Has anti‐D prophylaxis increased the rate of positive direct antiglobulin test results and can the direct antiglobulin test predict need for phototherapy in Rh/ABO incompatibility?

Abstract

Rh D prophylaxis has increased positive DAT results, which may increase the number of unnecessary bilirubin measurements. A low or high DAT grade is strongly predictive of whether an infant does or does not require phototherapy. However, an intermediate DAT requires concomitant bilirubin measurements to determine phototherapy requirements.

Retrospective analysis of HDFN due to ABO incompatibility in a single institution over 6 years

“…The incidence of a positive DAT in newborns ranges from 1·9–3·5% of ABO‐incompatible pregnancies up to 17–28%. These rates may be based on the different uses of DAT techniques and population examined (Dillon et al, ; Ozgonenel et al, ; Valsami et al, ). In African mothers with ABO incompatibility, the rate of immunisation with a DAT‐positive baby is higher than in Caucasians and appears to be around 18·8%.…”

Clinically significant hemolytic disease of the newborn secondary to passive transfer of anti‐D from maternal RhIG

“…Antenatal administration of RhIG was first proposed nearly 50 years ago . A recent review and meta‐analysis was performed of RhIG studies and includes commentary, without presented data, that RhIG antenatal administration “does not have side effects on the fetus.” Often, antenatal RhIG passively crosses the placenta and results in a positive DAT in the newborn without any reported clinically significant sequelae . Bowman and colleagues reported 28% of ABO‐compatible D– mothers who received RhIG at 28 and 34 weeks, or either 28 or 34 weeks, delivered newborns with weakly positive DATs (reaction strength was not defined and elution studies, if performed, were not reported).…”

“…Few studies have explicitly evaluated neonatal hemolysis due to RhIG. In the recent study by Dillon and coworkers of 165 DAT‐positive D+ infants born to D– mothers who received RhIG prophylaxis, hematologic variables (Hb, hematocrit, LDH, reticulocyte %, etc.) were obtained but were not reported.…”

Mótefni bundin við rauðkorn nýbura; orsakir og klínískar afleiðingar - Tilfelli greind í Blóðbankanum 2005-2012

“…Innleiðing reglubundins fyrirbyggjandi RhIg á meðgöngu í þeirri rannsókn fjölgaði jákvaeðum DAT-prófum ný-bura umtalsvert og var skýringin talin óvirkur flutningur anti-D mótefnis yfir fylgju til fósturs. 17 Áhugavert var að yfir 20% maeðra nýbura með jákvaett DATpróf vegna rauðkornamótefna annarra en anti-A/-B höfðu fengið blóðgjöf fyrir meðgöngu en aðeins taep 5% maeðra annarra barna í rannsókninni. Þetta kemur heim og saman við þá staðreynd að þótt parað sé fyrir helstu mótefnisvökum við blóðgjöf getur naeming fyrir öðrum mótefnisvökum átt sér stað.…”