5% (856/4280) with RAADP administered in GA 28 were negative in routine antibody screening at delivery. In the small prospective study, 18% (7/39) had a negative antibody screen and 26% (10/39) had levels below 0·005 IU/ml, in the quantification assay, in GA 38. Anti-D prophylaxis administered in GA 38 showed detectable levels of anti-D up to 30 days post-delivery, with concentration at delivery 0·060 ± 0·034 IU/ml (mean ± SD). CONCLUSION Approximately 20% of the RhD-negative women show non-detectable levels of anti-D at term. A second dose of RAADP at GA 38 results in stable concentrations of anti-D at term, post-term and post-delivery, but with large interindividual variation.
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Affiliation(s)
- Agneta Wikman
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden.,Division of Immunology, Department of CLINTEC, Karolinska Institute, Stockholm, Sweden
| | - Anette Mörtberg
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden.,Division of Immunology, Department of CLINTEC, Karolinska Institute, Stockholm, Sweden
| | - Elisabeth Jalkesten
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Yvonne Jansson
- Pregnancy Care & Delivery, Karolinska University Hospital, Stockholm, Sweden
| | - Anita Karlsson
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Eleonor Tiblad
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Gunilla Ajne
- Pregnancy Care & Delivery, Karolinska University Hospital, Stockholm, Sweden.,Division of Obstet & Gynecol, Department of CLINTEC, Karolinska Institute, Stockholm, Sweden
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11
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Ayenew AA. Prevalence of rhesus D-negative blood type and the challenges of rhesus D immunoprophylaxis among obstetric population in Ethiopia: a systematic review and meta-analysis. Matern Health Neonatol Perinatol 2021; 7:8. [PMID: 33531050 PMCID: PMC7852089 DOI: 10.1186/s40748-021-00129-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/25/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Transplacental or fetomaternal hemorrhage (FMH) may occur during pregnancy or at delivery and lead to immunization to the D antigen if the mother is Rh-negative and the baby is Rh-positive. This can result in hemolytic disease of the fetus and newborn (HDFN) in subsequent D-positive pregnancies. Therefore, the aim of this systematic review and meta-analysis was to estimate distribution of ABO and Rh (D) blood groups among pregnant women in Ethiopia. METHOD We searched PubMed, Google Scholar, EMBASE, Cochrane Library, HINARI, AFRO Library Databases, and African Online Journal databases for all available studies using the following keywords: "High rhesus (Rh(D)) negative frequency", "ABO blood group distribution", "haemolytic disease of the newborn (HDN)", "rh isoimmunization", "anti-RhD immunoglobulin", "D-negative pregnancies", "Frequency", "ABO and Rh blood group distribution", "feto-maternal hemorrhage", "rhesus D negative pregnant mothers", "kleihauer-betke test (KBT)", "Neonatal Hyperbilirubinemia", "non-sensitized RhD-negative pregnant women", "antenatal anti-D immunoglobulin prophylaxis", "Hemolytic disease of the newborn (alloimmunization), Ethiopia. The search string was developed using "AND" and "OR" Boolean operators. All published and unpublished observational studies reporting the distribution of ABO and Rh (D) blood groups among pregnant women in Ethiopia were included. The study participants were all pregnant women in Ethiopia, and the main outcome measure of this systematic review and meta-analysis was Rhesus D-negative blood type and ABO blood group distribution among pregnant women in Ethiopia. The data was extracted by the author (AAA) by using a standardized JBI data extraction format. Microsoft Excel (2016), and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) software were used for data entry and analysis, respectively. The random effect model was used for estimating the pooled effects, and the publication bias was assessed by visual inspection of the funnel plots and objectively by using the Egger's test (i.e. p < 0.05). RESULTS One hundred thirty-two articles were identified through electronic database searching. Of which, 34 were excluded due to duplication, 65 through review of titles and abstracts, and 22 full-text articles were excluded for not reporting the outcome variable and other reasons. Finally, 7 were included to estimate the distribution of ABO and Rh (D) blood groups among pregnant women in Ethiopia. The pooled distribution of Rh-negative blood group among pregnant women in Ethiopia was 10.8% (95%CI: 7.53-14.07, I2 = 85%, p < 0.001). In the ABO system, type O was the most prevalent 39.9% (37.51-42.38), followed by A (30.59% (26.00-35.18)), B (23.04% (20.03-26.05)), and AB the least (4.82%(3.17-6.47)), in the pattern O > A > B > AB. CONCLUSION The pooled distribution of Rh-negative blood group among pregnant women in Ethiopia was high. Rh alloimmunization remains a major factor responsible for perinatal morbidity in Ethiopia and may result in the compromise of the woman's obstetric care due to the unaffordability of anti-D immunoglobulin. There is the urgent need for the implementation of universal access to anti-D immunoglobulin for the Rh-negative pregnant population in Ethiopia.
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Affiliation(s)
- Asteray Assmie Ayenew
- Midwifery Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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12
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Toly‐Ndour C, Huguet‐Jacquot S, Mailloux A, Delaby H, Canellini G, Olsson ML, Wikman A, Koelewijn JM, Minon J, Legler TJ, Clausen FB, Lambert M, Ryan H, Bricl I, Hasslund S, Orzinska A, Guz K, Uhrynowska M, Matteocci A, Nogues N, Muniz‐Diaz E, Sainio S, De Haas M, Van der Schoot CE. Rh disease prevention: the European Perspective. ACTA ACUST UNITED AC 2021. [DOI: 10.1111/voxs.12617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Cécile Toly‐Ndour
- Laboratory of the French National Reference Center in Perinatal Hemobiology Assistance Publique des Hôpitaux de Paris (AP‐HP) Paris France
| | - Stéphanie Huguet‐Jacquot
- Laboratory of the French National Reference Center in Perinatal Hemobiology Assistance Publique des Hôpitaux de Paris (AP‐HP) Paris France
| | - Agnès Mailloux
- Laboratory of the French National Reference Center in Perinatal Hemobiology Assistance Publique des Hôpitaux de Paris (AP‐HP) Paris France
| | - Hélène Delaby
- Laboratory of the French National Reference Center in Perinatal Hemobiology Assistance Publique des Hôpitaux de Paris (AP‐HP) Paris France
| | - Giorgia Canellini
- Transfusion Medicine Unit Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - Martin L. Olsson
- Department of Laboratory Medicine Lund University Lund Sweden
- Department of Clinical Immunology and Transfusion Medicine Office of Medical ServicesLund Sweden
| | - Agneta Wikman
- Department of Clinical Immunology and Transfusion Medicine Intervention and Technology Karolinska Institutet Karolinska University Hospital and Clinical Science Stockholm Sweden
| | - Joke M. Koelewijn
- Department of Experimental Immunohaematology Sanquin Research and Landsteiner Laboratory Amsterdam The Netherlands
| | - Jean‐Marc Minon
- Laboratory Medicine Department of Thrombosis‐ Haemostasis and Transfusion Centre Hospitalier Régional de la Citadelle Liège Belgium
| | - Tobias J. Legler
- Department of Transfusion Medicine University Medical Center Göttingen Germany
| | - Frederik B. Clausen
- Laboratory of Blood Genetics Department of Clinical Immunology Copenhagen University Hospital Copenhagen Denmark
| | - Mark Lambert
- Irish Blood Transfusion Service Blood Group Genetics National Blood Center Dublin Ireland
| | - Helen Ryan
- Irish Blood Transfusion Service Blood Group Genetics National Blood Center Dublin Ireland
| | - Irena Bricl
- Department of Immunohematology Blood Transfusion Center of Slovenia Ljubljana Slovenia
| | - Sys Hasslund
- Department of Clinical Immunology Aarhus University Hospital Aarhus Denmark
| | - Agnieszka Orzinska
- Department of Immunohaematology and Immunology of Blood Transfusion Institute of Haematology and Blood Transfusion Warsaw Poland
| | - Katarzyna Guz
- Department of Immunohaematology and Immunology of Blood Transfusion Institute of Haematology and Blood Transfusion Warsaw Poland
| | - Malgorzata Uhrynowska
- Department of Immunohaematology and Immunology of Blood Transfusion Institute of Haematology and Blood Transfusion Warsaw Poland
| | - Antonella Matteocci
- Department of Transfusion Medicine San Camillo Forlanini Hospital Roma Italy
| | - Nuria Nogues
- Immunohematology Department Banc de Sang i Teixits Barcelona Spain
| | | | | | - Masja De Haas
- Department of Immunohaematology Diagnostics and of Experimental Immunohaematology Sanquin Diagnostic Services and Sanquin Research Amsterdam Netherlands
| | - C. Ellen Van der Schoot
- Department of Immunohaematology Diagnostics and of Experimental Immunohaematology Sanquin Diagnostic Services and Sanquin Research Amsterdam Netherlands
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13
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Noninvasive Fetal RhD Blood Group Genotyping: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2020; 20:1-160. [PMID: 33240456 PMCID: PMC7670296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND RhD blood group incompatibility during pregnancy can cause serious health problems for the fetus. Noninvasive fetal RhD blood group genotyping is a test for fetal RhD status that may help prevent unnecessary preventive treatment (Rh immunoglobulin [RhIG] injections) and intensive pregnancy monitoring. We conducted a health technology assessment of noninvasive fetal RhD blood group genotyping for RhD-negative (RhD-) pregnancies. Our assessment evaluated the test's diagnostic accuracy, clinical utility, and cost-effectiveness, the budget impact of publicly funding this test, and patients' and providers' preferences and values. METHODS We performed a systematic literature search of the clinical and economic evidence to conduct an overview of reviews for test accuracy, a systematic review for clinical utility, and a review of the test's cost-effectiveness compared with usual care. We assessed the risk of bias of each included systematic review and study using the ROBIS and RoBANs tools, respectively. We assessed the quality of the body of clinical evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We developed probabilistic Markov microsimulation models to determine the cost-effectiveness and cost-utility of noninvasive fetal RhD genotyping compared with usual care from the Ontario Ministry of Health perspective. We also estimated the 5-year budget impact of publicly funding this test in Ontario. To examine patient and provider preferences related to noninvasive fetal RhD genotyping, we conducted a literature survey of quantitative studies on preference; the Canadian Agency for Drugs and Technologies in Health (CADTH) performed a review of qualitative literature about patient preferences; and we conducted interviews and an online survey with Ontario patients. RESULTS We included six systematic reviews in the overview of reviews on diagnostic test accuracy and 11 studies in the clinical utility review. Across systematic reviews, test accuracy was high for noninvasive fetal RhD genotyping. The evidence suggests that implementation of noninvasive fetal RhD genotyping may lead to avoidance of unnecessary RhIG prophylaxis (GRADE: Low), good compliance with targeted RhIG prophylaxis (GRADE: Very low), and high uptake of genotyping (GRADE: Low). Alloimmunization may not increase when using noninvasive fetal RhD genotyping to target prenatal RhIG prophylaxis (GRADE: Very low), and may allow unnecessary monitoring and invasive procedures to be avoided in alloimmunized pregnancies (GRADE: Very low).We included eight published economic studies that reported inconsistent results regarding the cost-effectiveness of noninvasive fetal RhD genotyping. In nonalloimmunized RhD- pregnancies, compared with usual care, the intervention identified more maternal alloimmunization cases (probability: 0.0022 vs. 0.0020) and was associated with a reduced number of RhIG injections per pregnancy (1.79 vs 1.43). It was more expensive ($154, 95% credible interval [CrI] $139 to $169) but had little impact on the QALYs of newborns followed over a 10-year time horizon (0.0007, 95% CrI -0.01 to 0.01). The cost of noninvasive fetal RhD genotyping and inclusion of paternal RhD typing were drivers of the cost-effectiveness results in this population. In alloimmunized RhD- pregnancies, noninvasive fetal RhD genotyping was associated with lower resource use during the pregnancy. Compared with usual care, it was less costly (-$6,280, 95% CrI -$6,325 to -$6,229) and more effective (0.19 QALYs, 95% CrI 0.17 to 0.20).The annual budget impact of publicly funding noninvasive fetal RhD genotyping in nonalloimmunized RhD- pregnancies in Ontario ranges from $2.6 million in year 1 (uptake of 80%) to $3.4 million in year 5 (uptake of 100%), with a 5-year total of about $14.8 million. In alloimmunized pregnancies, we estimate cost savings, from about $9 million in year 1 to about $12 million in year 5, with 5-year total savings of about $51.5 million.We included two studies in the survey of quantitative preferences literature. In the quantitative literature, RhD- pregnant people support routine offering of noninvasive fetal RhD genotyping as part of pregnancy care, with a preference to be adequately informed about the test process, attributes, timing, and risks in advance of the test, ideally in a dialogue with their health care provider. More than half of obstetric health care providers were supportive of offering the test. The qualitative review by CADTH and our own engagement with Ontario patients yielded similar results. Participants consistently expressed a desire for more information about the test and assurance about its safety. They also consistently mentioned the prevention of unnecessary monitoring and treatment as potential benefits. CONCLUSIONS Noninvasive fetal RhD blood group genotyping is an accurate test to determine RhD incompatibility and guide management of RhD- pregnancies. Compared with usual care, noninvasive fetal RhD genotyping is less costly and more effective for the management of alloimmunized pregnancies. For nonalloimmunized pregnancies, noninvasive fetal RhD genotyping would generally not be considered cost-effective, compared with usual care, unless the cost of testing is much lower than what is proposed now. Publicly funding noninvasive fetal RhD genotyping for guiding the management of RhD- pregnancies in Ontario over next 5 years is associated with a total budget impact of about $15 million in nonalloimmunized pregnancies and total cost savings of about $51 million in alloimmunized pregnancies. Patients and providers indicated support for the routine use of noninvasive fetal RhD genotyping in RhD- pregnancies.
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14
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Yaşa B, Şahin O, Öcüt E, Seven M, Sözer S. Assessment of Fetal Rhesus D and Gender with Cell-Free DNA and Exosomes from Maternal Blood. Reprod Sci 2020; 28:562-569. [PMID: 32968935 DOI: 10.1007/s43032-020-00321-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 09/16/2020] [Indexed: 12/30/2022]
Abstract
The detection of fetal cell-free DNA (cfDNA) from maternal plasma has enabled the development of essential techniques in prenatal diagnosis during recent years. Extracellular vesicles including exosomes were determined to carry fetal DNA fragments. Considering the known difficulties during isolation and stability of cfDNA, exosomes might provide a new opportunity for prenatal diagnosis and screening. In this study, comparison of cfDNA and exosome DNA (exoDNA) for predicting the fetal sex and Rhesus D (RHD) genotype was performed by using real-time polymerase chain reaction with simultaneous amplification of sequences of SRY and RHD genes. Fetal sex and RHD were determined in 100 and 81 RHD-negative pregnant women with cfDNA and exoDNA, respectively. The gestation ages of pregnant women were between 9 and 40 weeks. The results were compared with the neonatal phenotype for gender and a serological test for RHD. The cfDNA revealed 95.75% sensitivity and 100% specificity in RHD positivity and 100% sensitivity and 95.45% specificity in SRY positivity. Cohen's agreement coefficient in the Kappa test ranged from 0.8 to 1.0 (P < 0.00001). Although the exoDNA failed to amplify 16 cases, the remaining 65 cases revealed a true estimate for both fetal RHD and SRY genes with 100% sensitivity and specificity. Successful application of exoDNA and cfDNA with real-time PCR for fetal genotyping enables this technique to be applied in the assessment of fetal RHD and gender during pregnancy, allowing initiation of early treatment methods and avoiding unnecessary interventions and cost.
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Affiliation(s)
- Büşra Yaşa
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
| | - Orhan Şahin
- Clinic of Obstetrics and Gynecology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Elif Öcüt
- Department of Statistics, Yıldız Technical University, Istanbul, Turkey
| | - Mehmet Seven
- Department of Medical Genetics, Cerrahpasa Medical School Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Selçuk Sözer
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
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15
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Hamel C, Esmaeilisaraji L, Thuku M, Michaud A, Sikora L, Fung-Kee-Fung K. Antenatal and postpartum prevention of Rh alloimmunization: A systematic review and GRADE analysis. PLoS One 2020; 15:e0238844. [PMID: 32913362 PMCID: PMC7482964 DOI: 10.1371/journal.pone.0238844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/25/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Existing systematic reviews of Rh immunoprophylaxis include only data from randomized controlled trials, have dated searches, and some do not report on all domains of risk of bias or evaluate the certainty of the evidence. Our objective was to perform an updated review, by including new trials, any comparative observational studies, and assessing the certainty of the evidence using the GRADE framework. METHODS We searched MEDLINE, Embase and the Cochrane Library from 2000 to November 26, 2019. Relevant websites and bibliographies of systematic reviews and guidelines were searched for studies published before 2000. Outcomes of interest were sensitization and adverse events. Risk of bias was evaluated with the Cochrane tool and ROBINS-I. The certainty of the evidence was performed using the GRADE framework. RESULTS Thirteen randomized trials and eight comparative cohort studies were identified, evaluating 12 comparisons. Although there is some evidence of beneficial treatment effects (e.g., at 6-months postpartum, fewer women who received RhIg at delivery compared to no RhIg became sensitized [70 fewer sensitized women per 1,000 (95%CI: 67 to 71 fewer); I2 = 73%]), due to very low certainty of the evidence, the magnitude of the treatment effect may be overestimated. The certainty of the evidence was very low for most outcomes often due to high risk of bias (e.g., randomization method, allocation concealment, selective reporting) and imprecision (i.e., few events and small sample sizes). There is limited evidence on prophylaxis for invasive fetal procedures (e.g. amniocentesis) in the comparative literature, and few studies reported adverse events. CONCLUSION Serious risk of bias and low to very low certainty of the evidence is found in existing RCTs and comparative observational studies addressing optimal effectiveness of Rh immunoprophylaxis. Guideline development committees should exercise caution when assessing the strength of the recommendations that inform and influence clinical practice in this area.
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Affiliation(s)
- Candyce Hamel
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Micere Thuku
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alan Michaud
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Karen Fung-Kee-Fung
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Maternal-Fetal Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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16
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Gudlaugsson B, Hjartardottir H, Svansdottir G, Gudmundsdottir G, Kjartansson S, Jonsson T, Gudmundsson S, Halldorsdottir AM. Rhesus D alloimmunization in pregnancy from 1996 to 2015 in Iceland: a nation-wide population study prior to routine antenatal anti-D prophylaxis. Transfusion 2019; 60:175-183. [PMID: 31850521 DOI: 10.1111/trf.15635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/22/2019] [Accepted: 11/24/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rhesus D (RhD) incompatibility is still the most important cause of hemolytic disease of the fetus and newborn (HDFN) worldwide. The aim of this study was to investigate the incidence, causes, and consequences of anti-D alloimmunizations in pregnancy in Iceland, prior to implementation of targeted routine antenatal anti-D prophylaxis (RAADP) in 2018. STUDY DESIGN AND METHODS This was a nation-wide cohort study of 130 pregnancies affected by RhD alloimmunization in Iceland in the period from 1996 through 2015. Data were collected from transfusion medicine databases, medical records, and the Icelandic Medical Birth Register. RESULTS Of 130 RhD alloimmunizations, 80 cases (61.5%) represented new RhD immunization in the current pregnancy. Sensitization was discovered in the third trimester in 41 (51.3%) and occurred in the first pregnancy in 14 cases (17.5%). The most likely causative immunization event was the index pregnancy for 45 (56.25%), a previous pregnancy/birth for 26 (32.5%), abortion for 3 (3.75%), and unknown for 6 women (7.5%). Higher anti-D titers were associated with shorter gestational length, cesarean sections, positive direct antiglobulin test (DAT), and severe HDFN. Intrauterine transfusion (IUT) was performed in five pregnancies (3.8%), and 35 of 132 (26.5%) live-born neonates received treatment for HDFN; 32 received phototherapy (24.2%), 13 exchange transfusion (9.8%), and seven simple blood transfusion (5.3%). CONCLUSION In about half of cases, RhD alloimmunization was caused by the index pregnancy and discovered in the third trimester. Thus, the newly implemented RAADP protocol should be effective in reducing the incidence of RhD immunization in Iceland in the future.
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Affiliation(s)
| | - Hulda Hjartardottir
- Department of Obstetrics and Gynecology, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Gudrun Svansdottir
- Blood Bank, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Gudny Gudmundsdottir
- Blood Bank, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Sveinn Kjartansson
- Department of Pediatrics, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Thorbjorn Jonsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Blood Bank, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Sveinn Gudmundsson
- Blood Bank, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Anna M Halldorsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Blood Bank, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
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17
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Clausen FB. Cell‐free fetal
DNA
and fetal blood group genotyping: non‐invasive prenatal testing. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/voxs.12521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Frederik Banch Clausen
- Laboratory of Blood Genetics Department of Clinical Immunology Copenhagen University Hospital Copenhagen Denmark
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18
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Saramago P, Yang H, Llewellyn A, Walker R, Harden M, Palmer S, Griffin S, Simmonds M. High-throughput non-invasive prenatal testing for fetal rhesus D status in RhD-negative women not known to be sensitised to the RhD antigen: a systematic review and economic evaluation. Health Technol Assess 2019; 22:1-172. [PMID: 29580376 DOI: 10.3310/hta22130] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND High-throughput non-invasive prenatal testing (NIPT) for fetal rhesus (D antigen) (RhD) status could avoid unnecessary treatment with routine anti-D immunoglobulin for RhD-negative women carrying a RhD-negative fetus, although this may lead to an increased risk of RhD sensitisations. OBJECTIVES To systematically review the evidence on the diagnostic accuracy, clinical effectiveness and implementation of high-throughput NIPT and to develop a cost-effectiveness model. METHODS We searched MEDLINE and other databases, from inception to February 2016, for studies of high-throughput NIPT free-cell fetal deoxyribonucleic acid (DNA) tests of maternal plasma to determine fetal RhD status in RhD-negative pregnant women who were not known to be sensitised to the RhD antigen. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) and A Cochrane Risk of Bias Assessment Tool: for Non-Randomised Studies of Interventions (ACROBAT-NRSI). Summary estimates of false-positive rates (FPRs) and false-negative rates (FNRs) were calculated using bivariate models. Clinical effectiveness evidence was used to conduct a simulation study. We developed a de novo probabilistic decision tree-based cohort model that considered four alternative ways in which the results of NIPT could guide the use of anti-D immunoglobulin antenatally and post partum. Sensitivity analyses (SAs) were conducted to address key uncertainties and model assumptions. RESULTS Eight studies were included in the diagnostic accuracy review, seven studies were included in the clinical effectiveness review and 12 studies were included in the review of implementation. Meta-analyses included women mostly at or post 11 weeks' gestation. The pooled FNR (women at risk of sensitisation) was 0.34% [95% confidence interval (CI) 0.15% to 0.76%] and the pooled FPR (women needlessly receiving anti-D) was 3.86% (95% CI 2.54% to 5.82%). SAs did not materially alter the overall results. Data on clinical outcomes, including sensitisation rates, were limited. Our simulation suggests that NIPT could substantially reduce unnecessary use of antenatal anti-D with only a small increase in the risk of sensitisation. All large implementation studies suggested that large-scale implementation of high-throughput NIPT was feasible. Seven cost-effectiveness studies were included in the review, which found that the potential for the use of NIPT to produce cost savings was dependent on the cost of the test. Our de novo model suggested that high-throughput NIPT is likely to be cost saving compared with the current practice of providing routine antenatal anti-D prophylaxis to all women who are RhD negative. The extent of the cost saving appeared to be sufficient to outweigh the small increase in sensitisations. However, the magnitude of the cost saving is highly sensitive to the cost of NIPT itself. LIMITATIONS There was very limited evidence relating to the clinical effectiveness of high-throughput NIPT, with no evidence on potential adverse effects. The generalisability of the findings to non-white women and multiple pregnancies is unclear. CONCLUSIONS High-throughput NIPT is sufficiently accurate to detect fetal RhD status in RhD-negative women from 11 weeks' gestation and would considerably reduce unnecessary treatment with routine anti-D immunoglobulin, potentially resulting in cost savings of between £485,000 and £671,000 per 100,000 pregnancies if the cost of implementing NIPT is in line with that reflected in this evaluation. FUTURE WORK Further research on the diagnostic accuracy of NIPT in non-white women is needed. STUDY REGISTRATION This study is registered as PROSPERO CRD42015029497. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Pedro Saramago
- Centre for Health Economics, University of York, York, UK
| | - Huiqin Yang
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Alexis Llewellyn
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ruth Walker
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Susan Griffin
- Centre for Health Economics, University of York, York, UK
| | - Mark Simmonds
- Centre for Reviews and Dissemination, University of York, York, UK
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19
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Shi J, Luo Y. Effects of RHD gene polymorphisms on distinguishing weak D or DEL from RhD- in blood donation in a Chinese population. Mol Genet Genomic Med 2019; 7:e00681. [PMID: 30950221 PMCID: PMC6565595 DOI: 10.1002/mgg3.681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Weak D or DEL red blood cell units may be mistyped as RhD- by current serology assays, which can lead to incompatible transfusion to RhD- recipients and further cause anti-D immunization. Molecular RHD blood group typing is a very effective method for overcoming current technical limits. The purpose of this study was to identify RHD single-nucleotide polymorphisms (SNPs) and compare the genotype prevalence among confirmed RhD- individuals in a Chinese population as well as explore effective biomarkers for current weak D or DEL detection before blood transfusion. METHODS In the present study, 125 weak D (1, 2, 3, and 4.1) or DEL and 185 RhD- blood samples from donors detected by current standard serology were collected. Genotyping system was used to analyze the SNPs of RHD in each sample. RESULTS Seven SNPs (rs592372, rs11485789, rs6669352, rs3118454, rs1053359, rs590787, and rs3927482) were detected in the RHD region. Rs3118454, rs1053359, rs590787, and rs3927482 showed significant differences between the weak D (1, 2, 3 and 4.1) or DEL and RhD- groups. Further combined analysis of the allelic distribution of these four SNPs revealed their higher frequencies in the RhD- group. CONCLUSION The SNPs rs3118454, rs1053359, rs590787, and rs3927482 in RHD showed a significantly higher frequency among an RhD- Chinese population and are potential biomarkers.
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Affiliation(s)
- Jie Shi
- Nanjing Red Cross Blood Center, Nanjing, Jiangsu, P. R. China
| | - Ying Luo
- Nanjing Red Cross Blood Center, Nanjing, Jiangsu, P. R. China.,Division of Nephrology and Rheumatology, Center for Nephrology and Metabolomics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P. R. China
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20
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Wikman A, Jalkesten E, Ajne G, Höglund P, Mörtberg A, Tiblad E. Anti-D quantification in relation to anti-D titre, middle cerebral artery Doppler measurement and clinical outcome in RhD-immunized pregnancies. Vox Sang 2018; 113:779-786. [PMID: 30311187 DOI: 10.1111/vox.12716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 09/04/2018] [Accepted: 09/12/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The optimal strategy to monitor RhD-immunized pregnancies is not evident. Whether a quantitative analysis of anti-D antibodies adds valuable information to anti-D titre is unclear. The aim of this study was to evaluate the relevance of anti-D quantification in routine monitoring of RhD-immunized pregnancies. MATERIALS AND METHODS In a retrospective study, 64 consecutive pregnancies in 61 immunized women with anti-D titre ≥128 at any time during pregnancy were included. According to routine, at titre ≥128, anti-D quantification was performed by flow cytometry and the peak systolic velocity in the middle cerebral artery was measured by ultrasound. Decisions for treatment with intrauterine blood transfusion were based on increased peak systolic velocity in the middle cerebral artery. RESULTS Increasing anti-D concentrations correlated well to increasing anti-D titres, but at each titre value, there was a large interindividual variation, in the determined anti-D concentration. Intrauterine transfusions were initiated in 35 pregnancies according to algorithms based on ultrasound measurements, at anti-D concentrations of 2·4-619 IU/ml and titre 128-16 000. Sixty pregnancies resulted in a live-born child, three in miscarriage and one in termination of pregnancy. During the perinatal care in the neonatal intensive care unit, thirty-one of the neonates were treated with blood exchange transfusions and/or red cell transfusions and 47 were treated with phototherapy. CONCLUSION Anti-D quantification does not add further information compared to anti-D titre, in defining a critical level to start monitoring RhD-immunized pregnancies with Doppler ultrasound.
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Affiliation(s)
- Agneta Wikman
- Department of Immunology and Transfusion Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Elisabeth Jalkesten
- Department of Immunology and Transfusion Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Ajne
- Department of Obstetrics and Gynecology, Center for Fetal Medicine, Karolinska University Hospital and Clintec, Karolinska Institutet, Stockholm, Sweden
| | - Petter Höglund
- Department of Immunology and Transfusion Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Anette Mörtberg
- Department of Immunology and Transfusion Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Eleonor Tiblad
- Department of Obstetrics and Gynecology, Center for Fetal Medicine, Karolinska University Hospital and Clintec, Karolinska Institutet, Stockholm, Sweden
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Clausen FB. Lessons learned from the implementation of non-invasive fetalRHDscreening. Expert Rev Mol Diagn 2018; 18:423-431. [DOI: 10.1080/14737159.2018.1461562] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Frederik Banch Clausen
- Laboratory of Blood Genetics, Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
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Prenatal non-invasive foetal RHD genotyping: diagnostic accuracy of a test as a guide for appropriate administration of antenatal anti-D immunoprophylaxis. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018; 16:514-524. [PMID: 29757138 DOI: 10.2450/2018.0270-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/13/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Foetal RHD genotyping can be predicted by real-time polymerase chain reaction (qPCR) using cell-free foetal DNA extracted from maternal plasma. The object of this study was to determine the diagnostic accuracy and feasibility of non-invasive RHD foetal genotyping, using a commercial multiple-exon assay, as a guide to appropriate administration of targeted antenatal immunoprophylaxis. MATERIAL AND METHODS Cell-free foetal DNA was extracted from plasma of RhD-negative women between 11-30 weeks of pregnancy. The foetal RHD genotype was determined non-invasively by qPCR amplification of exons 5, 7 and 10 of the RHD gene using the Free DNA Fetal Kit® RhD. Results were compared with serological RhD cord blood typing at birth. The analysis of diagnostic accuracy was restricted to the period (24-28+6 weeks) during which foetal genotyping is usually performed for targeted antenatal immunoprophylaxis. RESULTS RHD foetal genotyping was performed on 367 plasma samples (24-28+6 weeks). Neonatal RhD phenotype results were available for 284 pregnancies. Foetal RHD status was inconclusive in 9/284 (3.2%) samples, including four cases with RhD maternal variants. Two false-positive results were registered. The sensitivity was 100% and the specificity was 97.5% (95% CI: 94.0-100). The diagnostic accuracy was 99.3% (95% CI: 98.3-100), decreasing to 96.1% (95% CI: 93.9-98.4) when the inconclusive results were included. The negative and positive predictive values were 100% (95% CI: 100-100) and 99.0% (95% CI: 97.6-100), respectively. There was one false-negative result in a sample collected at 18 weeks. After inclusion of samples at early gestational age (<23+6 week), sensitivity and accuracy were 99.6% (95% CI: 98.7-100) and 95.5% (95% CI: 93.3-97.8), respectively. DISCUSSION This study demonstrates that foetal RHD detection on maternal plasma using a commercial multiple-exon assay is a reliable and accurate tool to predict foetal RhD phenotype. It can be a safe guide for the appropriate administration of targeted prenatal immunoprophylaxis.
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Abstract
BACKGROUND Hemolytic disease of the fetus and newborn due to maternal red blood cell alloimmunization can have serious consequences. Because early detection enables careful monitoring of affected pregnancies, programs to routinely screen all pregnant women have been widely adopted. Due to the low prevalence of alloimmunization, these require large investments of resources to detect a small number of cases. METHODS We conducted a validation study of a decision tree developed in the Netherlands for determining whether to screen for alloimmunization. In a Swedish cohort, we compared the performance of that decision tree to two alternative models that used maternal characteristics, obstetric history, and transfusion history to identify high-risk women for screening or low-risk women who might be exempt from screening. The models were compared for predictive ability and potential reduction in the volume of screening. RESULTS The decision tree applied to our study population identified 89% of alloimmunized women with a negative predictive value (NPV) of 99.7% by screening 62% of the population. To achieve the same NPV, our model exempting low-risk women captured 90% of alloimmunizations by screening 63% of the population. In contrast, the model identifying high-risk women for screening while maintaining a similar NPV captured 63% of alloimmunized women by screening 20% of the population. CONCLUSIONS We validated that an existing decision tree for selecting women for maternal screening performed well in our population, identifying a large proportion of women who became alloimmunized, with a predictive performance almost identical to that of a more elaborate model.
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Daniels G, Finning K, Lozano M, Hyland CA, Liew YW, Powley T, Castilho L, Bonet Bub C, Kutner JM, Banch Clausen F, Christiansen M, Sulin K, Haimila K, Legler TJ, Lambert M, Ryan H, Ní Loingsigh S, Matteocci A, Pierelli L, Dovc Drnovsek T, Bricl I, Nogués N, Muñiz-Diaz E, Olsson ML, Wikman A, de Haas M, van der Schoot CE, Massey E, Westhoff CM. Vox Sanguinis International Forum on application of fetal blood grouping. Vox Sang 2017; 113:e26-e35. [DOI: 10.1111/vox.12615] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - C. A. Hyland
- Australian Red Cross Blood Service, Research and Development; 44 Musk Avenue, Kelvin Grove Brisbane Qld 4059 Australia
| | - Y.-W. Liew
- Australian Red Cross Blood Service, Research and Development; 44 Musk Avenue, Kelvin Grove Brisbane Qld 4059 Australia
| | - T. Powley
- Australian Red Cross Blood Service, Research and Development; 44 Musk Avenue, Kelvin Grove Brisbane Qld 4059 Australia
| | - L. Castilho
- Departamento de Hemoterapia; Hospital Israelita Albert Einstein; Avenida Albert Einstein, 627-3° andar Bloco E CEP: 05651-901 São Paulo SP Brazil
| | - C. Bonet Bub
- Departamento de Hemoterapia; Hospital Israelita Albert Einstein; Avenida Albert Einstein, 627-3° andar Bloco E CEP: 05651-901 São Paulo SP Brazil
| | - J. M. Kutner
- Departamento de Hemoterapia; Hospital Israelita Albert Einstein; Avenida Albert Einstein, 627-3° andar Bloco E CEP: 05651-901 São Paulo SP Brazil
| | - F. Banch Clausen
- Laboratory of Blood Genetics, Rigshospitalet, Section 2034, Department of Clinical Immunology; Copenhagen University Hospital; Blegdamsvej 9 Copenhagen Denmark
| | - M. Christiansen
- Department of Clinical Immunology; Aarhus University Hospital; Palle Juul-Jensens Boulevard 99 8200 Aarhus N Denmark
| | - K. Sulin
- Blood Group Unit; Finnish Red Cross Blood Service; Kivihaantie 7 FI-00310 Helsinki Finland
| | - K. Haimila
- Blood Group Unit; Finnish Red Cross Blood Service; Kivihaantie 7 FI-00310 Helsinki Finland
| | - T. J. Legler
- Department of Transfusion Medicine; University Medical Center Göttingen; Georg-August-Universität; Robert-Koch-Str. 40 Göttingen 37075 Germany
| | - M. Lambert
- Irish Blood Transfusion Service; Blood Group Genetics; National Blood Centre; James's Street Dublin 8 Ireland
| | - H. Ryan
- Irish Blood Transfusion Service; Blood Group Genetics; National Blood Centre; James's Street Dublin 8 Ireland
| | - S. Ní Loingsigh
- Irish Blood Transfusion Service; Blood Group Genetics; National Blood Centre; James's Street Dublin 8 Ireland
| | - A. Matteocci
- Department of Transfusion Medicine; San Camillo Forlanini Hospital; Circonvallazione Gianicolense 87 00152 Roma Italy
| | - L. Pierelli
- Department of Experimental Medicine; Sapienza University of Rome; Piazzale Aldo Moro 5 00185 Roma Italy
- Department of Transfusion Medicine; San Camillo Forlanini Hospital; Circonvallazione Gianicolense 87 00152 Roma Italy
| | - T. Dovc Drnovsek
- Department of Immunohematology; Blood Transfusion Centre of Slovenia; Slajmerjeva 6 SI-Ljubljana Slovenia
| | - I. Bricl
- Department of Immunohematology; Blood Transfusion Centre of Slovenia; Slajmerjeva 6 SI-Ljubljana Slovenia
| | - N. Nogués
- Immunohematology Department; Banc de Sang i Teixits; Passeig de Taulat 116 08005 Barcelona Spain
| | - E. Muñiz-Diaz
- Immunohematology Department; Banc de Sang i Teixits; Passeig de Taulat 116 08005 Barcelona Spain
| | - M. L. Olsson
- Department of Laboratory Medicine; Lund University; Lund Sweden
- Department of Clinical Immunology and Transfusion Medicine; LabMedicine; Office of Medical Services; Region Skåne Lund Sweden
| | - A. Wikman
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - M. de Haas
- Sanquin Diagnostic Services; Department of Immunohematology Diagnostics; Sanquin Research; Plesmanlaan 125 1066 CX Amsterdam The Netherlands
- Center for Clinical Transfusion Research; Leiden The Netherlands
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden The Netherlands
| | - C. E. van der Schoot
- Sanquin Research; Plesmanlaan 125 1066 CX Amsterdam The Netherlands
- Department of Experimental Immunohematology; Sanquin Research; Amsterdam The Netherlands
- Landsteiner Laboratory; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - E. Massey
- Diagnostic and Therapeutic Services; NHS Blood and Transplant; North Bristol Park, Northway Filton Bristol BS34 7QH UK
| | - C. M. Westhoff
- Immunohematology and Genomics; New York Blood Center; 310 E 67th St New York NY 10065 USA
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El Wafi M, El Housse H, Zaid N, Zouine S, Nourichafi N, Bouisk K, Benajiba M, Habti N. Novel intronic RHD variants identified in serologically D-negative blood donors. Vox Sang 2017; 112:796-802. [DOI: 10.1111/vox.12570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/05/2017] [Accepted: 07/17/2017] [Indexed: 01/28/2023]
Affiliation(s)
- M. El Wafi
- Laboratory of Hematology; Cellular and Genetic Engineering; Faculty of Medicine and Pharmacy Casablanca; Hassan II University of Casablanca; Casablanca Morocco
- Laboratory of Biotechnology and Experimental Medicine; Faculty of Medicine and Pharmacy Casablanca; Hassan II University of Casablanca; Casablanca Morocco
| | - H. El Housse
- Laboratory of Hematology; Cellular and Genetic Engineering; Faculty of Medicine and Pharmacy Casablanca; Hassan II University of Casablanca; Casablanca Morocco
- Laboratory of Biotechnology and Experimental Medicine; Faculty of Medicine and Pharmacy Casablanca; Hassan II University of Casablanca; Casablanca Morocco
| | - N. Zaid
- Beaulieu-Saucier Pharmacogenomics Center; Montreal Heart Institute; Montreal QC Canada
| | - S. Zouine
- Laboratory of Hematology; Cellular and Genetic Engineering; Faculty of Medicine and Pharmacy Casablanca; Hassan II University of Casablanca; Casablanca Morocco
- Laboratory of Biotechnology and Experimental Medicine; Faculty of Medicine and Pharmacy Casablanca; Hassan II University of Casablanca; Casablanca Morocco
| | - N. Nourichafi
- Regional Blood Transfusion Center in Casablanca; Casablanca Morocco
| | - K. Bouisk
- Regional Blood Transfusion Center in Casablanca; Casablanca Morocco
| | - M. Benajiba
- National Blood Transfusion and Hematology Center; Rabat Morocco
| | - N. Habti
- Laboratory of Hematology; Cellular and Genetic Engineering; Faculty of Medicine and Pharmacy Casablanca; Hassan II University of Casablanca; Casablanca Morocco
- Laboratory of Biotechnology and Experimental Medicine; Faculty of Medicine and Pharmacy Casablanca; Hassan II University of Casablanca; Casablanca Morocco
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Bollason G, Hjartardottir H, Jonsson T, Gudmundsson S, Kjartansson S, Halldorsdottir AM. Red blood cell alloimmunization in pregnancy during the years 1996-2015 in Iceland: a nation-wide population study. Transfusion 2017; 57:2578-2585. [DOI: 10.1111/trf.14262] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/09/2017] [Accepted: 06/21/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Gunnar Bollason
- University of Iceland, Faculty of Medicine; Reykjavik Iceland
| | - Hulda Hjartardottir
- Department of Obstetrics and Gynecology; Landspitali University Hospital; Reykjavik Iceland
| | - Thorbjorn Jonsson
- University of Iceland, Faculty of Medicine; Reykjavik Iceland
- Blood Bank, Landspitali University Hospital; Reykjavik Iceland
| | | | - Sveinn Kjartansson
- Department of Pediatrics; Landspitali University Hospital; Reykjavik Iceland
| | - Anna Margret Halldorsdottir
- University of Iceland, Faculty of Medicine; Reykjavik Iceland
- Blood Bank, Landspitali University Hospital; Reykjavik Iceland
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Haimila K, Sulin K, Kuosmanen M, Sareneva I, Korhonen A, Natunen S, Tuimala J, Sainio S. Targeted antenatal anti-D prophylaxis program for RhD-negative pregnant women - outcome of the first two years of a national program in Finland. Acta Obstet Gynecol Scand 2017; 96:1228-1233. [DOI: 10.1111/aogs.13191] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/08/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Kati Sulin
- Finnish Red Cross Blood Service; Helsinki Finland
| | | | | | - Anu Korhonen
- Finnish Red Cross Blood Service; Helsinki Finland
| | - Suvi Natunen
- Finnish Red Cross Blood Service; Helsinki Finland
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Johnson JA, MacDonald K, Clarke G, Skoll A. N o 343-Prédiction du génotype RHD fœtal par test prénatal non invasif de routine au Canada : l’heure est venue. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:374-381. [DOI: 10.1016/j.jogc.2017.03.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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No. 343-Routine Non-invasive Prenatal Prediction of Fetal RHD Genotype in Canada: The Time is Here. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:366-373. [DOI: 10.1016/j.jogc.2016.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vivanti A, Benachi A, Huchet FX, Ville Y, Cohen H, Costa JM. Diagnostic accuracy of fetal rhesus D genotyping using cell-free fetal DNA during the first trimester of pregnancy. Am J Obstet Gynecol 2016; 215:606.e1-606.e5. [PMID: 27393271 DOI: 10.1016/j.ajog.2016.06.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/08/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Rhesus D genotyping with cell-free fetal DNA currently is used throughout the world. Although this technique has spread rapidly, its optimal use is still a matter of debate. This screening test has been introduced mainly for the treatment of RhD-negative pregnant women during the third trimester of pregnancy, thereby avoiding systematic anti-D prophylaxis, yet such a strategy has proved cost-ineffective. Publications reporting on fetal RHD genotyping with cell-free DNA in maternal plasma, specifically during the first trimester of pregnancy, are scarce in the scientific literature. OBJECTIVE This study sought to assess the performance of noninvasive fetal Rhesus D genotyping in the first trimester of pregnancy with a single-exon real-time polymerase chain reaction assay. STUDY DESIGN This was a retrospective observational multicenter study. Cell-free fetal DNA was extracted from maternal blood of both nonimmunized and immunized women at 10-14 weeks of gestation. RHD sequence was determined by quantitative polymerase chain reaction, with amplification of exon 10. Results were compared with RhD phenotype data that were obtained by cord blood sampling of neonates. RESULTS In total, 416 serum samples from RhD-negative pregnant women were collected during the first trimester of pregnancy. The test's overall sensitivity and specificity were 100% (95% confidence interval, 96.9-100.0) and 95.2% (95% confidence interval, 90.5-97.6), respectively. The negative and positive predictive values were 99.8% (95% confidence interval, 94.9-100.0) and 97.1% (95% confidence interval, 94.2-98.6), respectively. Fetal RHD status was inconclusive in 9 cases (2.2%). CONCLUSION Noninvasive fetal RHD determination by single-exon quantitative polymerase chain reaction during the first trimester of pregnancy exhibits high accuracy.
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Weng YJ, Husebekk A, Skogen B, Kjaer M, Lin LT, Burnouf T. Anti-Human Platelet Antigen-1a Immunoglobulin G Preparation Intended to Prevent Fetal and Neonatal Alloimmune Thrombocytopenia. PLoS One 2016; 11:e0162973. [PMID: 27627660 PMCID: PMC5023090 DOI: 10.1371/journal.pone.0162973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 08/31/2016] [Indexed: 11/26/2022] Open
Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a severe disease that is caused by maternal alloantibodies generated during pregnancy or at delivery as a result of incompatibility between maternal and fetal human platelet antigens (HPAs) inherited from the father. Antibody-mediated immune suppression using anti-HPA-1a immunoglobulins is thought to be able to prevent FNAIT caused by HPA-1a. A fractionation process to prepare anti-HPA-1a immunoglobulin (Ig) G (IgG) from human plasma was therefore developed. Anti-HPA-1a plasma was obtained from volunteer mothers who underwent alloimmunization against HPA-1a during a previous pregnancy. Plasma was cryoprecipitated and the supernatant treated with caprylic acid and solvent/detergent (S/D), purified by chromatography, nanofiltered, concentrated, and sterile-filtered. The anti-HPA-1a immunoglobulin fraction was characterized for purity and safety. PAK12 and quantitative monoclonal antibody immobilization of platelet antigen (MAIPA) assays were used to detect anti-HPA-1a IgG. Hepatitis C virus (HCV) removal during nanofiltration was assessed by spiking experiments, using cell culture-derived reporter HCV and luciferase analysis. The caprylic acid treatment precipitated non-Ig proteins yielding a 90% pure Ig supernatant. S-HyperCel chromatography of the S/D-treated supernatant followed by HyperCel STAR AX provided high IgG recovery (>80%) and purity (>99.5%), and efficient IgA and IgM removal. Concentrations of complement factors C3 and C4 were < 0.5 and < 0.4 mg/dL, respectively. The final IgG could be nanofiltered on Planova 20N under conditions removing more than 3 log HCV infectivity to baseline mock infection level, and concentrated to ca. 30 g/L. Proteolytic activity and thrombin generation were low in the final fraction. The Pak12 and MAIPA assays showed good recovery of anti-HPA-1a throughout the process. Clinical-grade HPA-1a IgG can be prepared using a process compliant with current quality requirements opening perspectives for the prevention of FNAIT.
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Affiliation(s)
- Ying-Jan Weng
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Anne Husebekk
- Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Björn Skogen
- Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Laboratory Medicine, University Hospital North Norway, Tromsø, Norway
| | - Mette Kjaer
- Department of Laboratory Medicine, University Hospital North Norway, Tromsø, Norway
- Finnmark Hospital Trust, Hammerfest, Norway
| | - Liang-Tzung Lin
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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Moezzi L, Keshavarz Z, Ranjbaran R, Aboualizadeh F, Behzad-Behbahani A, Abdullahi M, Ramezani A, Samsami A, Sharifzadeh S. Fetal RHD Genotyping Using Real-Time Polymerase Chain Reaction Analysis of Cell-Free Fetal DNA in Pregnancy of RhD Negative Women in South of Iran. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:62-70. [PMID: 27123202 PMCID: PMC4845531 DOI: 10.22074/ijfs.2016.4770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 06/29/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Maternal-fetal RhD antigen incompatibility causes approximately 50% of clinically significant alloimmunization cases. The routine use of prophylactic anti-D immunoglobulin has dramatically reduced hemolytic disease of the fetus and newborn. Recently, fetal RHD genotyping in RhD negative pregnant women has been suggested for appropriate use of anti-D immunoglobulin antenatal prophylaxis and decrease unnecessary prenatal interventions. MATERIALS AND METHODS In this prospective cohort study, in order to develop a reliable and non-invasive method for fetal RHD genotyping, cell free fetal DNA (cffD- NA) was extracted from maternal plasma. Real-time quantitative polymerase chain reaction (qPCR) for detection of RHD exons 7, 5, 10 and intron 4 was performed and the results were compared to the serological results of cord blood cells as the gold standard method. SRY gene and hypermethylated Ras-association domain family member 1 (RASSF1A) gene were used to confirm the presence of fetal DNA in male and female fetuses, respectively. RESULTS Out of 48 fetuses between 8 and 32 weeks (wks) of gestational age (GA), we correctly diagnosed 45 cases (93.75%) of RHD positive fetuses and 2 cases (4.16%) of the RHD negative one. Exon 7 was amplified in one sample, while three other RHD gene sequences were not detected; the sample was classified as inconclusive, and the RhD serology result after birth showed that the fetus was RhD-negative. CONCLUSION Our results showed high accuracy of the qPCR method using cffDNA for fetal RHD genotyping and implicate on the efficiency of this technique to predict the competence of anti-D immunoglobulin administration.
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Affiliation(s)
- Leili Moezzi
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zeinab Keshavarz
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Ranjbaran
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Aboualizadeh
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Behzad-Behbahani
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masooma Abdullahi
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Ramezani
- School of Advanced Medical Science and Technology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alamtaj Samsami
- Department of Obstetrics and Gynecology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Sharifzadeh
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Neovius M, Tiblad E, Westgren M, Kublickas M, Neovius K, Wikman A. Cost-effectiveness of first trimester non-invasive fetalRHDscreening for targeted antenatal anti-D prophylaxis in RhD-negative pregnant women: a model-based analysis. BJOG 2015; 123:1337-46. [DOI: 10.1111/1471-0528.13801] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 12/01/2022]
Affiliation(s)
- M Neovius
- Department of Medicine; Clinical Epidemiology Unit; Karolinska Institutet; Stockholm Sweden
| | - E Tiblad
- Obstetrics & Gynaecology Unit; CLINTEC; Karolinska Institutet; Stockholm Sweden
| | - M Westgren
- Obstetrics & Gynaecology Unit; CLINTEC; Karolinska Institutet; Stockholm Sweden
| | - M Kublickas
- Obstetrics & Gynaecology Unit; CLINTEC; Karolinska Institutet; Stockholm Sweden
| | | | - A Wikman
- Department of Clinical Immunology and Transfusion Medicine; Karolinska Institutet; Stockholm Sweden
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van den Veyver IB, Eng CM. Genome-Wide Sequencing for Prenatal Detection of Fetal Single-Gene Disorders. Cold Spring Harb Perspect Med 2015; 5:cshperspect.a023077. [PMID: 26253094 DOI: 10.1101/cshperspect.a023077] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
New sequencing methods capable of rapidly analyzing the genome at increasing resolution have transformed diagnosis of single-gene or oligogenic genetic disorders in pediatric and adult medicine. Targeted tests, consisting of disease-focused multigene panels and diagnostic exome sequencing to interrogate the sequence of the coding regions of nearly all genes, are now clinically offered when there is suspicion for an undiagnosed genetic disorder or cancer in children and adults. Implementation of diagnostic exome and genome sequencing tests on invasively and noninvasively obtained fetal DNA samples for prenatal genetic diagnosis is also being explored. We predict that they will become more widely integrated into prenatal care in the near future. Providers must prepare for the practical, ethical, and societal dilemmas that accompany the capacity to generate and analyze large amounts of genetic information about the fetus during pregnancy.
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Affiliation(s)
- Ignatia B van den Veyver
- Department of Obstetrics and Gynecology, Baylor College of Medicine, The Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, Texas 77030 Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030
| | - Christine M Eng
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030
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Banch Clausen F, Steffensen R, Christiansen M, Rudby M, Jakobsen MA, Jakobsen TR, Krog GR, Madsen RD, Nielsen KR, Rieneck K, Sprogøe U, Homburg KM, Baech J, Dziegiel MH, Grunnet N. Routine noninvasive prenatal screening for fetalRHDin plasma of RhD-negative pregnant women-2 years of screening experience from Denmark. Prenat Diagn 2014; 34:1000-5. [DOI: 10.1002/pd.4419] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/12/2014] [Accepted: 05/19/2014] [Indexed: 12/20/2022]
Affiliation(s)
- F. Banch Clausen
- Department of Clinical Immunology; Copenhagen University Hospital; Copenhagen Denmark
| | - R. Steffensen
- Department of Clinical Immunology; Aalborg University Hospital; Aalborg Denmark
| | - M. Christiansen
- Department of Clinical Immunology; Aarhus University Hospital; Skejby Aarhus Denmark
| | - M. Rudby
- Department of Clinical Immunology; Naestved Hospital; Naestved Denmark
| | - M. A. Jakobsen
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | - T. R. Jakobsen
- Department of Obstetrics and Gynecology; Copenhagen University Hospital; Copenhagen Denmark
| | - G. R. Krog
- Department of Clinical Immunology; Copenhagen University Hospital; Copenhagen Denmark
| | - R. D. Madsen
- Department of Clinical Immunology; Aarhus University Hospital; Skejby Aarhus Denmark
| | - K. R. Nielsen
- Department of Clinical Immunology; Aalborg University Hospital; Aalborg Denmark
| | - K. Rieneck
- Department of Clinical Immunology; Copenhagen University Hospital; Copenhagen Denmark
| | - U. Sprogøe
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | - K. M. Homburg
- Department of Clinical Immunology; Naestved Hospital; Naestved Denmark
| | - J. Baech
- Department of Clinical Immunology; Aalborg University Hospital; Aalborg Denmark
| | - M. H. Dziegiel
- Department of Clinical Immunology; Copenhagen University Hospital; Copenhagen Denmark
| | - N. Grunnet
- Department of Clinical Immunology; Aarhus University Hospital; Skejby Aarhus Denmark
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Clausen FB. Integration of noninvasive prenatal prediction of fetal blood group into clinical prenatal care. Prenat Diagn 2014; 34:409-15. [PMID: 24431264 DOI: 10.1002/pd.4326] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/08/2014] [Accepted: 01/12/2014] [Indexed: 12/21/2022]
Abstract
Incompatibility of red blood cell blood group antigens between a pregnant woman and her fetus can cause maternal immunization and, consequently, hemolytic disease of the fetus and newborn. Noninvasive prenatal testing of cell-free fetal DNA can be used to assess the risk of hemolytic disease of the fetus and newborn to fetuses of immunized women. Prediction of the fetal RhD type has been very successful and is now integrated into clinical practice to assist in the management of the pregnancies of RhD immunized women. In addition, noninvasive prediction of the fetal RhD type can be applied to guide targeted prenatal prophylaxis, thus avoiding unnecessary exposure to anti-D in pregnant women. The analytical aspect of noninvasive fetal RHD typing is very robust and accurate, and its routine utilization has demonstrated high sensitivities for fetal RHD detection. A high compliance with administering anti-D is essential for obtaining a clinical effect. Noninvasive fetal typing of RHC/c, RHE/e, and KEL may become more widely used in the future.
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Affiliation(s)
- Frederik Banch Clausen
- Laboratory of Blood Genetics, Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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de Haas M, Finning K, Massey E, Roberts DJ. Anti-D prophylaxis: past, present and future. Transfus Med 2014; 24:1-7. [DOI: 10.1111/tme.12099] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M. de Haas
- Department of Immunohaematology, Division of Diagnostic Services; Sanquin; Amsterdam the Netherlands
| | - K. Finning
- National Health Service Blood and Transplant; Bristol UK
| | - E. Massey
- National Health Service Blood and Transplant; Bristol UK
| | - D. J. Roberts
- National Health Service Blood and Transplant; Oxford UK
- Radcliffe Department of Medicine, John Radcliffe Hospital; University of Oxford; Oxford UK
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