Enhancement of Antibody Titre and Development of Additional Red Cell Alloantibodies Following Intrauterine Transfusion

Abstract

Intrauterine blood transfusion is the mainstay of managing foetuses with severe anemia. It may however result in fetomaternal hemorrhage, which in cases of Rh isoimmunisation may increase the severity of the disease by enhancing the maternal immunological response to fetal antigens. This study was conducted to determine the frequency, specificity and origin of additional red cell antibodies which developed after IUT. The change in the titre of allo anti-D following IUT was also determined. Antibody detection and titration was done on the blood samples of all the patients before and after intrauterine blood transfusion to check for the development of additional antibody and change in the titre of existing anti-D. Severe anemia was found in 17 (58.6 %) fetuses who received a total of 42 ultrasound-guided IUTs. Development of antibodies additional to anti-D in maternal serum was seen in 5 (29.4 %) cases. The specificity of additional alloantibodies was anti-C in four cases whereas it was anti-E in one case. Four fold or greater increase in existing allo-anti D titre was seen in 6 (35.3 %) cases after IUT. Enhancement of maternal sensitisation leading to an increase in maternal antibody titre is particularly seen after the first IUT. Matching of the donor RBCs particularly for Rh antigens might prevent the induction of additional alloantibodies against these antigens. IUT as a treatment modality should be given judiciously and only when the need is inevitable.

Changing Times for the IJHBT

“…Among the benign disorders, Dubey et al [6] investigate how life-saving intra-uterine blood transfusions to Rh-negative fetuses of Rh-positive mothers may carry the risk of inducing additional maternal antibodies against fetal antigens, thereby aggravating Rhisoimmunization. Sen et al [7] similarly caution that highpressure carbon dioxide insufflation, commonly used in laparoscopic surgeries, may depress natural anticoagulant systems as well as fibrinolysis thus contributing to surgeryassociated thrombophilia.…”

Hemolytic disease of the fetus and newborn: systematic literature review of the antenatal landscape

“…The frequency of IUTs in pregnancies with a positive anti-Rh(D) screening monitored without serological cut-off values was 11.2% (range, 4.5–58.6) in the collective cases (42/376) reported by 5 studies [ 25 , 29 , 33 , 37 , 65 ]. The number of IUTs required was only reported by 1 study with a mean of 2.4 (SD not reported) [ 33 ].…”

“…Antenatal treatment data were available for 24 studies (Table S 8 ) [ 24 , 25 , 29 , 30 , 33 – 37 , 42 , 43 , 48 , 51 , 52 , 56 , 58 – 63 , 65 , 71 , 80 ]. The most commonly reported antenatal treatment across these studies was IUT ( n = 9 with representative data [ 25 , 29 , 33 , 36 , 37 , 56 , 59 , 60 , 65 ]; n = 3 with nonrepresentative data [ 35 , 58 , 62 ].…”

Racial/ethnic disparities among women receiving intrauterine transfusions for alloimmunization at a single fetal treatment center

“…The risk of alloimmunization with new antibodies following serial intrauterine transfusions has been previously documented. 18,19 Moreover, non-White patients are at higher risk for having Rh(D) variants, which requires genotyping and was not performed in this study. 20 However, our finding that anti-C and anti-Jk (a) were the most common antibodies newly detected on subsequent prenatal screens was likely due to an anamnestic response 21 following the first IUT.…”

“…We also found that women in our IUT cohort were more likely to have “new” antibodies identified during the current pregnancy if they received a higher number of IUTs. The risk of alloimmunization with new antibodies following serial intrauterine transfusions has been previously documented 18, 19 . Moreover, non‐White patients are at higher risk for having Rh(D) variants, which requires genotyping and was not performed in this study 20 .…”