High additional maternal red cell alloimmunization after Rhesus- and K-matched intrauterine intravascular transfusions for hemolytic disease of the fetus

Schonewille, Henk; Klumper, Frans; Watering, Leo M.G. van de; Kanhai, Humphrey H.H.; Brand, Anneke

doi:10.1016/j.ajog.2006.10.895

Cited by 53 publications

(73 citation statements)

References 22 publications

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“…35 A study in the Netherlands found that a proportion of maternal sensitization to non-RhD blood groups with clinically affected offspring was due to intrauterine transfusion itself. 26 Therefore, these measures may be effective in reducing the incidence of HDFN; however, further comparative studies are needed.…”

Section: Prevention (Transfusion Rhig)mentioning

confidence: 99%

“…25 Despite this, there is evidence that women undergoing Rh-and K-matched IUTs still form additional alloantibodies [to Duffy (FY), Kidd (JK) and (MNS) S blood group antigens]. 26 Following one or more IUT procedures, the fetal circulation is comprised primarily of donor red cells, as fetal marrow production is suppressed and the remaining circulating red cells are destroyed. 27 The procedure of intrauterine transfusion carries a 1%-3% risk of fetal adverse events such as infection or rupture of membranes; procedure outcomes in the early second trimester are poor.…”

Section: Fetal Managementmentioning

confidence: 99%

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Hemolytic disease of the fetus and newborn: managing the mother, fetus, and newborn

Delaney

Matthews

2015

Hematology

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Hemolytic disease of the fetus and newborn (HDFN) affects 3/100 000 to 80/100 000 patients per year. It is due to maternal blood group antibodies that cause fetal red cell destruction and in some cases, marrow suppression. This process leads to fetal anemia, and in severe cases can progress to edema, ascites, heart failure, and death. Infants affected with HDFN can have hyperbilirubinemia in the acute phase and hyporegenerative anemia for weeks to months after birth. The diagnosis and management of pregnant women with HDFN is based on laboratory and radiographic monitoring. Fetuses with marked anemia may require intervention with intrauterine transfusion. HDFN due to RhD can be prevented by RhIg administration. Prevention for other causal blood group specificities is less studied. Learning Objectives• Explain the fetal and infant clinical findings associated with hemolytic disease of the fetus and newborn (HDFN) • Describe the approach to pregnancy management when a mother has red cell alloimmunization • Discuss the prevention strategies for HDFN Hemolytic disease of the fetus and newborn (HDFN) is rare condition that occurs when maternal red blood cell (RBC) or blood group antibodies cross the placenta during pregnancy and cause fetal red cell destruction. The fetal physiological consequences of severe anemia in the fetus can also lead to edema, ascites, hydrops, heart failure, and death. In less severe cases, the in utero red cell incompatibility can persist postnatally with neonatal anemia due to hemolysis, along with hyperbilirubinemia and erythropoietic suppression. Epidemiology and pathophysiologyThere are an estimated 3/100 000 to 80/100 000 cases of HDFN per year in the United States. 1 The maternal blood group antibodies that cause HDFN can be naturally occurring ABO antibodies (isohemagglutinins), or develop after exposure to foreign RBC; the latter are called blood group alloantibodies. For HDFN to occur, the fetus must be antigen positive (paternally inherited) and the mother must be antigen negative. Several studies have investigated the prevalence of red cell sensitization. In a large series of 22 102 females in the US, 254 (1.15%) of the women were found to have a red cell alloantibodies, of whom 18% had more than one alloantibody. 2 In the Netherlands, the prevalence of red cell alloantibodies detected in the first trimester was 1.2%. 3 The most common cause of blood group incompatibility results from the ABO blood group system, with incompatibility present in up to 20% of infants. 4 However, because anti-ABO antibodies are predominantly IgM class, most are not effectively transported across the placenta. In addition, the A and B antigens are not well developed on fetal red blood cells. Together, this results in a low rate of clinically severe HDFN due to ABO compatibility, although

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Section: Prevention (Transfusion Rhig)mentioning

confidence: 99%

Section: Fetal Managementmentioning

confidence: 99%

Hemolytic disease of the fetus and newborn: managing the mother, fetus, and newborn

Delaney

Matthews

2015

Hematology

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“…Intrauterine transfusions are usually carried out with O-negative, washed, irradiated, leukocytedepleted blood, negative for the antigens against which the mother is immunized [27,53]. In the Netherlands, donor blood for IUTs is additionally matched with the maternal Duffy, Kidd and S blood group, to reduce the high risk on the formation of new antibodies [54]. Donations are usually from an allogenic donor, as multiple maternal blood donations have been associated with adverse pregnancy outcome [55,56], although a direct cause-effect relation seems unlikely [57].…”

Section: Intravascular Intrauterine Blood Transfusion (Iut)mentioning

confidence: 99%

Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn – review on current management and outcome

Zwiers

Kamp

Oepkes

et al. 2017

Expert Review of Hematology

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Introduction: Hemolytic disease of the fetus and newborn (HDFN) remains a serious pregnancy complication which can lead to severe fetal anemia, hydrops and perinatal death. Areas covered: This review focusses on the current prenatal management, treatment with intrauterine transfusion (IUT) and promising non-invasive treatment options for HDFN. Expert commentary: IUTs are the cornerstone in prenatal management of HDFN and have significantly improved perinatal outcome in the past decades. IUT is now a relatively safe procedure, however the risk of complications is still high when performed early in the second trimester. Non-invasive management using intravenous immunoglobulin may be a safe alternative and requires further investigation. ARTICLE HISTORY

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“…However, a study done by Schonewille et al [6] to determine the antibody formation after introduction of preventive Rh and K matching of IUT donors showed no decline in the incidence. Twenty-five percent of the women formed new antibodies after Rh and K matched IUT and out of total, additional antibodies in 48 % cases were directed against Rhesus and K antigens induced by the fetus or as natural antibodies.…”

Section: Discussionmentioning

confidence: 94%

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

Sonker

Chaudhary

2013

Indian J Hematol Blood Transfus

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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.

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High additional maternal red cell alloimmunization after Rhesus- and K-matched intrauterine intravascular transfusions for hemolytic disease of the fetus

Cited by 53 publications

References 22 publications

Hemolytic disease of the fetus and newborn: managing the mother, fetus, and newborn

Hemolytic disease of the fetus and newborn: managing the mother, fetus, and newborn

Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn – review on current management and outcome

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

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