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De Winter DP, Hulzebos C, Van 't Oever RM, De Haas M, Verweij EJ, Lopriore E. History and current standard of postnatal management in hemolytic disease of the fetus and newborn. Eur J Pediatr 2023; 182:489-500. [PMID: 36469119 DOI: 10.1007/s00431-022-04724-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 12/07/2022]
Abstract
UNLABELLED Since the discovery of the Rh blood group system in 1940, a greater understanding of hemolytic disease of the fetus and newborn (HDFN) was gained. In the years thereafter, researchers and clinicians came to the current understanding that fetal and neonatal red blood cells (RBC) are hemolyzed by maternal alloantibodies directed against RBC antigens potentially leading to severe disease. Preventative measures, such as Rhesus(D) immunoprophylaxis (RhIG), have greatly decreased the prevalence of Rh(D)-mediated HDFN, although a gap between high-income countries and middle- to low-income countries was created largely due to a lack in availability and high costs of RhIG. Other important developments in the past decades have improved the identification, monitoring, and care of pregnancies, fetuses, and neonates with HDFN. Prenatally, fetal anemia may occur and intrauterine transfusions may be needed. Postnatally, pediatricians should be aware of the (antenatally determined) risk of hemolysis in RBC alloimmunization and should provide treatment for hyperbilirubinemia in the early phase and monitor for anemia in the late phase of the disease. Through this review, we aim to provide an overview of important historic events and to provide hands-on guidelines for the delivery and postnatal management of neonates with HDFN. Secondarily, we aim to describe recent scientific findings and evidence gaps. CONCLUSION Multiple developments have improved the identification, monitoring, and care of pregnancies and neonates with HDFN throughout the centuries. Pediatricians should be aware of the (antenatally determined) risk of hemolysis in RBC alloimmunization and should provide treatment for hyperbilirubinemia in the early phase and monitor for late anemia in the late phase of the disease. Future studies should be set in an international setting and ultimately aim to eradicate HDFN on a global scale. WHAT IS KNOWN • Developments have led to a greater understanding of the pathophysiology, an improved serological identification and monitoring of at-risk cases and the current pre- and postnatal treatment. WHAT IS NEW • This review provides the pediatrician with hands-on guidelines for the delivery and postnatal management of neonates with HDFN. • Future studies should be set in an international setting with the ultimate aim of eradicating HDFN.
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Affiliation(s)
- Derek P De Winter
- Department of Pediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Albinusdreef 2, 2333, Leiden, The Netherlands. .,Department of Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, The Netherlands.
| | - Christian Hulzebos
- Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Renske M Van 't Oever
- Department of Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, The Netherlands.,Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Masja De Haas
- Department of Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, The Netherlands.,Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ejt Joanne Verweij
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Department of Pediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Albinusdreef 2, 2333, Leiden, The Netherlands
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2
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De Vos TW, De Haas M, Oepkes D, Tan RRNGB, Van der Schoot CE, Steggerda SJ, de Vries LS, Lopriore E, Van Klink JMM. Long-term neurodevelopmental outcome in children after antenatal intravenous immune globulin treatment in fetal and neonatal alloimmune thrombocytopenia. Am J Obstet Gynecol 2022; 227:637.e1-637.e9. [PMID: 35671780 DOI: 10.1016/j.ajog.2022.05.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/17/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children with fetal and neonatal alloimmune thrombocytopenia (FNAIT) face increased risk of intracranial hemorrhage (ICH) potentially leading to developmental impairment. To prevent ICH, pregnant women with alloantibodies against fetal platelets are often treated with intravenous immunoglobulin (IVIg). IVIg appears effective in vastly reducing the risk of fetal or neonatal bleeding complications. However, information on long-term neurodevelopment of these children is lacking. OBJECTIVE To evaluate long-term neurodevelopmental outcome in children with FNAIT who were treated with IVIg antenatally. STUDY DESIGN An observational cohort study was performed including children of mothers who were treated with IVIg during pregnancy because a previous child was diagnosed with FNAIT. Children, were invited for a follow-up assessment including standardized cognitive and neurologic tests. The parents were asked to complete a behavioral questionnaire and school performance reports. The primary outcome was severe neurodevelopmental impairment (NDI), defined as severe cognitive impairment (IQ < 70), cerebral palsy with Gross Motor Function Classification System (GMFCS) Level ≥ 3, bilateral blindness, and/or bilateral deafness (requiring amplification). The secondary outcome was mild to moderate NDI, defined as either mild to moderate cognitive impairment (IQ < 85), cerebral palsy with GMFCS Level ≤ 2, minor neurologic dysfunction, vision loss, and/or hearing loss. RESULTS Between 2003 and 2017, 51 children were liveborn after antenatal IVIg treatment. One family moved abroad and was therefore not eligible for inclusion. In total, 82% (41/50) of the eligible cases were included for neurodevelopmental assessment at a median age of 9 years and 8 months. Severe NDI was not detected. The incidence of mild to moderate NDI was 14% (6/41, 95% confidence interval: 6%-29%). The children's mean cognitive score, behavioral scores, and academic achievement were not different from the Dutch norm groups. Neuroimaging was performed in 90% (37/41) of cases. Severe ICH had been diagnosed in two cases (5%), one antenatally before the start of IVIg and the other case 1 day after birth. Both cases had a normal neurodevelopmental outcome. CONCLUSION The risk of NDI in children whose mothers were treated for FNAIT with antenatal IVIg is comparable to that in the general population.
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Affiliation(s)
- Thijs W De Vos
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands; Center of Clinical Transfusion Research, Sanquin Research, Amsterdam; Department of Experimental Immunohematology, Sanquin Research, Amsterdam.
| | - Masja De Haas
- Center of Clinical Transfusion Research, Sanquin Research, Amsterdam; Department Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam; Department of Hematology, Leiden University Medical Center, Leiden
| | - Dick Oepkes
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden
| | - Ratna R N G B Tan
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
| | | | - Sylke J Steggerda
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
| | - Linda S de Vries
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
| | - Enrico Lopriore
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, the Netherlands
| | - Jeanine M M Van Klink
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Child and Adolescent Psychology, Leiden University Medical Center, the Netherlands
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Van Osch TLJ, Oosterhoff JJ, Bentlage AEH, Nouta J, Koeleman CAM, Geerdes DM, Mok JY, Heidt S, Mulder A, Van Esch WJE, Kapur R, Porcelijn L, Van der Schoot CE, De Haas M, Wuhrer M, Voorberg J, Vidarsson G. Fc galactosylation of anti-platelet hIgG1 alloantibodies enhance complement activation on platelets. Haematologica 2022; 107:2432-2444. [PMID: 35354253 PMCID: PMC9521249 DOI: 10.3324/haematol.2021.280493] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Indexed: 11/09/2022] Open
Abstract
Approximately 20% of patients receiving multiple platelet transfusions develop platelet alloantibodies, which can be directed against human leukocyte antigens (HLA) and, to a lesser extent, against human platelet antigens (HPA). These antibodies can lead to the rapid clearance of donor platelets, presumably through IgG-Fc receptor (FcγR)-mediated phagocytosis or via complement activation, resulting in platelet refractoriness. Strikingly, not all patients with anti-HLA or -HPA antibodies develop platelet refractoriness upon unmatched platelet transfusions. Previously, we found that IgG Fc glycosylation of anti-HLA antibodies was highly variable between patients with platelet refractoriness, especially with respect to galactosylation and sialylation of the Fc-bound sugar moiety. Here, we produced recombinant glycoengineered anti-HLA and anti-HPA-1a monoclonal antibodies with varying Fc galactosylation and sialylation levels and studied their ability to activate the classical complement pathway. We observed that anti-HLA monoclonal antibodies with different specificities, binding simultaneously to the same HLA-molecules, or anti-HLA in combination with anti-HPA-1a monoclonal antibodies interacted synergistically with C1q, the first component of the classical pathway. Elevated Fc galactosylation and, to a lesser extent, sialylation significantly increased the complement-activating properties of anti-HLA and anti-HPA-1a monoclonal antibodies. We propose that both the breadth of the polyclonal immune response, with recognition of different HLA epitopes and in some cases HPA antigens, and the type of Fc glycosylation can provide an optimal stoichiometry for C1q binding and subsequent complement activation. These factors can shift the effect of a platelet alloimmune response to a clinically relevant response, leading to complement-mediated clearance of donor platelets, as observed in platelet refractoriness.
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Affiliation(s)
- Thijs L J Van Osch
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam
| | - Janita J Oosterhoff
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam
| | - Arthur E H Bentlage
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam
| | - Jan Nouta
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden
| | | | | | | | - Sebastiaan Heidt
- Department of Immunology, Leiden University Medical Center, Leiden
| | - Arend Mulder
- Department of Immunology, Leiden University Medical Center, Leiden
| | | | - Rick Kapur
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam
| | - Leendert Porcelijn
- Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam
| | - C Ellen Van der Schoot
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam
| | - Masja De Haas
- Department of Immunology, Leiden University Medical Center, Leiden, the Netherlands; Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden
| | - Jan Voorberg
- Departement of Molecular Hematology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam
| | - Gestur Vidarsson
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Clarke G, Bodnar M, Lozano M, Nadarajan VS, Lee C, Baud D, Canellini G, Gleich-Nagel T, Torres OW, Rey PL, Bonet Bub C, Mauro Kutner J, Castilho L, Saifee NH, Delaney M, Nester T, Wikman A, Tiblad E, Pierelli L, Matteocci A, Maresca M, Maisonneuve E, Cortey A, Jouannic JM, Fornells J, Albersen A, De Haas M, Oepkes D, Lieberman L. Vox Sanguinis International Forum on the selection and preparation of blood components for intrauterine transfusion: Summary. Vox Sang 2020; 115:813-826. [PMID: 32400093 DOI: 10.1111/vox.12901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gwen Clarke
- Canadian Blood Services, University of Alberta, 8249 114 St. NW, Edmonton, AB, T6G 2R8, Canada
| | - Melanie Bodnar
- Laboratory Medicine and Pathology Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada
| | - Miquel Lozano
- Department of Hemotherapy and Hemostasis, Hospital Clinic, Villaroel 170, Barcelona, 08036, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lani Lieberman
- Department of Laboratory Hematology (Transfusion Medicine), University Health Network and Affiliated Hospitals, University of Toronto, 306 - 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
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6
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Slootweg YM, Walg C, Koelewijn JM, Van Kamp IL, De Haas M. Knowledge, attitude and practices of obstetric care providers towards maternal red-blood-cell immunization during pregnancy. Vox Sang 2019; 115:211-220. [PMID: 31884705 PMCID: PMC7187211 DOI: 10.1111/vox.12883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 11/29/2022]
Abstract
Background and objectives A successful routine RBC alloantibody screening programme should not lead to unnecessary emotional burden during pregnancy due to inadequate counselling on the risk of severe haemolytic disease of the foetus and the newborn (HDFN). Rareness of this disease may result in insufficient knowledge and subsequent inadequate information transfer to women, diagnosed with RBC antibodies. We investigated the current knowledge, views and experiences of Dutch obstetric care providers regarding RBC alloimmunization during pregnancy. Materials and methods We performed a quantitative cross‐sectional study, using a structured digital questionnaire to measure knowledge, attitude and practices (KAP) regarding maternal RBC alloimmunization among Dutch obstetric care providers in 2016. Results About 10% of obstetric care providers completed the questionnaire. A sufficient level of knowledge was found in 7% of all participants (N = 329). Knowledge about RhD immunisation and prophylaxis was sufficient in 60% of the responders. Knowledge gaps were found concerning the relevance of non‐RhD RBC antibodies, the indications for giving extra RhD prophylaxis and the interpretation of laboratory test results. Healthcare providers estimated their own level of knowledge ‘sufficient’ (primary/secondary care) to ‘good’ (tertiary care), and all participants considered their professional role important within the screening programme. Conclusion Dutch obstetric care providers showed a lack of knowledge regarding maternal RBC immunization. Awareness of the lack of knowledge is necessary to help obstetric care providers to be careful in giving information and even to decide to contact the expert centre before counselling the patient.
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Affiliation(s)
- Yolentha M Slootweg
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
| | - Chawa Walg
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Joke M Koelewijn
- Department of Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Inge L Van Kamp
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Masja De Haas
- Department of Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
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Porcelijn L, Huiskes E, Onderwater-Van Den Hoogen L, Folman CC, Zwaginga JJ, De Haas M. Plasma thrombopoietin levels as additional tool in clinical management of thrombocytopenic neonates. Platelets 2019; 31:62-67. [DOI: 10.1080/09537104.2019.1572877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Leendert Porcelijn
- Department of Immunohematology Diagnostic Services Amsterdam, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Elly Huiskes
- Department of Immunohematology Diagnostic Services Amsterdam, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | | | - Claudia C Folman
- Department of Immunohematology Diagnostic Services Amsterdam, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Jaap Jan Zwaginga
- Department of Immuno-hematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
- Center for Clinical Transfusion Research, Sanquin Research, Leiden and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Masja De Haas
- Department of Immunohematology Diagnostic Services Amsterdam, Sanquin Diagnostic Services, Amsterdam, The Netherlands
- Department of Immuno-hematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
- Center for Clinical Transfusion Research, Sanquin Research, Leiden and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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8
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Slootweg YM, Lindenburg IT, Koelewijn JM, Van Kamp IL, Oepkes D, De Haas M. Predicting anti-Kell-mediated hemolytic disease of the fetus and newborn: diagnostic accuracy of laboratory management. Am J Obstet Gynecol 2018; 219:393.e1-393.e8. [PMID: 30063902 DOI: 10.1016/j.ajog.2018.07.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/21/2018] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is controversy on critical cut-off values of laboratory testing to select pregnancies at increased risk for anti-Kell-mediated hemolytic disease of the fetus and newborn. Without early detection and treatment, anti-Kell-mediated hemolytic disease of the fetus and newborn may result in progressive fetal anemia, fetal hydrops, asphyxia, and perinatal death. OBJECTIVE We aimed to determine the value of repeated anti-Kell titer determination and biological activity measurement using the antibody-dependent cellular cytotoxicity test determination in the management of pregnancies at risk for anti-Kell-mediated hemolytic disease of the fetus and newborn. STUDY DESIGN This was a retrospective cohort study of pregnancies with anti-Kell and a Kell-positive fetus, identified from January 1999 through April 2015. Laboratory test results and clinical outcome were collected from the Dutch nationwide screening program and the national reference center for fetal therapy in The Netherlands, the Leiden University Medical Center. Diagnostic accuracy was measured (receiver operating characteristic curves, sensitivity, specificity, positive and negative predictive values) for anti-Kell titers and antibody-dependent cellular cytotoxicity test. The relationship between the titer and antibody-dependent cellular cytotoxicity measurements and the 2 foregoing measurements were computed with a Pearson product-moment correlation coefficient. RESULTS In a 16-year unselected cohort, representing screening results of 3.2 million pregnancies resulting in live births in The Netherlands, we identified 1026 Kell-immunized pregnancies. In all, 93 pregnant women had anti-Kell and a Kell-positive child, without other red cell alloantibodies. In all, 49 children (53%) needed intrauterine or postnatal transfusion therapy. The first anti-Kell titer showed already a high diagnostic accuracy with an area under the curve of 91%. The optimal cut-off point for the titer was 4 (sensitivity 100%; 95% confidence interval, 91-100), specificity 27% (95% confidence interval, 15-43), and positive predictive value 60% (49-71%). The antibody-dependent cellular cytotoxicity test was not informative to select high-risk pregnancies. Linear regression showed no significant change during pregnancy, when antibody titer and antibody-dependent cellular cytotoxicity test results were compared with every 2 foregoing measurements (P < .0001). CONCLUSION Early determination of the anti-Kell titer is sufficient to select pregnancies at increased risk for hemolytic disease of the fetus and newborn with need for transfusion therapy. If the Kell status of the fetus is known to be positive, a titer of ≥4 can be used to target intensive clinical monitoring.
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Affiliation(s)
- Yolentha M Slootweg
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Irene T Lindenburg
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Joke M Koelewijn
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands; Department of Clinical Transfusion Research, Sanquin Research, Amsterdam, The Netherlands
| | - Inge L Van Kamp
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Masja De Haas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands; Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands; Department of Clinical Transfusion Research, Sanquin Research, Amsterdam, The Netherlands
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9
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Miescher S, Spycher MO, Amstutz H, De Haas M, Kleijer M, Kalus UJ, Radtke H, Hubsch A, Andresen I, Martin RM, Bichler J. A single recombinant anti-RhD IgG prevents RhD immunization: association of RhD-positive red blood cell clearance rate with polymorphisms in the FcγRIIA and FcγIIIA genes. Blood 2004; 103:4028-35. [PMID: 14976055 DOI: 10.1182/blood-2003-11-3929] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
A single recombinant immunoglobulin G1 (IgG1) anti-RhD antibody (MonoRho) was compared with a currently used polyclonal anti-RhD product (Rhophylac) in a phase 1 study for safety, efficacy of Rhesus D (RhD)–positive red blood cell (RBC) clearance, and prevention of RhD immunization in RhD-negative men challenged with 15 mL RhD-positive RBCs. Both the polyclonal product and recombinant anti-RhD effectively cleared RhD-positive RBCs after intravenous and intramuscular injection. The recombinant anti-RhD demonstrated a slower clearance rate compared with the polyclonal anti-RhD. There was no dose response, and there was considerable variation among subjects who received the same dose of recombinant anti-RhD. Interestingly, RhD-positive RBC clearance rates were strongly associated with Fcγ receptor IIA (FcγRIIA) and FcγIIIA but not with FcγIIIB polymorphisms. Subjects homozygous for FcγRIIA-131H or FcγRIIIA-158V allotypes showed a faster clearance rate compared with both the heterozygote and the corresponding alternative homozygote allotypes. A similar but less marked trend was seen for the polyclonal anti-RhD. Despite the variation in clearance rates there was no evidence of anti-RhD alloantibodies in any of the subjects at +6 months after the RBC challenge.
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Affiliation(s)
- Sylvia Miescher
- ZLB Bioplasma AG, Wankdorfstrasse 10, CH-3000 Bern 22, Switzerland.
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Masuda M, Morimoto T, De Haas M, Nishimura N, Nakamoto K, Okuda K, Komiyama Y, Ogawa R, Takahashi H. Increase of soluble FcgRIIIa derived from natural killer cells and macrophages in plasma from patients with rheumatoid arthritis. J Rheumatol 2003; 30:1911-7. [PMID: 12966590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE FcgRIII (CD16), one of the low affinity IgG Fc receptors, is found in 2 alternative forms, a transmembrane FcgRIIIa expressed on natural killer (NK) cells and macrophages, and a glycosylphosphatidylinositol-linked FcgRIIIb present on neutrophils. Both FcgRIII are released from the cell surface by proteolytic cleavage and these soluble forms (sFcgRIII) are present in plasma. Since NK cells and macrophages will be activated locally, leading to shedding of FcgRIIIa and its subsequent release into blood, we investigated whether sFcgRIIIa plasma concentrations would be a good marker for disease activity in patients with rheumatoid arthritis (RA). METHODS We measured sFcgRIIIa with an immuno-PCR in plasma of NA(1+,2-) phenotyped donors. In this assay, we used CD16 GRM1, which recognizes NA2-FcgRIIIb and FcgRIIIa. We also analyzed precipitated sFcgRIIIa derived from plasma with immunoblotting with CD16 CLB-LM6.30. RESULTS The concentration of sFcgRIIIa in patients with RA was about 3 times higher than in healthy controls. In controls, the sFcgRIIIa levels in plasma correlated with the number of NK cells in peripheral blood. In RA patients, sFcgRIIIa levels were increased directly proportionally to the concentrations of IgG, IgA, or IgM and to erythrocyte sedimentation rate or Lansbury Index. The electrophoretic mobility of plasma sFcgRIIIa corresponded with sFcgRIIIa derived from NK cells and/or macrophages. In general, plasma sFcgRIIIa originated from both cell types; however, the ratio of sFcgRIIIaNK to sFcgRIIIaMf varied in the RA patients. CONCLUSION Increased sFcgRIIIa levels in RA patients were found to be caused by NK cell and/or macrophage activation. Plasma sFcgRIIIa levels may serve as a marker for disease activity in RA.
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Affiliation(s)
- Midori Masuda
- Department of Clinical Sciences, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka 570-8506, Japan.
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