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Bodnar M, Lieberman L, Arsenault V, Berardi P, Duncan J, Lane D, Lavoie M, McCarthy J, Morrison D, Robitaille N, Shehata N, Wilson A, Clarke G. The selection and preparation of red cell components for intrauterine transfusion: A national survey. Vox Sang 2024; 119:265-271. [PMID: 38141176 DOI: 10.1111/vox.13575] [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: 08/01/2023] [Revised: 11/13/2023] [Accepted: 12/01/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND AND OBJECTIVES The practice regarding the selection and preparation of red blood cells (RBCs) for intrauterine transfusion (IUT) is variable reflecting historical practice and expert opinion rather than evidence-based recommendations. The aim of this survey was to assess Canadian hospital blood bank practice with respect to red cell IUT. MATERIALS AND METHODS A survey was sent to nine hospital laboratories known to perform red cell IUT. Questions regarding component selection, processing, foetal pre-transfusion testing, transfusion administration, documentation and traceability were assessed. RESULTS The median annual number of IUTs performed in Canada was 109 (interquartile range, 103-118). RBC selection criteria included allogeneic, Cytomegalovirus seronegative, irradiated, fresh units with most sites preferentially providing HbS negative, group O, RhD negative, Kell negative and units lacking the corresponding maternal antibody without extended matching to the maternal phenotype. Red cell processing varied with respect to target haematocrit, use of saline reconstitution (n = 4), use of an automated procedure for red cell concentration (n = 1) and incorporation of a wash step (n = 2). Foetal pre-transfusion testing uniformly included haemoglobin measurement, but additional serologic testing varied. A variety of strategies were used to link the IUT event to the neonate post-delivery, including the creation of a unique foetal blood bank identifier at three sites. CONCLUSION This survey reviews current practice and highlights the need for standardized national guidelines regarding the selection and preparation of RBCs for IUT. This study has prompted a re-examination of priorities for RBC selection for IUT and highlighted strategies for transfusion traceability in this unique setting.
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Affiliation(s)
- Melanie Bodnar
- Canadian Blood Services, Medical Laboratory and Stem Cell Services, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Lani Lieberman
- Department of Clinical Pathology, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Valerie Arsenault
- Centre Hospitalier Universitaire Sainte Justine, Montréal, Quebec, Canada
| | | | | | - Debra Lane
- Health Sciences Centre Winnipeg, Winnipeg, Manitoba, Canada
| | - Marianne Lavoie
- Centre Hospitalier Universitaire de Quebec (Université Laval), Québec City, Québec, Canada
| | | | - Douglas Morrison
- BC Children's and Women's Hospital, Vancouver, British Columbia, Canada
| | - Nancy Robitaille
- Centre Hospitalier Universitaire Sainte Justine, Montréal, Quebec, Canada
- Héma-Québec, Transfusion Medicine, Montréal, Québec, Canada
| | | | - Ann Wilson
- McGill University Health Centre, Montréal, Québec, Canada
| | - Gwen Clarke
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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Quraishy N, Sapatnekar S. Immunohematological testing and transfusion management of the prenatal patient. Adv Clin Chem 2023; 117:163-208. [PMID: 37973319 DOI: 10.1016/bs.acc.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The primary indication for immunohematological testing in the prenatal patient is to detect and identify maternal red cell antibodies. If there are antibodies that are expected to hemolyze the fetus' red cells, their strength of reactivity must be tested, and the fetus' antigen status determined. After delivery, testing is performed to assess the extent of fetomaternal hemorrhage, as a large hemorrhage may require other therapeutic interventions. Another major role for immunohematological testing is to select blood components appropriately when intrauterine transfusion is required for fetal anemia resulting from maternal alloimmunization or some other cause. Supplementation with molecular methods has transformed the practice of immunohematology, particularly as it applies to typing for the D antigen of the Rh blood group system. Notwithstanding the advances in testing, close coordination and communication between the transfusion service and the obstetrics service are the foundation for ensuring the finest care for prenatal patients, and for new mothers and their infants. This review describes testing and transfusion practices for prenatal patients, using case presentations to highlight the management of selected immunohematological findings. It also includes a discussion of key patient management topics that are currently unresolved.
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Affiliation(s)
- NurJehan Quraishy
- Section of Transfusion Medicine, Department of Laboratory Medicine, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Suneeti Sapatnekar
- Section of Transfusion Medicine, Department of Laboratory Medicine, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, United States.
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Kim MS, Kim JS, Park H, Chung Y, Kim H, Ko DH, Hwang SH, Won HS, Oh HB. Fatal hemolytic disease of the fetus and newborn caused by anti-Jr a antibody: A case report and literature review. Transfus Apher Sci 2019; 59:102605. [PMID: 31324575 DOI: 10.1016/j.transci.2019.06.029] [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] [Received: 02/14/2019] [Revised: 04/01/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
The Jra antigen of the JR blood group system is a highly prevalent red blood cell antigen. Although anti-Jra-associated hemolytic disease of the fetus and newborn (HDFN) is generally considered mild-to-moderate, a rare fatal case was recently reported. We report the third example of HDFN-related anti-Jra with fatal outcomes. The clinical significance of anti-Jra antibody as a cause of HDFN should be reassessed.
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Affiliation(s)
- Min-Sun Kim
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Jin Seok Kim
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Hyewon Park
- Seegene Medical Foundation, Seoul, Republic of Korea
| | - Yousun Chung
- Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Hyungsuk Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dae-Hyun Ko
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea.
| | - Sang-Hyun Hwang
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Heung-Bum Oh
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
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Webb J, Delaney M. Red Blood Cell Alloimmunization in the Pregnant Patient. Transfus Med Rev 2018; 32:213-219. [PMID: 30097223 DOI: 10.1016/j.tmrv.2018.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/22/2018] [Accepted: 07/05/2018] [Indexed: 12/13/2022]
Abstract
Alloimmunization to red blood cell (RBC) antigens represents a challenge for physicians caring for women of child bearing potential. Exposure to non-self RBC antigens may occur during transfusion or pregnancy leading to the development of antibodies. If a subsequent fetus bears that antigen, maternal antibodies may attack the fetal red blood cells causing red cell destruction and clinically significant hemolytic disease of the fetus and newborn (HDFN). In the most severe cases, HDFN may result in intrauterine fetal demise due to high output cardiac failure, effusions and ascites, known as "hydrops fetalis". This article reviews strategies for management and prevention of RBC alloimmunization in women of child bearing potential.
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Affiliation(s)
- Jennifer Webb
- Children's National Health System, Washington, D.C., USA; The George Washington University, Departments of Pediatrics & Pathology, Washington, DC, USA.
| | - Meghan Delaney
- Children's National Health System, Washington, D.C., USA; The George Washington University, Departments of Pediatrics & Pathology, Washington, DC, USA
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Schonewille H, Prinsen-Zander KJ, Reijnart M, van de Watering L, Zwaginga JJ, Meerman RH, van Kamp IL, Brand A. Extended matched intrauterine transfusions reduce maternal Duffy, Kidd, and S antibody formation. Transfusion 2015; 55:2912-9; quiz 2911. [DOI: 10.1111/trf.13231] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 04/24/2015] [Accepted: 06/08/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Henk Schonewille
- Center for Clinical Transfusion Research; Sanquin Research
- Jon J. van Rood Center for Clinical Transfusion Research; Sanquin-Leiden University Medical Center
| | - Karin J.M. Prinsen-Zander
- Department of Immuno-hematology and Blood Transfusion; Leiden University Medical Center; Leiden the Netherlands
| | - Mila Reijnart
- Sanquin Blood Bank, Sanquin Blood Supply; Dordrecht the Netherlands
| | - Leo van de Watering
- Center for Clinical Transfusion Research; Sanquin Research
- Jon J. van Rood Center for Clinical Transfusion Research; Sanquin-Leiden University Medical Center
| | - Jaap-Jan Zwaginga
- Center for Clinical Transfusion Research; Sanquin Research
- Department of Immuno-hematology and Blood Transfusion; Leiden University Medical Center; Leiden the Netherlands
| | - Robertjan H. Meerman
- Department of Obstetrics and Fetal Medicine; Leiden University Medical Center; Leiden the Netherlands
| | - Inge L. van Kamp
- Department of Obstetrics and Fetal Medicine; Leiden University Medical Center; Leiden the Netherlands
| | - Anneke Brand
- Jon J. van Rood Center for Clinical Transfusion Research; Sanquin-Leiden University Medical Center
- Department of Immuno-hematology and Blood Transfusion; Leiden University Medical Center; Leiden the Netherlands
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Bontekoe IJ, Scharenberg J, Schonewille H, Zwaginga JJ, Brand A, van der Meer PF, de Korte D. A new preparation method for red blood cells for intrauterine transfusion enabling reduction of donor exposure. Transfusion 2015; 55:1693-9. [DOI: 10.1111/trf.13020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Henk Schonewille
- Centre for Clinical Transfusion Research; Sanquin Research; Leiden
- Jon J. Van Rood Centre for Clinical Transfusion Research; Sanquin-Leiden University Medical Centre; Leiden
| | - Jaap Jan Zwaginga
- Jon J. Van Rood Centre for Clinical Transfusion Research; Sanquin-Leiden University Medical Centre; Leiden
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden
| | | | - Pieter F. van der Meer
- Sanquin Blood Supply; Amsterdam the Netherlands
- Centre for Clinical Transfusion Research; Sanquin Research; Leiden
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Verduin EP, Brand A, van de Watering LMG, Claas FHJ, Oepkes D, Lopriore E, Doxiadis IIN, Schonewille H. Factors associated with persistence of red blood cell antibodies in woman after pregnancies complicated by fetal alloimmune haemolytic disease treated with intrauterine transfusions. Br J Haematol 2014; 168:443-51. [DOI: 10.1111/bjh.13130] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 08/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Esther P. Verduin
- Centre for Clinical Transfusion Research; Sanquin Research; Leiden the Netherlands
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Centre; Leiden the Netherlands
- Jon J van Rood Centre for Clinical Transfusion Research; Sanquin-Leiden University Medical Centre; Leiden the Netherlands
| | - Anneke Brand
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Centre; Leiden the Netherlands
- Jon J van Rood Centre for Clinical Transfusion Research; Sanquin-Leiden University Medical Centre; Leiden the Netherlands
| | - Leo M. G. van de Watering
- Centre for Clinical Transfusion Research; Sanquin Research; Leiden the Netherlands
- Jon J van Rood Centre for Clinical Transfusion Research; Sanquin-Leiden University Medical Centre; Leiden the Netherlands
| | - Frans H. J. Claas
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Centre; Leiden the Netherlands
| | - Dick Oepkes
- Department of Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
| | - Enrico Lopriore
- Division of Neonatology; Department of Pediatrics; Leiden University Medical Centre; Leiden The Netherlands
| | - Ilias I. N. Doxiadis
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Centre; Leiden the Netherlands
| | - Henk Schonewille
- Centre for Clinical Transfusion Research; Sanquin Research; Leiden the Netherlands
- Jon J van Rood Centre for Clinical Transfusion Research; Sanquin-Leiden University Medical Centre; Leiden the Netherlands
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8
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Doyle B, Quigley J, Lambert M, Crumlish J, Walsh C, Adshead S, Woolfson M, McParland P, Culliton M, Fitzgerald J. Red cell alloimmunisation following intrauterine transfusion and the feasibility of providing extended phenotype-matched red cell units. Transfus Med 2014; 24:311-5. [DOI: 10.1111/tme.12145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 06/10/2014] [Accepted: 07/22/2014] [Indexed: 11/28/2022]
Affiliation(s)
- B. Doyle
- Red Cell Immunohaematology Laboratory; Irish Blood Transfusion Service
| | - J. Quigley
- Department of Transfusion Medicine; National Maternity Hospital
| | - M. Lambert
- Red Cell Immunohaematology Laboratory; Irish Blood Transfusion Service
| | - J. Crumlish
- Red Cell Immunohaematology Laboratory; Irish Blood Transfusion Service
| | - C. Walsh
- Department of Fetal Medicine; National Maternity Hospital
| | - S. Adshead
- Automated Donor Grouping Laboratory; Irish Blood Transfusion Service; Dublin Ireland
| | - M. Woolfson
- Red Cell Immunohaematology Laboratory; Irish Blood Transfusion Service
| | - P. McParland
- Department of Fetal Medicine; National Maternity Hospital
| | - M. Culliton
- Department of Transfusion Medicine; National Maternity Hospital
| | - J. Fitzgerald
- Red Cell Immunohaematology Laboratory; Irish Blood Transfusion Service
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9
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Lindenburg ITM, van Kamp IL, Oepkes D. Intrauterine blood transfusion: current indications and associated risks. Fetal Diagn Ther 2014; 36:263-71. [PMID: 24903741 DOI: 10.1159/000362812] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/09/2014] [Indexed: 11/19/2022]
Abstract
Fetal anemia is a serious complication in pregnancy and associated with perinatal mortality and morbidity. During 25 years of worldwide experience with intravascular intrauterine blood transfusion, a variety of indications have been described. Intrauterine transfusion (IUT) treatment is considered most successful for fetal anemia due to red cell alloimmunization. Moreover, the use of this procedure has also been reported in pregnancies with parvovirus B19 infection, fetomaternal hemorrhage and placental chorioangiomas, for example. This review focuses on the current indications of intrauterine blood transfusions. In addition, we describe the potential complications of IUT treatment.
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Affiliation(s)
- Irene T M Lindenburg
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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10
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Enhancement of Antibody Titre and Development of Additional Red Cell Alloantibodies Following Intrauterine Transfusion. Indian J Hematol Blood Transfus 2013; 32:92-4. [PMID: 26855513 DOI: 10.1007/s12288-013-0308-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/28/2013] [Indexed: 10/25/2022] Open
Abstract
Intrauterine blood transfusion is the mainstay of managing foetuses with severe anemia. It may however result in fetomaternal hemorrhage, which in cases of Rh isoimmunisation may increase the severity of the disease by enhancing the maternal immunological response to fetal antigens. This study was conducted to determine the frequency, specificity and origin of additional red cell antibodies which developed after IUT. The change in the titre of allo anti-D following IUT was also determined. Antibody detection and titration was done on the blood samples of all the patients before and after intrauterine blood transfusion to check for the development of additional antibody and change in the titre of existing anti-D. Severe anemia was found in 17 (58.6 %) fetuses who received a total of 42 ultrasound-guided IUTs. Development of antibodies additional to anti-D in maternal serum was seen in 5 (29.4 %) cases. The specificity of additional alloantibodies was anti-C in four cases whereas it was anti-E in one case. Four fold or greater increase in existing allo-anti D titre was seen in 6 (35.3 %) cases after IUT. Enhancement of maternal sensitisation leading to an increase in maternal antibody titre is particularly seen after the first IUT. Matching of the donor RBCs particularly for Rh antigens might prevent the induction of additional alloantibodies against these antigens. IUT as a treatment modality should be given judiciously and only when the need is inevitable.
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Wong KS, Connan K, Rowlands S, Kornman LH, Savoia HF. Antenatal immunoglobulin for fetal red blood cell alloimmunization. Cochrane Database Syst Rev 2013:CD008267. [PMID: 23728672 DOI: 10.1002/14651858.cd008267.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Red blood cell alloimmunization in pregnancy can lead to fetal anaemia with potentially disastrous consequences. Traditional management involves the use of intrauterine transfusion, which is associated with significant procedure-related risks. An alternative treatment that has been trialled is the use of immunoglobulin administered intravenously to the mother. OBJECTIVES The objective of this review was to assess the efficacy and safety of the use of intravenous immunoglobulin antenatally to women with severe fetal red blood cell alloimmunization. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group trials register (19 December 2012), and reference lists of articles. SELECTION CRITERIA Randomized trials assessing the antenatal use of intravenous immunoglobulin administered at any dose, frequency or duration with a control group (using any other, or no treatment) in the management of fetal red blood cell alloimmunization. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the available evidence. MAIN RESULTS There are no included studies. AUTHORS' CONCLUSIONS No information is available from randomized trials to indicate whether the antenatal use of intravenous immunoglobulin is effective in the management of fetal red blood cell alloimmunization. Several case series suggest a beneficial role in delaying the onset of fetal anaemia requiring invasive intrauterine transfusion.
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Affiliation(s)
- Kae Sheen Wong
- Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, Parkville, Australia.
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Schonewille H, Klumper FJCM, van de Watering LMG, Kanhai HHH, Brand A. High additional maternal red cell alloimmunization after Rhesus- and K-matched intrauterine intravascular transfusions for hemolytic disease of the fetus. Am J Obstet Gynecol 2007; 196:143.e1-6. [PMID: 17306657 DOI: 10.1016/j.ajog.2006.10.895] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 07/28/2006] [Accepted: 10/25/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Intrauterine transfusion (IUT) is a life-saving therapy for the severely anemic fetus with hemolytic disease. However, maternal additional antibody formation is a complication of the procedure. In this study, we determined antibody formation after introduction of preventive Rh-D, -C, -c, -E, and -e and K matching of IUT donors. STUDY DESIGN This was a retrospective follow-up study. RESULTS During an 11-year period, 686 Rhesus- and K-matched IUTs were performed in 233 pregnancies and in 95% (652/686) posttransfusion antibody testing was performed after a median interval of 21 days. Twenty-five percent (53/212) of the women formed 64 new antibodies and, compared to our previous study, this incidence was not decreased by the use of Rhesus- and K-matched donors. After delivery, 72% (153/212) of the women had multiple RBC antibodies. Additional antibodies were in 48% (31/64) directed against Rhesus and K antigens, induced by the fetus, or as natural antibodies. In 52% (33/64) the antibodies were directed against non-Rhesus and -K antigens and in 65% (11/17) of eligible cases the IUT donor and not the fetus expressed the corresponding antigen(s). CONCLUSION Despite Rhesus- and K-matching, women treated with IUTs still show strikingly broad red cell alloimmunization. More extensive IUT donor red cell matching, including FY, JK, and S antigens, to reduce the formation of new red cell antibodies should be explored.
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