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Blomme S, Nollet F, Rosseel W, Bogaard N, Devos H, Emmerechts J, Cauwelier B. Routine noninvasive prenatal screening for fetal Rh D in maternal plasma—A 2‐year experience from a single center in Belgium. Transfusion 2022; 62:1103-1109. [DOI: 10.1111/trf.16868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Siska Blomme
- Department of Laboratory Medicine AZ Sint‐Jan Hospitals Brugge‐Oostende Brugge Belgium
| | - Friedel Nollet
- Department of Laboratory Medicine AZ Sint‐Jan Hospitals Brugge‐Oostende Brugge Belgium
| | - Wesley Rosseel
- Department of Laboratory Medicine AZ Sint‐Jan Hospitals Brugge‐Oostende Brugge Belgium
| | - Natalie Bogaard
- Department of Laboratory Medicine AZ Sint‐Jan Hospitals Brugge‐Oostende Brugge Belgium
| | - Helena Devos
- Department of Laboratory Medicine AZ Sint‐Jan Hospitals Brugge‐Oostende Brugge Belgium
| | - Jan Emmerechts
- Department of Laboratory Medicine AZ Sint‐Jan Hospitals Brugge‐Oostende Brugge Belgium
| | - Barbara Cauwelier
- Department of Laboratory Medicine AZ Sint‐Jan Hospitals Brugge‐Oostende Brugge Belgium
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Volkova E, Sippert E, Liu M, Mercado T, Denomme GA, Illoh O, Liu Z, Rios M. Validated Reference Panel from Renewable Source of Genomic DNA Available for Standardization of Blood Group Genotyping. J Mol Diagn 2019; 21:525-537. [PMID: 30872185 DOI: 10.1016/j.jmoldx.2019.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/19/2018] [Accepted: 02/06/2019] [Indexed: 11/30/2022] Open
Abstract
Extended blood group genotyping is an invaluable tool used for prevention of alloimmunization. Genotyping is particularly suitable when antigens are weak, specific antisera are unavailable, or accurate phenotyping is problematic because of a disease state or recent transfusions. In addition, genotyping facilitates establishment of mass-scale patient-matched donor databases. However, standardization of genotyping technologies has been hindered by the lack of reference panels. A well-characterized renewable reference panel for standardization of blood group genotyping was developed. The panel consists of genomic DNA lyophilized and stored in glass vials. Genomic DNA was extracted in bulk from immortalized lymphoblastoid cell lines, generated by Epstein-Barr virus transformation of peripheral blood lymphocytes harvested from volunteer blood donors. The panel was validated by an international collaborative study involving 28 laboratories that tested each DNA panel member for 41 polymorphisms associated with 17 blood group systems. Overall, analysis of genotyping results showed >98% agreement with the expected outcomes, demonstrating suitability of the material for use as reference. Highest levels of discordance were observed for the genes CR1, CD55, BSG, and RHD. Although limited, observed inconsistencies and procedural limitations reinforce the importance of reference reagents to standardize and harmonize results. Results of stability and accelerated degradation studies support the suitability of this panel for use as reference reagent for blood group genotyping assay development and standardization.
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Affiliation(s)
- Evgeniya Volkova
- Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Emilia Sippert
- Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Meihong Liu
- Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Teresita Mercado
- Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Gregory A Denomme
- Blood Research Institute and Diagnostic Laboratories, Versiti/BloodCenter of Wisconsin, Milwaukee, Wisconsin
| | - Orieji Illoh
- Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Zhugong Liu
- Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Maria Rios
- Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland.
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Elkins MB, Davenport RD, Bluth MH. Molecular Pathology in Transfusion Medicine: New Concepts and Applications. Clin Lab Med 2019; 38:277-292. [PMID: 29776631 DOI: 10.1016/j.cll.2018.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Virtually all the red blood cell and platelet antigen systems have been characterized at the molecular level. Highly reliable methods for red blood cell and platelet antigen genotyping are now available. Genotyping is a useful adjunct to traditional serology and can help resolve complex serologic problems. Although red blood cell and platelet phenotypes can be inferred from genotype, knowledge of the molecular basis is essential for accurate assignment. Genotyping of blood donors is an effective method of identifying antigen-negative and/or particularly rare donors. Cell-free DNA analysis provides a promising noninvasive method of assessing fetal genotypes of blood group alloantigens.
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Affiliation(s)
- Matthew B Elkins
- Department of Pathology, Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
| | - Robertson D Davenport
- Department of Pathology, University of Michigan, UH 2g332, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5054, USA
| | - Martin H Bluth
- Department of Pathology, Wayne State University, School of Medicine, 540 East Canfield Street, Detroit, MI 48201, USA; Pathology Laboratories, Michigan Surgical Hospital, 21230 Dequindre Road, Warren, MI 48091, USA
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A new biosensor for noninvasive determination of fetal RHD status in maternal blood of RhD negative pregnant women. PLoS One 2018; 13:e0197855. [PMID: 29874251 PMCID: PMC5991352 DOI: 10.1371/journal.pone.0197855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 05/09/2018] [Indexed: 12/03/2022] Open
Abstract
Prenatal detection of the fetal RHD status can be useful in the management of RhD incompatibility to identify fetuses at risk of hemolytic disease. Hemolytic disease causes morbidity and mortality of the fetus in the neonatal period. The routine use of antenatal and postnatal anti-D prophylaxis has reduced the incidence of hemolytic disease of the fetus and newborn. This study describe the detection of fetal RhD antigens in blood of RhD negative pregnant women using a nanopolymer coated electrochemical biosensor for medical diagnosis. Cell free fetal DNA in maternal plasma was also used to genotyping fetal RHD status using multiplex real-time PCR. Twenty-six RhD negative pregnant women in different gestational ages were included in the study. RhD positive fetal antibodies detected with a developed biosensor in maternal blood of RhD negative mothers. The electrochemical measurements were performed on a PalmSens potentiostat, and corundum ceramic based screen printed gold electrode combined with the reference Ag/AgCl electrode, and the auxiliary Au/Pd (98/2%) electrode. Fetal RHD genotyping performed using fluorescence-based multiplex real-time PCR exons 5 and 7 of the RHD gene. The fetal RHD status of 26 RhD negative cases were detected 21 as RhD positive and 5 as RhD negative with electrochemical biosensor. Fetal RHD status confirmed with extracted fetal DNA in maternal plasma using multiplex real-time PCR RHD genotyping and by serological test after delivery. The new method for fetal RhD detection in early pregnancy is useful and can be carry out rapidly in clinical diagnosis. Using automated biosensors are reproducible, quick and results can be generated within a few minutes compared to noninvasive fetal RHD genotyping from maternal plasma with real-time PCR-based techniques. We suggest the biosensor techniques could become an alternative part of fetal RHD genotyping from maternal plasma as a prenatal screening in the management of RhD incompatibility.
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Prenatal non-invasive foetal RHD genotyping: diagnostic accuracy of a test as a guide for appropriate administration of antenatal anti-D immunoprophylaxis. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018; 16:514-524. [PMID: 29757138 DOI: 10.2450/2018.0270-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/13/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Foetal RHD genotyping can be predicted by real-time polymerase chain reaction (qPCR) using cell-free foetal DNA extracted from maternal plasma. The object of this study was to determine the diagnostic accuracy and feasibility of non-invasive RHD foetal genotyping, using a commercial multiple-exon assay, as a guide to appropriate administration of targeted antenatal immunoprophylaxis. MATERIAL AND METHODS Cell-free foetal DNA was extracted from plasma of RhD-negative women between 11-30 weeks of pregnancy. The foetal RHD genotype was determined non-invasively by qPCR amplification of exons 5, 7 and 10 of the RHD gene using the Free DNA Fetal Kit® RhD. Results were compared with serological RhD cord blood typing at birth. The analysis of diagnostic accuracy was restricted to the period (24-28+6 weeks) during which foetal genotyping is usually performed for targeted antenatal immunoprophylaxis. RESULTS RHD foetal genotyping was performed on 367 plasma samples (24-28+6 weeks). Neonatal RhD phenotype results were available for 284 pregnancies. Foetal RHD status was inconclusive in 9/284 (3.2%) samples, including four cases with RhD maternal variants. Two false-positive results were registered. The sensitivity was 100% and the specificity was 97.5% (95% CI: 94.0-100). The diagnostic accuracy was 99.3% (95% CI: 98.3-100), decreasing to 96.1% (95% CI: 93.9-98.4) when the inconclusive results were included. The negative and positive predictive values were 100% (95% CI: 100-100) and 99.0% (95% CI: 97.6-100), respectively. There was one false-negative result in a sample collected at 18 weeks. After inclusion of samples at early gestational age (<23+6 week), sensitivity and accuracy were 99.6% (95% CI: 98.7-100) and 95.5% (95% CI: 93.3-97.8), respectively. DISCUSSION This study demonstrates that foetal RHD detection on maternal plasma using a commercial multiple-exon assay is a reliable and accurate tool to predict foetal RhD phenotype. It can be a safe guide for the appropriate administration of targeted prenatal immunoprophylaxis.
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de Haas M, Thurik FF, van der Ploeg CPB, Veldhuisen B, Hirschberg H, Soussan AA, Woortmeijer H, Abbink F, Page-Christiaens GCML, Scheffer PG, Ellen van der Schoot C. Sensitivity of fetal RHD screening for safe guidance of targeted anti-D immunoglobulin prophylaxis: prospective cohort study of a nationwide programme in the Netherlands. BMJ 2016; 355:i5789. [PMID: 27821701 PMCID: PMC5098549 DOI: 10.1136/bmj.i5789] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine the accuracy of non-invasive fetal testing for the RHD gene in week 27 of pregnancy as part of an antenatal screening programme to restrict anti-D immunoglobulin use to women carrying a child positive for RHD DESIGN: Prospectively monitoring of fetal RHD testing accuracy compared with serological cord blood typing on introduction of the test. Fetal RHD testing was performed with a duplex real time quantitative polymerase chain reaction, with cell-free fetal DNA isolated from 1 mL of maternal plasma The study period was between 4 July 2011 and 7 October 2012. The proportion of women participating in screening was determined. SETTING Nationwide screening programme, the Netherlands. Tests are performed in a centralised setting. PARTICIPANTS 25 789 RhD negative pregnant women. MAIN OUTCOME MEASURES Sensitivity, specificity, false negative rate, and false positive rate of fetal RHD testing compared with serological cord blood typing; proportion of technical failures; and compliance to the screening programme. RESULTS A fetal RHD test result and serological cord blood result were available for 25 789 pregnancies. Sensitivity for detection of fetal RHD was 99.94% (95% confidence interval 99.89% to 99.97%) and specificity was 97.74% (97.43% to 98.02%). Nine false negative results for fetal RHD testing were registered (0.03%, 95% confidence interval 0.01% to 0.06%). In two cases these were due to technical failures. False positive fetal RHD testing results were registered for 225 samples (0.87%, 0.76% to 0.99%). Weak RhD expression was shown in 22 of these cases, justifying anti-D immunoglobulin use. The negative and positive predictive values were 99.91% (95% confidence interval 99.82% to 99.95%) and 98.60% (98.40% to 98.77%), respectively. More than 98% of the women participated in the screening programme. CONCLUSIONS Fetal RHD testing in week 27 of pregnancy as part of a national antenatal screening programme is highly reliable and can be used to target both antenatal and postnatal anti-D immunoglobulin use.
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Affiliation(s)
- Masja de Haas
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Center for Clinical Transfusion Research, Sanquin Research and Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden
- Department of Immunohematology Diagnostic Services, Sanquin Research, Amsterdam, Netherlands
| | - Florentine F Thurik
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- University Medical Center Utrecht, Division Woman and Baby, Department of Obstetrics, Utrecht, Netherlands
| | | | - Barbera Veldhuisen
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Immunohematology Diagnostic Services, Sanquin Research, Amsterdam, Netherlands
| | - Hoang Hirschberg
- National Institute for Public Health and the Environment, Service for vaccine provision and prevention programs, Bilthoven, Netherlands
| | - Aicha Ait Soussan
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Heleen Woortmeijer
- Department of Immunohematology Diagnostic Services, Sanquin Research, Amsterdam, Netherlands
| | - Frithjofna Abbink
- National Institute for Public Health and the Environment, Center for population screening, Bilthoven, Netherlands
| | | | - Peter G Scheffer
- University Medical Center Utrecht, Division Woman and Baby, Department of Obstetrics, Utrecht, Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Moezzi L, Keshavarz Z, Ranjbaran R, Aboualizadeh F, Behzad-Behbahani A, Abdullahi M, Ramezani A, Samsami A, Sharifzadeh S. Fetal RHD Genotyping Using Real-Time Polymerase Chain Reaction Analysis of Cell-Free Fetal DNA in Pregnancy of RhD Negative Women in South of Iran. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:62-70. [PMID: 27123202 PMCID: PMC4845531 DOI: 10.22074/ijfs.2016.4770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 06/29/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Maternal-fetal RhD antigen incompatibility causes approximately 50% of clinically significant alloimmunization cases. The routine use of prophylactic anti-D immunoglobulin has dramatically reduced hemolytic disease of the fetus and newborn. Recently, fetal RHD genotyping in RhD negative pregnant women has been suggested for appropriate use of anti-D immunoglobulin antenatal prophylaxis and decrease unnecessary prenatal interventions. MATERIALS AND METHODS In this prospective cohort study, in order to develop a reliable and non-invasive method for fetal RHD genotyping, cell free fetal DNA (cffD- NA) was extracted from maternal plasma. Real-time quantitative polymerase chain reaction (qPCR) for detection of RHD exons 7, 5, 10 and intron 4 was performed and the results were compared to the serological results of cord blood cells as the gold standard method. SRY gene and hypermethylated Ras-association domain family member 1 (RASSF1A) gene were used to confirm the presence of fetal DNA in male and female fetuses, respectively. RESULTS Out of 48 fetuses between 8 and 32 weeks (wks) of gestational age (GA), we correctly diagnosed 45 cases (93.75%) of RHD positive fetuses and 2 cases (4.16%) of the RHD negative one. Exon 7 was amplified in one sample, while three other RHD gene sequences were not detected; the sample was classified as inconclusive, and the RhD serology result after birth showed that the fetus was RhD-negative. CONCLUSION Our results showed high accuracy of the qPCR method using cffDNA for fetal RHD genotyping and implicate on the efficiency of this technique to predict the competence of anti-D immunoglobulin administration.
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Affiliation(s)
- Leili Moezzi
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zeinab Keshavarz
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Ranjbaran
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Aboualizadeh
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Behzad-Behbahani
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masooma Abdullahi
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Ramezani
- School of Advanced Medical Science and Technology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alamtaj Samsami
- Department of Obstetrics and Gynecology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Sharifzadeh
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
Determination of fetal RHD from maternal plasma is increasingly used as a valuable tool for prenatal diagnosis. A remaining pitfall which hampers its use in situations with severe consequences is the following: (a) The reliability of negative results, however, is limited by difficulties to distinguish true negative results from false negative results due to insufficient amounts of free fetal DNA (ffDNA). False negative results can result in severe complications for the fetus and have to be reliably excluded. Large studies were performed in the last 10 years to investigate the reliability of noninvasive fetal RHD typing with real-time PCR. The majority of the assays were performed without internal controls. We present a protocol for inclusion of standards to assess the presence of adequate amounts of ffDNA for prenatal genotyping in maternal blood.
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Affiliation(s)
- Andrea Doescher
- German Red Cross Blood Transfusion Service NSTOB, Brandenburger Str. 21, 26133, Oldenburg, Germany,
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10
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Abstract
Maternal-fetal red cell antigen incompatibility can lead to alloimmunization, maternal immunoglobulin transplacental transfer, and hemolytic disease of the fetus and newborn (HDFN). The use of routine antenatal anti-D prophylaxis (RAADP) has sharply decreased the incidence of and mortality from HDFN due to RhD allosensitization. The ability to identify pregnancies/fetuses at risk of HDFN has significantly improved due to paternal molecular RHD zygosity testing, and non-invasive fetal molecular diagnostics for detecting putative antigen(s) (notably RhD) in fetuses utilizing cff-DNA in maternal plasma. Fetal RHD genotyping using cff-DNA has become increasingly accurate for fetal RHD detection, prompting some countries to implement targeted RAADP through mass screening programs of RhD-negative pregnant women. Along with middle cerebral artery Doppler ultrasonography for predicting fetal anemia, non-invasive fetal molecular diagnostics have greatly decreased the need for invasive diagnostic procedures in pregnancies at risk for severe HDFN. This review highlights these molecular advancements in HDFN-related prenatal diagnostics.
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Affiliation(s)
- Ross M Fasano
- Transfusion, Tissue, and Apheresis, Children's Healthcare of Atlanta, Atlanta, GA, USA; Grady Health System Transfusion Services, Atlanta, GA, USA.
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Adamczyk T, Doescher A, Haydock PV, Aldrich R, Petershofen EK, Müller TH. The Glass Slide Extraction System Snap Card Improves Non-Invasive Prenatal Genotyping in Pregnancies with Antibodies. Transfus Med Hemother 2016; 42:379-84. [PMID: 26733769 DOI: 10.1159/000441542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/26/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Determination of fetal blood groups in maternal plasma samples critically depends on adequate pre-analytical steps for optimal amplification of fetal DNA. We compared the extraction of cell-free DNA by binding on a glass surface (BCSI SNAP™ Card) with an automated system based on bead technology (MagnaPure compact™). METHODS Maternal blood samples from 281 pregnancies (7th-39th week of gestation) with known antibodies were evaluated in this study. Both the SNAP card and the MagnaPure method were applied to isolate DNA in order to directly compare the amplification in a single base extension assay and/or real-time PCR. RESULTS The mean concentration of total DNA obtained by the SNAP card (33.8 ng/µl) exceeded more than twofold that of MagnaPure extraction (15.7 ng/µl). SNAP card-extracted samples allowed to detect 3.7 single nucleotide polymorphisms (SNPs) versus 2.5 SNPs in MagnaPure extracts to control for traces of fetal DNA. This difference is highest for samples from 7th-13th week of gestation. CONCLUSION The SNAP card system improves DNA extraction efficacy for prenatal diagnosis in maternal blood samples and provides an at least eightfold higher total amount of DNA for the ensuing analysis. Its advantage is most evident for samples from early stages of pregnancy and thus especially valuable for pregnancies with antibodies.
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Affiliation(s)
- Thomasz Adamczyk
- Medical Hospital 'Links der Weser', Gesundheit Nord, Department Internal Medicine, Bremen, Germany
| | - Andrea Doescher
- German Red Cross Blood Transfusion Service NSTOB, Institute Oldenburg, Germany
| | | | | | | | - Thomas H Müller
- German Red Cross Blood Transfusion Service NSTOB, Institute Springe, Germany
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12
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Svensson AM, Delaney M. Considerations of red blood cell molecular testing in transfusion medicine. Expert Rev Mol Diagn 2015; 15:1455-64. [PMID: 26367503 DOI: 10.1586/14737159.2015.1086646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The field of transfusion medicine is on the threshold of a paradigm shift, as the technology for genotyping of red blood cell antigens, including US FDA-approved arrays, is now moving into standard practice. Access to cost-efficient, high-resolution genotyping has the potential to increase the quality of care by decreasing the risk for alloimmunization and incompatible transfusions in individuals on long-term blood transfusion protocols, including patient groups with hemoglobinopathies and other chronic diseases. Current and future applications of molecular methods in transfusion medicine and blood banking are discussed, with emphasis on indications for genotyping in various clinical scenarios. Furthermore, limitations of the current gold standard methodology and serology, as well as of contemporary molecular methodology, are examined.
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Affiliation(s)
- Annika M Svensson
- a 1 Department of Pathology, School of Medicine, University of Colorado , Denver, USA.,b 2 Department of Pathology and Laboratory Medicine, Children's Hospital Colorado , Colorado, USA
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Sun K, Jiang P, Chan KCA. The impact of digital DNA counting technologies on noninvasive prenatal testing. Expert Rev Mol Diagn 2015; 15:1261-8. [PMID: 26358092 DOI: 10.1586/14737159.2015.1084227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The discovery of cell-free DNA molecules in maternal plasma has opened up numerous opportunities for noninvasive prenatal testing. The advent of new digital counting technologies, including digital polymerase chain reaction and massive parallel sequencing, has provided the opportunity to quantify the cell-free DNA molecules in maternal plasma in an unprecedentedly precise manner. Powered by these technologies, prenatal testing of different kinds of hereditary conditions, ranging from monogenic diseases to chromosome aneuploidies, has been shown to be possible through the analysis of maternal plasma DNA. Discussed here are the principles of the approaches used in the noninvasive testing of different fetal conditions, with an emphasis on the impact that different digital DNA counting strategies have made on the development of these tests.
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Affiliation(s)
- Kun Sun
- a Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Peiyong Jiang
- a Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
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Sillence KA, Roberts LA, Hollands HJ, Thompson HP, Kiernan M, Madgett TE, Welch CR, Avent ND. Fetal Sex and RHD Genotyping with Digital PCR Demonstrates Greater Sensitivity than Real-time PCR. Clin Chem 2015; 61:1399-407. [PMID: 26354802 DOI: 10.1373/clinchem.2015.239137] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 08/24/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Noninvasive genotyping of fetal RHD (Rh blood group, D antigen) can prevent the unnecessary administration of prophylactic anti-D to women carrying RHD-negative fetuses. We evaluated laboratory methods for such genotyping. METHODS Blood samples were collected in EDTA tubes and Streck® Cell-Free DNA™ blood collection tubes (Streck BCTs) from RHD-negative women (n = 46). Using Y-specific and RHD-specific targets, we investigated variation in the cell-free fetal DNA (cffDNA) fraction and determined the sensitivity achieved for optimal and suboptimal samples with a novel Droplet Digital™ PCR (ddPCR) platform compared with real-time quantitative PCR (qPCR). RESULTS The cffDNA fraction was significantly larger for samples collected in Streck BCTs compared with samples collected in EDTA tubes (P < 0.001). In samples expressing optimal cffDNA fractions (≥4%), both qPCR and digital PCR (dPCR) showed 100% sensitivity for the TSPY1 (testis-specific protein, Y-linked 1) and RHD7 (RHD exon 7) assays. Although dPCR also had 100% sensitivity for RHD5 (RHD exon 5), qPCR had reduced sensitivity (83%) for this target. For samples expressing suboptimal cffDNA fractions (<2%), dPCR achieved 100% sensitivity for all assays, whereas qPCR achieved 100% sensitivity only for the TSPY1 (multicopy target) assay. CONCLUSIONS qPCR was not found to be an effective tool for RHD genotyping in suboptimal samples (<2% cffDNA). However, when testing the same suboptimal samples on the same day by dPCR, 100% sensitivity was achieved for both fetal sex determination and RHD genotyping. Use of dPCR for identification of fetal specific markers can reduce the occurrence of false-negative and inconclusive results, particularly when samples express high levels of background maternal cell-free DNA.
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Affiliation(s)
- Kelly A Sillence
- School of Biomedical and Healthcare Sciences, Plymouth University, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Llinos A Roberts
- Department of Fetal Medicine, Plymouth Hospitals National Health Service Trust, Plymouth, UK
| | - Heidi J Hollands
- Department of Fetal Medicine, Plymouth Hospitals National Health Service Trust, Plymouth, UK
| | - Hannah P Thompson
- School of Biomedical and Healthcare Sciences, Plymouth University, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Michele Kiernan
- School of Biomedical and Healthcare Sciences, Plymouth University, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Tracey E Madgett
- School of Biomedical and Healthcare Sciences, Plymouth University, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - C Ross Welch
- Department of Fetal Medicine, Plymouth Hospitals National Health Service Trust, Plymouth, UK
| | - Neil D Avent
- School of Biomedical and Healthcare Sciences, Plymouth University, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK;
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15
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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] [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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Picchiassi E, Di Renzo GC, Tarquini F, Bini V, Centra M, Pennacchi L, Galeone F, Micanti M, Coata G. Non-Invasive Prenatal RHD Genotyping Using Cell-Free Fetal DNA from Maternal Plasma: An Italian Experience. Transfus Med Hemother 2014; 42:22-8. [PMID: 25960712 DOI: 10.1159/000370233] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/27/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND This study assessed the diagnostic accuracy of a non-invasive approach to fetal RHD genotyping using cell-free fetal DNA in maternal plasma and a combination of methodological strategies. METHODS Real-time PCR (qPCR) was performed on 216 RhD-negative women between weeks 10+0 and 14+6 of gestation (1st qPCR). qPCR was repeated (2nd qPCR) to increase the amount of each sample for analysis, on 95 plasma aliquots that were available from first trimester blood collection (group 1) and on 13 samples that were collected between weeks 18+0 and 25+6 of gestation (group 2). qPCR was specific for exons 5 and 7 of the RHD gene (RHD5 and RHD7). The results were interpreted according to the number of positive replicates of both exons. RESULTS 1st qPCR: diagnostic accuracy was of 93.3%. Diagnostic accuracy increased from 90.5% (1st qPCR) to 93.7% (2nd qPCR) in group 1 and from 84.6% (1st qPCR) to 92.3% (2nd qPCR) in group 2. These increments were not statistically significant. CONCLUSION Our approach to RHD genotyping in early pregnancy yielded high diagnostic accuracy. Increasing the amount of DNA analyzed in each sample did not improve significantly the diagnostic accuracy of the test.
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Affiliation(s)
- Elena Picchiassi
- Department of Obstetrics and Gynecology, University Hospital of Perugia, Perugia, Italy
| | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology, University Hospital of Perugia, Perugia, Italy
| | - Federica Tarquini
- Department of Obstetrics and Gynecology, University Hospital of Perugia, Perugia, Italy
| | - Vittorio Bini
- Department of Internal Medicine, University Hospital of Perugia, Perugia, Italy
| | - Michela Centra
- Department of Obstetrics and Gynecology, University Hospital of Perugia, Perugia, Italy
| | - Luana Pennacchi
- Department of Obstetrics and Gynecology, University Hospital of Perugia, Perugia, Italy
| | - Fabiana Galeone
- Department of Obstetrics and Gynecology, University Hospital of Perugia, Perugia, Italy
| | - Mara Micanti
- Department of Obstetrics and Gynecology, University Hospital of Perugia, Perugia, Italy
| | - Giuliana Coata
- Department of Obstetrics and Gynecology, University Hospital of Perugia, Perugia, Italy
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Chitty LS, Finning K, Wade A, Soothill P, Martin B, Oxenford K, Daniels G, Massey E. Diagnostic accuracy of routine antenatal determination of fetal RHD status across gestation: population based cohort study. BMJ 2014; 349:g5243. [PMID: 25190055 PMCID: PMC4154470 DOI: 10.1136/bmj.g5243] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess the accuracy of fetal RHD genotyping using cell-free fetal DNA in maternal plasma at different gestational ages. DESIGN A prospective multicentre cohort study. SETTING Seven maternity units in England. PARTICIPANTS RhD negative pregnant women who booked for antenatal care before 24 weeks' gestation. INTERVENTIONS Women who gave consent for fetal RHD genotyping had blood taken at the time of booking for antenatal care and, when possible, at other routine visits such as for Down's syndrome screening between 11 and 21 weeks' gestation, at the anomaly scan at 18-21 weeks, and in the third trimester when blood was taken for the routine antibody check. The results of cord blood analysis, done routinely in RhD negative pregnancies, were also obtained to confirm the fetal RHD genotyping. MAIN OUTCOME MEASURES The accuracy of fetal RHD genotyping compared with RhD status predicted by cord blood serology. RESULTS Up to four analyses per woman were performed in 2288 women, generating 4913 assessable fetal results. Sensitivity for detection of fetal RHD positivity was 96.85% (94.95% to 98.05%), 99.83% (99.06% to 99.97%), 99.67% (98.17% to 99.94%), 99.82% (98.96% to 99.97%), and 100% (99.59% to 100%) at <11, 11-13, 14-17, 18-23, and >23 completed weeks' gestation, respectively. Before 11 weeks' gestation 16/865 (1.85%) babies tested were falsely predicted as RHD negative. CONCLUSIONS Mass throughput fetal RHD genotyping is sufficiently accurate for the prediction of RhD type if it is performed from 11 weeks' gestation. Testing before this time could result in a small but significant number of babies being incorrectly classified as RHD negative. These mothers would not receive anti-RhD immunoglobulin, and there would be a risk of haemolytic disease of the newborn in subsequent pregnancies.
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Affiliation(s)
- Lyn S Chitty
- UCL Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust and University College London Hospitals NHS Foundation Trust, London WC1N 3BH, UK
| | - Kirstin Finning
- International Blood Group Reference Laboratory, NHS Blood and Transplant, Bristol BS34 7QH, UK Kirstin Finning
| | - Angela Wade
- Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London WC1N 1EH, UK
| | - Peter Soothill
- Fetal Medicine Unit, St Michael's Hospital, Bristol BS2 8EG, UK
| | - Bill Martin
- Fetal Medicine Unit, Birmingham Women's NHS Foundation Trust, Birmingham B15 2TG, UK
| | - Kerry Oxenford
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
| | - Geoff Daniels
- International Blood Group Reference Laboratory, NHS Blood and Transplant, Bristol BS34 7QH, UK Kirstin Finning
| | - Edwin Massey
- International Blood Group Reference Laboratory, NHS Blood and Transplant, Bristol BS34 7QH, UK Kirstin Finning
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Banch Clausen F, Steffensen R, Christiansen M, Rudby M, Jakobsen MA, Jakobsen TR, Krog GR, Madsen RD, Nielsen KR, Rieneck K, Sprogøe U, Homburg KM, Baech J, Dziegiel MH, Grunnet N. Routine noninvasive prenatal screening for fetalRHDin plasma of RhD-negative pregnant women-2 years of screening experience from Denmark. Prenat Diagn 2014; 34:1000-5. [DOI: 10.1002/pd.4419] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/12/2014] [Accepted: 05/19/2014] [Indexed: 12/20/2022]
Affiliation(s)
- F. Banch Clausen
- Department of Clinical Immunology; Copenhagen University Hospital; Copenhagen Denmark
| | - R. Steffensen
- Department of Clinical Immunology; Aalborg University Hospital; Aalborg Denmark
| | - M. Christiansen
- Department of Clinical Immunology; Aarhus University Hospital; Skejby Aarhus Denmark
| | - M. Rudby
- Department of Clinical Immunology; Naestved Hospital; Naestved Denmark
| | - M. A. Jakobsen
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | - T. R. Jakobsen
- Department of Obstetrics and Gynecology; Copenhagen University Hospital; Copenhagen Denmark
| | - G. R. Krog
- Department of Clinical Immunology; Copenhagen University Hospital; Copenhagen Denmark
| | - R. D. Madsen
- Department of Clinical Immunology; Aarhus University Hospital; Skejby Aarhus Denmark
| | - K. R. Nielsen
- Department of Clinical Immunology; Aalborg University Hospital; Aalborg Denmark
| | - K. Rieneck
- Department of Clinical Immunology; Copenhagen University Hospital; Copenhagen Denmark
| | - U. Sprogøe
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | - K. M. Homburg
- Department of Clinical Immunology; Naestved Hospital; Naestved Denmark
| | - J. Baech
- Department of Clinical Immunology; Aalborg University Hospital; Aalborg Denmark
| | - M. H. Dziegiel
- Department of Clinical Immunology; Copenhagen University Hospital; Copenhagen Denmark
| | - N. Grunnet
- Department of Clinical Immunology; Aarhus University Hospital; Skejby Aarhus Denmark
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Kent J, Farrell AM, Soothill P. Routine administration of Anti-D: the ethical case for offering pregnant women fetal RHD genotyping and a review of policy and practice. BMC Pregnancy Childbirth 2014; 14:87. [PMID: 24568571 PMCID: PMC3944436 DOI: 10.1186/1471-2393-14-87] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/14/2014] [Indexed: 12/01/2022] Open
Abstract
Background Since its introduction in the 1960s Anti-D immunoglobulin (Anti-D Ig) has been highly successful in reducing the incidence of haemolytic disease of the fetus and newborn (HDFN) and achieving improvements to maternal and fetal health. It has protected women from other invasive interventions during pregnancy and prevented deaths and damage amongst newborns and is a technology which has been adopted worldwide. Currently about one third of pregnant women with the blood group Rhesus D (RhD) negative in the UK (approximately 40,000 women per year in England and Wales), receive antenatal Anti-D Ig in pregnancy when they do not require it because they are carrying a RhD negative fetus. Since 1997, a test using cell free fetal DNA (cffDNA) in maternal blood has been developed to identify the genotype of the fetus and can be used to predict the fetal RhD blood group. Discussion This paper considers whether it is ethically acceptable to continue administering antenatal Anti-D Ig to all RhD negative women when fetal RHD genotyping using maternal blood could identify those women who do not need this product. Summary The antenatal administration of Anti-D Ig to a third of RhD negative pregnant women who carry a RhD negative fetus and therefore do not need it raises important ethical issues. If fetal RHD genotyping using maternal blood was offered to all RhD negative pregnant women it would assist them to make an informed choice about whether or not to have antenatal Anti-D Ig.
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Affiliation(s)
- Julie Kent
- Department of Health & Social Sciences, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK.
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Clausen FB. Integration of noninvasive prenatal prediction of fetal blood group into clinical prenatal care. Prenat Diagn 2014; 34:409-15. [PMID: 24431264 DOI: 10.1002/pd.4326] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/08/2014] [Accepted: 01/12/2014] [Indexed: 12/21/2022]
Abstract
Incompatibility of red blood cell blood group antigens between a pregnant woman and her fetus can cause maternal immunization and, consequently, hemolytic disease of the fetus and newborn. Noninvasive prenatal testing of cell-free fetal DNA can be used to assess the risk of hemolytic disease of the fetus and newborn to fetuses of immunized women. Prediction of the fetal RhD type has been very successful and is now integrated into clinical practice to assist in the management of the pregnancies of RhD immunized women. In addition, noninvasive prediction of the fetal RhD type can be applied to guide targeted prenatal prophylaxis, thus avoiding unnecessary exposure to anti-D in pregnant women. The analytical aspect of noninvasive fetal RHD typing is very robust and accurate, and its routine utilization has demonstrated high sensitivities for fetal RHD detection. A high compliance with administering anti-D is essential for obtaining a clinical effect. Noninvasive fetal typing of RHC/c, RHE/e, and KEL may become more widely used in the future.
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Affiliation(s)
- Frederik Banch Clausen
- Laboratory of Blood Genetics, Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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22
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de Haas M, Finning K, Massey E, Roberts DJ. Anti-D prophylaxis: past, present and future. Transfus Med 2014; 24:1-7. [DOI: 10.1111/tme.12099] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M. de Haas
- Department of Immunohaematology, Division of Diagnostic Services; Sanquin; Amsterdam the Netherlands
| | - K. Finning
- National Health Service Blood and Transplant; Bristol UK
| | - E. Massey
- National Health Service Blood and Transplant; Bristol UK
| | - D. J. Roberts
- National Health Service Blood and Transplant; Oxford UK
- Radcliffe Department of Medicine, John Radcliffe Hospital; University of Oxford; Oxford UK
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Kolialexi A, Tounta G, Mavrou A. Noninvasive fetal RhD genotyping from maternal blood. Expert Rev Mol Diagn 2014; 10:285-96. [DOI: 10.1586/erm.10.5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
This article provides an overview of the application of molecular diagnostic methods to red cell and platelet compatibility testing. The advantages and limitations of molecular methods are evaluated compared with traditional serologic methods. The molecular bases of clinically significant red cell and platelet antigens are presented. Current recommendations for reporting molecular assay results and distinctions between genotype and phenotype are discussed.
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Affiliation(s)
- Matthew B Elkins
- Department of Pathology, Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
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Pre-analytical conditions in non-invasive prenatal testing of cell-free fetal RHD. PLoS One 2013; 8:e76990. [PMID: 24204719 PMCID: PMC3800077 DOI: 10.1371/journal.pone.0076990] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 08/26/2013] [Indexed: 02/03/2023] Open
Abstract
Background Non-invasive prenatal testing of cell-free fetal DNA (cffDNA) in maternal plasma can predict the fetal RhD type in D negative pregnant women. In Denmark, routine antenatal screening for the fetal RhD gene (RHD) directs the administration of antenatal anti-D prophylaxis only to women who carry an RhD positive fetus. Prophylaxis reduces the risk of immunization that may lead to hemolytic disease of the fetus and the newborn. The reliability of predicting the fetal RhD type depends on pre-analytical factors and assay sensitivity. We evaluated the testing setup in the Capital Region of Denmark, based on data from routine antenatal RHD screening. Methods Blood samples were drawn at gestational age 25 weeks. DNA extracted from 1 mL of plasma was analyzed for fetal RHD using a duplex method for exon 7/10. We investigated the effect of blood sample transportation time (n = 110) and ambient outdoor temperatures (n = 1539) on the levels of cffDNA and total DNA. We compared two different quantification methods, the delta Ct method and a universal standard curve. PCR pipetting was compared on two systems (n = 104). Results The cffDNA level was unaffected by blood sample transportation for up to 9 days and by ambient outdoor temperatures ranging from -10°C to 28°C during transport. The universal standard curve was applicable for cffDNA quantification. Identical levels of cffDNA were observed using the two automated PCR pipetting systems. We detected a mean of 100 fetal DNA copies/mL at a median gestational age of 25 weeks (range 10–39, n = 1317). Conclusion The setup for real-time PCR-based, non-invasive prenatal testing of cffDNA in the Capital Region of Denmark is very robust. Our findings regarding the transportation of blood samples demonstrate the high stability of cffDNA. The applicability of a universal standard curve facilitates easy cffDNA quantification.
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van der Schoot CE, Thurik FF, Veldhuisen B, de Haas M. Noninvasive prenatal blood group and HPA-1a genotyping: the current European experience. Transfusion 2013; 53:2834-6. [DOI: 10.1111/trf.12411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 08/07/2013] [Indexed: 12/13/2022]
Affiliation(s)
- C. Ellen van der Schoot
- Department of Experimental Immunohematology; Sanquin Research; Landsteiner Laboratory; Academic Medical Center; University of Amsterdam; Amsterdam; the Netherlands
| | - Florentine F. Thurik
- Department of Experimental Immunohematology; Sanquin Research; Landsteiner Laboratory; Academic Medical Center; University of Amsterdam; Amsterdam; the Netherlands
| | | | - Masja de Haas
- Department of Diagnostic Immunohematology; Sanquin Diagnostic Services; Amsterdam; the Netherlands
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Targeted routine antenatal anti-D prophylaxis in the prevention of RhD immunisation--outcome of a new antenatal screening and prevention program. PLoS One 2013; 8:e70984. [PMID: 23940682 PMCID: PMC3735499 DOI: 10.1371/journal.pone.0070984] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 06/25/2013] [Indexed: 01/30/2023] Open
Abstract
Objective To estimate the incidence of RhD immunisation after implementation of first trimester non-invasive fetal RHD screening to select only RhD negative women carrying RHD positive fetuses for routine antenatal anti-D prophylaxis (RAADP). Materials and Methods We present a population-based prospective observational cohort study with historic controls including all maternity care centres and delivery hospitals in the Stockholm region, Sweden. All RhD negative pregnant women were screened for fetal RHD genotype in the first trimester of pregnancy. Anti-D immunoglobulin (250–300 µg) was administered intramuscularly in gestational week 28–30 to participants with RHD positive fetuses. Main outcome measure was the incidence of RhD immunisation developing during or after pregnancy. Results During the study period 9380 RhD negative women gave birth in Stockholm. Non-invasive fetal RHD genotyping using cell-free fetal DNA in maternal plasma was performed in 8374 pregnancies of which 5104 (61%) were RHD positive and 3270 (39%) RHD negative. In 4590 pregnancies with an RHD positive test the women received antenatal anti-D prophylaxis. The incidence of RhD immunisation in the study cohort was 0.26 percent (24/9380) (95% CI 0.15–0.36%) compared to 0.46 percent (86/18546) (95% CI 0.37 to 0.56%) in the reference cohort. The risk ratio (RR) for sensitisation was 0.55 (95% CI 0.35 to 0.87) and the risk reduction was statistically significant (p = 0.009). The absolute risk difference was 0.20 percent, corresponding to a number needed to treat (NNT) of 500. Conclusions Using first trimester non-invasive antenatal screening for fetal RHD to target routine antenatal anti-D prophylaxis selectively to RhD negative women with RHD positive fetuses significantly reduces the incidence of new RhD immunisation. The risk reduction is comparable to that reported in studies evaluating the outcome of non selective RAADP to all RhD negative women. The cost-effectiveness of this targeted approach remains to be studied.
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Affiliation(s)
- M. de Haas
- Department of Immunohaematology Diagnostics; Sanquin Diagnostic Services; Amsterdam; the Netherlands
| | - 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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Dovč-Drnovšek T, Klemenc P, Toplak N, Blejec T, Bricl I, Rožman P. Reliable Determination of Fetal RhD Status by RHD Genotyping from Maternal Plasma. ACTA ACUST UNITED AC 2013; 40:37-43. [PMID: 23637648 DOI: 10.1159/000345682] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 04/12/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Immunoprophylaxis with IgG anti-D is a standard prevention of hemolytic disease of the fetus and newborn. Fetal Rhesus D (RhD) blood group genotyping from maternal plasma of RhD-negative pregnant women allows targeted prophylaxis with IgG anti-D in RhD-positive pregnancies only. We set up a reliable protocol for prenatal RHD genotyping. METHODS 153 pregnant Caucasian RhD-negative women were tested in the 27th week (range 7-38th week) of pregnancy. 18 of them were alloimmunized to the RhD antigen. The fetal RHD genotype was determined based on an automated DNA extraction and real-time polymerase chain reaction method. Intron 4 and exons 5, 7 and 10 of the RHD gene and the SRY gene were targeted. RESULTS The fetal RhD status and gender was 100% correctly predicted in all 153 pregnancies (55 RhD-positive males, 45 RhD-positive females; 23 RhD-negative males, 30 RhD-negative females). CONCLUSION The accuracy and applicability of our protocol for non-invasive fetal RhD determination allows the correct management of RhD-incompatible pregnancies. Our protocol could prevent unnecessary immunoprophylaxis in 53 of 153 cases. We therefore recommend that non-invasive fetal RHD genotyping is introduced as an obligatory part of prenatal screening.
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Affiliation(s)
- Tadeja Dovč-Drnovšek
- Blood Transfusion Center of Slovenia, University Medical Center, Ljubljana, Slovenia
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Doescher A, Petershofen EK, Wagner FF, Schunter M, Müller TH. Evaluation of single-nucleotide polymorphisms as internal controls in prenatal diagnosis of fetal blood groups. Transfusion 2012; 53:353-62. [DOI: 10.1111/j.1537-2995.2012.03738.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Stumm M, Entezami M, Trunk N, Beck M, Löcherbach J, Wegner RD, Hagen A, Becker R, Hofmann W. Noninvasive prenatal detection of chromosomal aneuploidies using different next generation sequencing strategies and algorithms. Prenat Diagn 2012; 32:569-77. [PMID: 22573401 DOI: 10.1002/pd.3862] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Markus Stumm
- Zentrum für Pränataldiagnostik und Humangenetik; Kurfürstendamm 199 10719 Berlin Germany
| | - Michael Entezami
- Zentrum für Pränataldiagnostik und Humangenetik; Kurfürstendamm 199 10719 Berlin Germany
| | - Nastasja Trunk
- GATC Biotech AG; Jakob-Stadler-Platz 7 78467 Konstanz Germany
| | - Martina Beck
- GATC Biotech AG; Jakob-Stadler-Platz 7 78467 Konstanz Germany
| | | | - Rolf-Dieter Wegner
- Zentrum für Pränataldiagnostik und Humangenetik; Kurfürstendamm 199 10719 Berlin Germany
| | - Andreas Hagen
- Zentrum für Pränataldiagnostik und Humangenetik; Kurfürstendamm 199 10719 Berlin Germany
| | - Rolf Becker
- Zentrum für Pränataldiagnostik und Humangenetik; Kurfürstendamm 199 10719 Berlin Germany
| | - Wera Hofmann
- LifeCodexx AG; Jakob-Stadler-Platz 7 78467 Konstanz Germany
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Benachi A, Delahaye S, Leticee N, Jouannic JM, Ville Y, Costa JM. Impact of non-invasive fetal RhD genotyping on management costs of rhesus-D negative patients: results of a French pilot study. Eur J Obstet Gynecol Reprod Biol 2012; 162:28-32. [DOI: 10.1016/j.ejogrb.2012.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 11/16/2011] [Accepted: 02/01/2012] [Indexed: 10/28/2022]
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Baudhuin LM, Donato LJ, Uphoff TS. How novel molecular diagnostic technologies and biomarkers are revolutionizing genetic testing and patient care. Expert Rev Mol Diagn 2012; 12:25-37. [PMID: 22133117 DOI: 10.1586/erm.11.85] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Technological applications and novel biomarkers in the field of molecular diagnostics have never been evolving at a more rapid pace. These novel applications have the promise to change the face of clinical care as we move into the era of personalized medicine. While some of these technologies and biomarkers have been adopted by some clinical laboratories, most laboratories face a steep learning curve in bringing these dramatically new and different molecular diagnostic applications on board. Furthermore, interpreting the vast amounts and new types of data produced by these novel applications brings forth challenges for laboratorians and clinicians alike. In this article, we discuss how some of these emerging novel molecular diagnostic technologies and analytes, such as next-generation sequencing, chromosomal microarray, microRNAs and circulating fetal nucleic acids are revolutionizing patient care and personalized medicine.
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Affiliation(s)
- Linnea M Baudhuin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
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Prenatal assessment of fetal chromosomal and genetic disorders through maternal plasma DNA analysis. Pathology 2012; 44:69-72. [DOI: 10.1097/pat.0b013e32834e8e29] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Cell-free fetal nucleic acid testing: a review of the technology and its applications. Obstet Gynecol Surv 2012; 66:431-42. [PMID: 21944155 DOI: 10.1097/ogx.0b013e31822dfbe2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Cell-free fetal nucleic acids circulating in the blood of pregnant women afford the opportunity for early, noninvasive prenatal genetic testing. The predominance of admixed maternal genetic material in circulation demands innovative means for identification and analysis of cell-free fetal DNA and RNA. Techniques using polymerase chain reaction, mass spectrometry, and sequencing have been developed for the purposes of detecting fetal-specific sequences, such as paternally inherited or de novo mutations, or determining allelic balance or chromosome dosage. Clinical applications of these methods include fetal sex determination and blood group typing, which are currently available commercially although not offered routinely in the United States. Other uses of cell-free fetal DNA and RNA being explored are the detection of single-gene disorders, chromosomal abnormalities, and inheritance of parental polymorphisms across the whole fetal genome. The concentration of cell-free fetal DNA may also provide predictive capabilities for pregnancy-associated complications. The roles that cell-free fetal nucleic acid testing assume in the existing framework of prenatal screening and invasive diagnostic testing will depend on factors such as costs, clinical validity and utility, and perceived benefit-risk ratios for different applications. As cell-free fetal DNA and RNA testing continues to be developed and translated, significant ethical, legal, and social questions will arise that will need to be addressed by those with a stake in the use of this technology. TARGET AUDIENCE Obstetricians & Gynecologists and Family Physicians Learning Objectives: After participating in this activity, physicians should be better able to evaluate techniques and tools for analyzing cell-free fetal nucleic acids, assess clinical applications of prenatal testing, using cell-free fetal nucleic acids and barriers to implementation, and distinguish between relevant clinical features of cell-free fetal nucleic acid testing and existing prenatal genetic screening and diagnostic procedures.
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Chan KCA. Clinical applications of the latest molecular diagnostics in noninvasive prenatal diagnosis. Top Curr Chem (Cham) 2012; 336:47-65. [PMID: 22918715 DOI: 10.1007/128_2012_352] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The presence of cell-free fetal DNA in the plasma of pregnant women has opened up the possibility of noninvasive prenatal diagnosis. With the advances in molecular techniques of microfluidics and massive parallel sequencing, an increasing number of fetal genetic diseases/conditions can be noninvasively detected using maternal plasma DNA analysis. Remarkably, it has recently been shown that the genome-wide genetic map of an unborn fetus can be constructed through extensive sequencing of maternal plasma DNA. In this chapter the different qualitative and quantitative approaches and related methodology for the analysis of fetal DNA in maternal plasma are discussed.
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Affiliation(s)
- K C Allen Chan
- Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China,
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37
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The controversy about controls for fetal blood group genotyping by cell-free fetal DNA in maternal plasma. Curr Opin Hematol 2011; 18:467-73. [DOI: 10.1097/moh.0b013e32834bab2d] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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38
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Müller SP, Bartels I, Stein W, Emons G, Gutensohn K, Legler TJ. Cell-free fetal DNA in specimen from pregnant women is stable up to 5 days. Prenat Diagn 2011; 31:1300-4. [DOI: 10.1002/pd.2889] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 09/12/2011] [Accepted: 09/12/2011] [Indexed: 11/12/2022]
Affiliation(s)
- Sina P. Müller
- Department of Transfusion Medicine; University Medical Center; Göttingen Germany
| | - Iris Bartels
- Department of Human Genetics; University Medical Center; Göttingen Germany
| | - Werner Stein
- Department of Obstetrics and Gynaecology; University Medical Center; Göttingen Germany
| | - Günter Emons
- Department of Obstetrics and Gynaecology; University Medical Center; Göttingen Germany
| | | | - Tobias J. Legler
- Department of Transfusion Medicine; University Medical Center; Göttingen Germany
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39
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Clausen FB, Christiansen M, Steffensen R, Jørgensen S, Nielsen C, Jakobsen MA, Madsen RD, Jensen K, Krog GR, Rieneck K, Sprogøe U, Homburg KM, Grunnet N, Dziegiel MH. Report of the first nationally implemented clinical routine screening for fetal RHD in D− pregnant women to ascertain the requirement for antenatal RhD prophylaxis. Transfusion 2011; 52:752-8. [DOI: 10.1111/j.1537-2995.2011.03362.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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40
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Metcalfe P, Rigsby P, Tait E, Urbaniak S. An international reference reagent for the detection of RHD and SRY DNA in plasma. Vox Sang 2011; 102:243-9. [DOI: 10.1111/j.1423-0410.2011.01543.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Scheffer PG, van der Schoot CE, Page-Christiaens GCML, de Haas M. Noninvasive fetal blood group genotyping of rhesus D, c, E and of K in alloimmunised pregnant women: evaluation of a 7-year clinical experience. BJOG 2011; 118:1340-8. [DOI: 10.1111/j.1471-0528.2011.03028.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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42
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Bombard AT, Akolekar R, Farkas DH, VanAgtmael AL, Aquino F, Oeth P, Nicolaides KH. Fetal RHD genotype detection from circulating cell-free fetal DNA in maternal plasma in non-sensitized RhD negative women. Prenat Diagn 2011; 31:802-8. [DOI: 10.1002/pd.2770] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 03/24/2011] [Accepted: 03/28/2011] [Indexed: 11/08/2022]
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43
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Bussani C, Di Tommaso M, Cioni R, Pasquini L, Quitadamo L, Scarselli G. Quantitative variation analysis of fetal DNA in maternal plasma samples collected before and after amniocentesis. J Obstet Gynaecol Res 2011; 37:571-4. [DOI: 10.1111/j.1447-0756.2010.01404.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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44
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Tynan JA, Angkachatchai V, Ehrich M, Paladino T, van den Boom D, Oeth P. Multiplexed analysis of circulating cell-free fetal nucleic acids for noninvasive prenatal diagnostic RHD testing. Am J Obstet Gynecol 2011; 204:251.e1-6. [PMID: 21092930 DOI: 10.1016/j.ajog.2010.09.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 06/30/2010] [Accepted: 09/20/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of the study was the evaluation of a novel multiplex assay to detect fetal Rh blood group D-antigen gene (RHD) loci in maternal plasma from RhD-negative, pregnant women. STUDY DESIGN An RHD genotyping assay was designed to detect exons 4, 5, 7, and 10 and RHDΨ (pseudogene) of the RHD gene along with a Y chromosome-specific assay and a generic polymerase chain reaction amplification control. Plasma samples from 150 RhD-negative pregnant women were assayed for fetal RHD genotype using the MassARRAY system. RESULTS The fetal RHD status of 148 of 150 samples (98.7%) was correctly classified; 86 (57.3%) and 62 (41.3%) were positive and negative, respectively. CONCLUSION This study demonstrates that noninvasive prenatal diagnostics with a single-reaction multiplexed assay is a viable path toward routine characterization of fetal RHD genotypes using circulating cell-free fetal DNA in maternal plasma on the MassARRAY system and is perhaps preferable to serologic testing as currently used clinically.
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Achargui S, Tijane M, Benchemsi N. Génotypage RHD fœtal par PCR dans le plasma de femmes enceintes D négatif. Transfus Clin Biol 2011; 18:13-9. [DOI: 10.1016/j.tracli.2010.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 10/01/2010] [Indexed: 11/25/2022]
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Szczepura A, Osipenko L, Freeman K. A new fetal RHD genotyping test: costs and benefits of mass testing to target antenatal anti-D prophylaxis in England and Wales. BMC Pregnancy Childbirth 2011; 11:5. [PMID: 21244652 PMCID: PMC3034710 DOI: 10.1186/1471-2393-11-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 01/18/2011] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Postnatal and antenatal anti-D prophylaxis have dramatically reduced maternal sensitisations and cases of rhesus disease in babies born to women with RhD negative blood group. Recent scientific advances mean that non-invasive prenatal diagnosis (NIPD), based on the presence of cell-free fetal DNA in maternal plasma, could be used to target prophylaxis on "at risk" pregnancies where the fetus is RhD positive. This paper provides the first assessment of cost-effectiveness of NIPD-targeted prophylaxis compared to current policies. METHODS We conducted an economic analysis of NIPD implementation in England and Wales. Two scenarios were considered. Scenario 1 assumed that NIPD will be only used to target antenatal prophylaxis with serology tests continuing to direct post-delivery prophylaxis. In Scenario 2, NIPD would also displace postnatal serology testing if an RhD negative fetus was identified. Costs were estimated from the provider's perspective for both scenarios together with a threshold royalty fee per test. Incremental costs were compared with clinical implications. RESULTS The basic cost of an NIPD in-house test is £16.25 per sample (excluding royalty fee). The two-dose antenatal prophylaxis policy recommended by NICE is estimated to cost the NHS £3.37 million each year. The estimated threshold royalty fee is £2.18 and £8.83 for Scenarios 1 and 2 respectively. At a £2.00 royalty fee, mass NIPD testing would produce no saving for Scenario 1 and £507,154 per annum for Scenario 2. Incremental cost-effectiveness analysis indicates that, at a test sensitivity of 99.7% and this royalty fee, NIPD testing in Scenario 2 will generate one additional sensitisation for every £9,190 saved. If a single-dose prophylaxis policy were implemented nationally, as recently recommended by NICE, Scenario 2 savings would fall. CONCLUSIONS Currently, NIPD testing to target anti-D prophylaxis is unlikely to be sufficiently cost-effective to warrant its large scale introduction in England and Wales. Only minor savings are calculated and, balanced against this, the predicted increase in maternal sensitisations may be unacceptably high. Reliability of NIPD assays still needs to be demonstrated rigorously in different ethnic minority populations. First trimester testing is unlikely to alter this picture significantly although other emerging technologies may.
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Affiliation(s)
- Ala Szczepura
- Warwick Medical School, University of Warwick, Coventry, UK.
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Akolekar R, Finning K, Kuppusamy R, Daniels G, Nicolaides KH. Fetal RHD Genotyping in Maternal Plasma at 11–13 Weeks of Gestation. Fetal Diagn Ther 2011; 29:301-6. [DOI: 10.1159/000322959] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 11/23/2010] [Indexed: 02/02/2023]
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48
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Clausen FB, Krog GR, Rieneck K, Råsmark EEF, Dziegiel MH. Evaluation of Two Real-Time Multiplex PCR Screening Assays Detecting Fetal RHD in Plasma from RhD Negative Women to Ascertain the Requirement for Antenatal RhD Prophylaxis. Fetal Diagn Ther 2011; 29:155-63. [DOI: 10.1159/000321347] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 09/20/2010] [Indexed: 11/19/2022]
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49
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Liao GJW, Lun FMF, Zheng YWL, Chan KCA, Leung TY, Lau TK, Chiu RWK, Lo YMD. Targeted massively parallel sequencing of maternal plasma DNA permits efficient and unbiased detection of fetal alleles. Clin Chem 2010; 57:92-101. [PMID: 21078840 DOI: 10.1373/clinchem.2010.154336] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Massively parallel sequencing has recently been used in noninvasive prenatal diagnosis. The current costs of this technology are still relatively expensive, however, and sample throughput is still relatively low when it is used as a molecular diagnostic tool. Rather than nonselectively sequencing the genome, target enrichment provides a logical approach for more efficient and cost-effective massively parallel sequencing because it increases the proportion of informative data from the targeted region(s). Existing applications of targeted sequencing have mainly been qualitative analyses of genomic DNA. In this study, we investigated its applicability in enriching selected genomic regions from plasma DNA and the quantitative performance of this approach. METHODS DNA was extracted from plasma samples collected from 12 pregnant women carrying female fetuses. The SureSelect Target Enrichment System (Agilent Technologies) was used to enrich for exons on chromosome X. Plasma DNA libraries with and without target enrichment were analyzed by massively parallel sequencing. Genomic DNA samples of the mother and fetus for each case were genotyped by microarray. RESULTS For the regions targeted by the enrichment kit, the mean sequence coverage of the enriched samples was 213-fold higher than that of the nonenriched samples. Maternal and fetal DNA molecules were enriched evenly. After target enrichment, the coverage of fetus-specific alleles within the targeted region increased from 3.5% to 95.9%. CONCLUSIONS Targeted sequencing of maternal plasma DNA permits efficient and unbiased detection of fetal alleles at genomic regions of interest and is a powerful method for measuring the proportion of fetal DNA in a maternal plasma sample.
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Affiliation(s)
- Gary J W Liao
- Centre for Research into Circulating Fetal Nucleic Acids, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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Illanes S, Soothill P. Management of red cell alloimmunisation in pregnancy: the non-invasive monitoring of the disease. Prenat Diagn 2010; 30:668-73. [DOI: 10.1002/pd.2551] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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