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Slootweg YM, Zwiers C, Koelewijn JM, van der Schoot E, Oepkes D, van Kamp IL, de Haas M. Risk factors for RhD immunisation in a high coverage prevention programme of antenatal and postnatal RhIg: a nationwide cohort study. BJOG 2022; 129:1721-1730. [PMID: 35133072 PMCID: PMC9543810 DOI: 10.1111/1471-0528.17118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/14/2021] [Revised: 12/30/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate which risk factors for RhD immunisation remain, despite adequate routine antenatal and postnatal RhIg prophylaxis (1000 IU RhIg) and additional administration of RhIg. The second objective was assessment of the current prevalence of RhD immunisations. DESIGN Prospective cohort study. SETTING The Netherlands. POPULATION Two-year nationwide cohort of alloimmunised RhD-negative women. METHODS RhD-negative women in their first RhD immunised pregnancy were included for risk factor analysis. We compared risk factors for RhD immunisation, occurring either in the previous non-immunised pregnancy or in the index pregnancy, with national population data derived from the Dutch perinatal registration (Perined). RESULTS In the 2-year cohort, data from 193 women were eligible for analysis. Significant risk factors in women previously experiencing a pregnancy of an RhD-positive child (n = 113) were: caesarean section (CS) (OR 1.7, 95% CI 1.1-2.6), perinatal death (OR 3.5, 95% CI 1.1-10.9), gestational age >42 weeks (OR 6.1, 95% CI 2.2-16.6), postnatal bleeding (>1000 ml) (OR 2.0, 95% CI 1.1-3.6), manual removal of the placenta (MRP) (OR 4.3, 95% CI 2.0-9.3); these factors often occurred in combination. The miscarriage rate was significantly higher than in the Dutch population (35% versus 12.-5%, P < 0.001). CONCLUSION Complicated deliveries, including cases of major bleeding and surgical interventions (CS, MRP), must be recognised as a risk factor, requiring estimation of fetomaternal haemorrhage volume and adjustment of RhIg dosing. The higher miscarriage rate suggests that existing RhIg protocols need adjustment or better compliance.
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Affiliation(s)
- Y M Slootweg
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,Centre for Clinical Transfusion Research, Sanquin Research, Amsterdam, the Netherlands
| | - C Zwiers
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,Centre for Clinical Transfusion Research, Sanquin Research, Amsterdam, the Netherlands
| | - J M Koelewijn
- Centre for Clinical Transfusion Research, Sanquin Research, Amsterdam, the Netherlands.,Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - E van der Schoot
- Centre for Clinical Transfusion Research, Sanquin Research, Amsterdam, the Netherlands.,Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - D Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - I L van Kamp
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - M de Haas
- Centre for Clinical Transfusion Research, Sanquin Research, Amsterdam, the Netherlands.,Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands.,Department of Haematology, Leiden University Medical Center, Leiden, the Netherlands
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van Kampen JJA, Bruns AHW, van Leeuwen E, Koelewijn JM, Ruijs WLM, Komen DJC, Vermont CL, Opstelten W. [Revised multidisciplinary guidelines 'Varicella'; broader indication for post-exposure prophylaxis]. Ned Tijdschr Geneeskd 2020; 164:D5308. [PMID: 32779924] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Post-exposure prophylaxis (PEP) with varicella zoster immunoglobulins (VZIG) should be administered as soon as possible after exposure to the virus, but always within ten days; in the previous guidelines this was within 96 hours. In cases of perinatal exposure, PEP with VZIG should be administered to neonates if the mother develops clinical chickenpox between seven days before delivery and seven days after delivery; in the previous guidelines this was between five days before delivery and two days after delivery. A new chapter on the treatment of chickenpox has been added to the guidelines.
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Affiliation(s)
- J J A van Kampen
- Erasmus MC, afd. Viroscience, Rotterdam
- Contact: J.J.A. van Kampen
| | - A H W Bruns
- UMC Utrecht, afd. Interne Geneeskunde, Utrecht
| | - E van Leeuwen
- Amsterdam UMC, locatie AMC, afd. Obstetrie en Gynaecologie, Amsterdam
| | | | - W L M Ruijs
- Rijksinstituut voor Volksgezondheid en Milieu, Centrum Infectieziektebestrijding, Bilthoven
| | - D J C Komen
- Dijklander Ziekenhuis, afd. Dermatologie, Hoorn
| | - C L Vermont
- Erasmus MC, Sophia Kinderziekenhuis, subafd. Kinderinfectieziekten, Immunologie en Reumatologie, Rotterdam
| | - W Opstelten
- Huisartsenpraktijk Vondelplein, Amersfoort(tevens: adjunct-hoofdredacteur NTvG, Amsterdam)
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Slootweg YM, Koelewijn JM, van Kamp IL, van der Bom JG, Oepkes D, de Haas M. Third trimester screening for alloimmunisation in Rhc-negative pregnant women: evaluation of the Dutch national screening programme. BJOG 2015; 123:955-63. [DOI: 10.1111/1471-0528.13816] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2015] [Indexed: 11/28/2022]
Affiliation(s)
- YM Slootweg
- Department of Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
| | - JM Koelewijn
- Department of Obstetrics and Gynaecology; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
- Department of Experimental Immunohaematology; Sanquin Research; Amsterdam the Netherlands
- Department of General Practice; University Medical Centre; Groningen the Netherlands
| | - IL van Kamp
- Department of Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
| | - JG van der Bom
- Centre for Clinical Transfusion Research, Sanquin Research; Department of Clinical Epidemiology; Leiden University Medical Centre; Leiden the Netherlands
| | - D Oepkes
- Department of Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
| | - M de Haas
- Department of Experimental Immunohaematology; Sanquin Research; Amsterdam the Netherlands
- Leiden University Medical Centre; Department of Translational Immunohematology; Leiden the Netherlands
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de Haas M, Thurik FF, Koelewijn JM, van der Schoot CE. Haemolytic disease of the fetus and newborn. Vox Sang 2015; 109:99-113. [PMID: 25899660 DOI: 10.1111/vox.12265] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 01/11/2015] [Accepted: 02/02/2015] [Indexed: 12/12/2022]
Abstract
Haemolytic Disease of the Fetus and Newborn (HDFN) is caused by maternal alloimmunization against red blood cell antigens. In severe cases, HDFN may lead to fetal anaemia with a risk for fetal death and to severe forms of neonatal hyperbilirubinaemia with a risk for kernicterus. Most severe cases are caused by anti-D, despite the introduction of antental and postnatal anti-D immunoglobulin prophylaxis. In general, red blood cell antibody screening programmes are aimed to detect maternal alloimmunization early in pregnancy to facilitate the identification of high-risk cases to timely start antenatal and postnatal treatment. In this review, an overview of the clinical relevance of red cell alloantibodies in relation to occurrence of HDFN and recent views on prevention, screening and treatment options of HDFN are provided.
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Affiliation(s)
- M de Haas
- Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands.,Department of Experimental Immunohaematology, Sanquin Research Amsterdam and Landsteiner laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - F F Thurik
- Department of Experimental Immunohaematology, Sanquin Research Amsterdam and Landsteiner laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - J M Koelewijn
- Department of Experimental Immunohaematology, Sanquin Research Amsterdam and Landsteiner laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.,Department of General Practice, University Medical Centre, Groningen, the Netherlands
| | - C E van der Schoot
- Department of Experimental Immunohaematology, Sanquin Research Amsterdam and Landsteiner laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Abstract
OBJECTIVE To identify risk factors for Rhesus D (RhD) immunisation in pregnancy, despite adequate antenatal and postnatal anti-D prophylaxis in the previous pregnancy. To generate evidence for improved primary prevention by extra administration of anti-D Ig in the presence of a risk factor. DESIGN Case-control study. SETTING Nation-wide evaluation of the Dutch antenatal anti-D-prophylaxis programme. POPULATION CASES 42 RhD-immunised parae-1, recognised by first-trimester routine red cell antibody screening in their current pregnancy, who received antenatal and postnatal anti-D Ig prophylaxis (gifts of 1000 iu) in their first pregnancy. CONTROLS 339 parae-1 without red cell antibodies. METHODS Data were collected via obstetric care workers and/or personal interviews with women. MAIN OUTCOME MEASURE Significant risk factors for RhD immunisation in multivariate analysis. RESULTS Independent risk factors were non-spontaneous delivery (assisted vaginal delivery or caesarean section) (OR 2.23; 95% CI:1.04-4.74), postmaturity (>or=42 weeks of completed gestation: OR 3.07; 95% CI:1.02-9.02), pregnancy-related red blood cell transfusion (OR 3.51; 95% CI:0.97-12.7 and age (OR 0.89/year; 95% CI:0.80-0.98). In 43% of cases, none of the categorical risk factors was present. CONCLUSIONS In at least half of the failures of anti-D Ig prophylaxis, a condition related to increased fetomaternal haemorrhage (FMH) and/or insufficient anti-D Ig levels was observed. Hence, RhD immunisation may be further reduced by strict compliance to guidelines concerning determination of FMH and accordingly adjusted anti-D Ig prophylaxis, or by routine administration of extra anti-D Ig after a non-spontaneous delivery and/or a complicated or prolonged third stage of labour.
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Affiliation(s)
- JM Koelewijn
- Sanquin Research, Amsterdam, and Landsteiner Laboratory, Academic Medical Centre, University of AmsterdamAmsterdam, the Netherlands
- Division of Public Health, Academic Medical Centre, University of Amsterdamthe Netherlands
| | - M de Haas
- Sanquin Research, Amsterdam, and Landsteiner Laboratory, Academic Medical Centre, University of AmsterdamAmsterdam, the Netherlands
| | - TGM Vrijkotte
- Division of Public Health, Academic Medical Centre, University of Amsterdamthe Netherlands
| | - CE van der Schoot
- Sanquin Research, Amsterdam, and Landsteiner Laboratory, Academic Medical Centre, University of AmsterdamAmsterdam, the Netherlands
- Division of Public Health, Academic Medical Centre, University of Amsterdamthe Netherlands
| | - GJ Bonsel
- Division of Public Health, Academic Medical Centre, University of Amsterdamthe Netherlands
- Department of Health Policy and Management, Erasmus Medical CentreRotterdam, the Netherlands
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Koelewijn JM, Vrijkotte TGM, de Haas M, van der Schoot CE, Bonsel GJ. Risk factors for the presence of non-rhesus D red blood cell antibodies in pregnancy. BJOG 2009; 116:655-64. [PMID: 19210505 DOI: 10.1111/j.1471-0528.2008.01984.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify risk factors for the presence of non-rhesus D (RhD) red blood cell (RBC) antibodies in pregnancy. To generate evidence for subgroup RBC antibody screening and for primary prevention by extended matching of transfusions in women <45 years. DESIGN Case-control study. SETTING Nationwide evaluation of screening programme for non-RhD RBC antibodies. POPULATION CASES consecutive pregnancies (n=900) with non-RhD immunisation identified from 1 September 2002 to 1 June 2003 and 1 October 2003 to 1 July 2004; controls (n=968): matched for obstetric caregiver and gestational age. METHODS Data collection from the medical records and/or from the respondents by a structured phone interview. MAIN OUTCOME MEASURES Significant risk factors for non-RhD immunisation in multivariate analysis. RESULTS Significant independent risk factors: history of RBC transfusion (OR 16.7; 95% CI: 11.4-24.6), parity (para-1 versus para-0: OR 1.3; 95% CI: 1.0-1.7; para-2 versus para-0: OR 1.4; 95% CI: 1.0-2.0; para >2 versus para-0: OR 3.2; 95% CI: 1.8-5.8), haematological disease (OR 2.1; 95% CI: 1.0-4.2), history of major surgery (OR 1.4; 95% CI: 1.1-1.8). For the clinically most important antibodies, anti-K, anti-c and other Rh-nonD-antibodies RBC transfusion was the most important risk factor, especially for anti-K (OR 96.4; 95%-CI: 56.6-164.1); 83% of the K-sensitised women had a history of RBC transfusion. Pregnancy-related risk factors were a prior male child (OR 1.7; 95% CI: 1.2-2.3) and caesarean section (OR 1.7; 95% CI: 1.1-2.7). CONCLUSIONS RBC transfusion is by far the most important independent risk factor for non-RhD immunisation in pregnancy, followed by parity, major surgery and haematological disease. Pregnancy-related risk factors are a prior male child and caesarean section. Subgroup screening for RBC antibodies, with exclusion of RhD-positive para-0 without clinical risk factors, is to be considered. This approach will be equally sensitive in detecting severe Haemolytic Disease of the Fetus and Newborn compared with the present RBC antibody screening programme without preselection. Primary prevention by extending preventive matching of transfusions in women younger than 45 will prevent more than 50% of pregnancy immunisations.
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Affiliation(s)
- J M Koelewijn
- Sanquin Research, Amsterdam, and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Department of Experimental Immunohematology, Amsterdam, The Netherlands
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Koelewijn JM, Vrijkotte TGM, de Haas M, van der Schoot CE, Bonsel GJ. Women's attitude towards prenatal screening for red blood cell antibodies, other than RhD. BMC Pregnancy Childbirth 2008; 8:49. [PMID: 19014424 PMCID: PMC2605433 DOI: 10.1186/1471-2393-8-49] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 04/29/2008] [Accepted: 11/11/2008] [Indexed: 11/13/2022] Open
Abstract
Background Since July 1998 all Dutch women (± 200,000/y) are screened for red cell antibodies, other than anti-RhesusD (RhD) in the first trimester of pregnancy, to facilitate timely treatment of pregnancies at risk for hemolytic disease of the fetus and newborn (HDFN). Evidence for benefits, consequences and costs of screening for non-RhD antibodies is still under discussion. The screening program was evaluated in a nation-wide study. As a part of this evaluation study we investigated, according to the sixth criterium of Wilson and Jüngner, the acceptance by pregnant women of the screening program for non-RhD antibodies. Methods Controlled longitudinal survey, including a prenatal and a postnatal measurement by structured questionnaires. Main outcome measures: information satisfaction, anxiety during the screening process (a.o. STAI state inventory and specific questionnaire modules), overall attitude on the screening program. Univariate analysis was followed by standard multivariate analysis to identify significant predictors of the outcome measures. Participants: 233 pregnant women, distributed over five groups, according to the screening result. Results Satisfaction about the provided information was moderate in all groups. All screen- positive groups desired more supportive information. Anxiety increased in screen- positives during the screening process, but decreased to basic levels postnatally. All groups showed a strongly positive balance between perceived utility and burden of the screening program, independent on test results or background characteristics. Conclusion Women highly accept the non-RhD antibody screening program. However, satisfaction about provided information is moderate. Oral and written information should be provided by obstetric care workers themselves, especially to screen-positive women.
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Affiliation(s)
- J M Koelewijn
- Sanquin Research, Amsterdam, and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Plesmanlaan 125, 1066 CX Amsterdam, The Netherlands.
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Koelewijn JM, Vrijkotte TGM, van der Schoot CE, Bonsel GJ, de Haas M. Effect of screening for red cell antibodies, other than anti-D, to detect hemolytic disease of the fetus and newborn: a population study in the Netherlands. Transfusion 2008; 48:941-52. [PMID: 18248570 DOI: 10.1111/j.1537-2995.2007.01625.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hemolytic disease of the fetus and newborn (HDFN) is a severe disease, resulting from maternal red cell (RBC) alloantibodies directed against fetal RBCs. The effect of a first-trimester antibody screening program on the timely detection of HDFN caused by antibodies other than anti-D was evaluated. STUDY DESIGN AND METHODS Nationwide, all women (1,002 in 305,000 consecutive pregnancies during 18 months) with alloantibodies other than anti-D, detected by a first-trimester antibody screen, were included in a prospective index-cohort study. In a parallel-coverage validation study, patients with HDFN caused by antibodies other than anti-D, that were missed by the screening program, were retrospectively identified. RESULTS The prevalence of positive antibody screens at first-trimester screening was 1,232 in 100,000; the prevalence of alloantibodies other than anti-D was 328 in 100,000, of which 191 of 100,000 implied a risk for occurrence of HDFN because the father carried the antigen. Overall, severe HDFN, requiring intrauterine or postnatal (exchange) transfusions, occurred in 3.7 percent of fetuses at risk: for anti-K in 11.6 percent; anti-c in 8.5 percent; anti-E in 1.1 percent; Rh antibodies other than anti-c, anti-D, or anti-E in 3.8 percent; and for antibodies other than Rh antibodies or anti-K, in none of the fetuses at risk. All affected children, where antibodies were detected, were promptly treated and healthy at the age of 1 year. The coverage validation study showed a sensitivity of the screening program of 75 percent. Five of 8 missed cases were caused by anti-c, with delay-induced permanent damage in at least 1. CONCLUSION First-trimester screening enables timely treatment of HDFN caused by antibodies other than anti-D, however, with a sensitivity of only 75 percent. A second screening at Week 30 of c- women will enhance the screening program. Severe HDFN, caused by antibodies other than anti-D, is associated with anti-K, anti-c, and to a lesser extent with other Rh-alloantibodies.
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