Management of Rh-immunized pregnancies

Queenan, John T.

doi:10.1002/(sici)1097-0223(199909)19:9<852::aid-pd649>3.0.co;2-w

Cited by 6 publications

(2 citation statements)

References 15 publications

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“…[1][2][3] Maternal antibody titres have been shown to correlate with disease severity in HDFN due to anti-D, and are a key determinant in the management of alloimmunized pregnancies. 4 Most centres use an anti-D titre of 8 to 32 as the "critical titre," i.e., the titre above which adverse effects are known to occur. 3,5,6 Referral to a maternal-fetal medicine specialist and increased fetal surveillance including MCA Doppler velocimetry are generally instituted once this critical titre is reached.…”

Section: Introductionmentioning

confidence: 99%

Alloimmune Red Blood Cell Antibodies: Prevalence and Pathogenicity in a Canadian Prenatal Population

Zwingerman

Jain

Hannon

et al. 2015

Journal of Obstetrics and Gynaecology Canada

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Section: Introductionmentioning

confidence: 99%

Alloimmune Red Blood Cell Antibodies: Prevalence and Pathogenicity in a Canadian Prenatal Population

Zwingerman

Jain

Hannon

et al. 2015

Journal of Obstetrics and Gynaecology Canada

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“…These tests should not be used to predict HDFN severity 1 . Nonetheless, early studies identified a “critical titer” of 16‐32 by conventional tube testing, 26,27 below which neither stillbirths nor deaths were seen. Studies of titration values in tube and gel note a two‐ fold difference 28 .…”

Section: Discussionmentioning

confidence: 99%

Impact of red blood cell alloimmunization on fetal and neonatal outcomes: A single center cohort study

et al. 2020

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Background Alloimmunization can impact both the fetus and neonate. Study objectives: (a) calculate the incidence of clinically significant RBC isoimmunization during pregnancy, (b) review maternal management and neonatal outcomes, (c) assess the value of prenatal and postnatal serological testing in predicting neonatal outcomes. Study Design and Methods A retrospective audit of consecutive alloimmunized pregnancies was conducted. Data collected included demographics, clinical outcomes, and laboratory results. Outcomes included: incidence of alloimmunization; outcomes for neonates with and without the cognate antigen; and sensitivity and specificity of antibody titration testing in predicting hemolytic disease of the fetus and newborn (HDFN). Results Over 6 years, 128 pregnant women (0.4%) were alloimmunized with 162 alloantibodies; anti‐E was the most common alloantibody (51/162; 31%). Intrauterine transfusions (IUTs) were employed in 2 (3%) of 71 mothers of cognate antigen positive (CoAg+) neonates. Of 74 CoAg+ neonates, 58% required observation alone, 23% intensive phototherapy, 9% top up transfusion, and 3% exchange transfusion; no fetal or neonatal deaths occurred. HDFN was diagnosed in 28% (21/74) of neonates; anti‐D was the most common cause. The sensitivity and specificity of the critical gel titer >32 in predicting HDFN were 76% and 75%, respectively (negative predictive value 95%; positive predictive value 36%). The sensitivity and specificity of a positive direct antiglobulin test (DAT) in predicting HDFN were 90% and 58%, respectively (NPV 97%; PPV 29%). Conclusion Morbidity and mortality related to HDFN was low; most alloimmunized pregnancies needed minimal intervention. Titers of >32 by gel warrant additional monitoring during pregnancy.

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Biochemistry testing associated with pregnancy and the newborn period—A lot has changed since you were a baby!

Thorlacius¹,

Blakney

Krahn

et al. 2006

Clinical Biochemistry

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Management of Rh-immunized pregnancies

Cited by 6 publications

References 15 publications

Alloimmune Red Blood Cell Antibodies: Prevalence and Pathogenicity in a Canadian Prenatal Population

Alloimmune Red Blood Cell Antibodies: Prevalence and Pathogenicity in a Canadian Prenatal Population

Impact of red blood cell alloimmunization on fetal and neonatal outcomes: A single center cohort study

Biochemistry testing associated with pregnancy and the newborn period—A lot has changed since you were a baby!

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