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Ni H, Sun X, Cong H. Analysis of Specificity and Distribution Characteristics of Red Blood Cell Irregular Antibodies. Lab Med 2023; 54:507-511. [PMID: 36810696 DOI: 10.1093/labmed/lmac160] [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: 02/24/2023] Open
Abstract
OBJECTIVE The presence of red blood cell (RBC) irregular antibodies can severely jeopardize mother and child and bring trouble to the treatment of anemia. The aim of this study was to analyze the specificity of RBC irregular antibody in inpatients. METHODS An analysis was performed on samples from patients with RBC irregular antibodies. Antibody screening positive samples were analyzed. RESULTS Among the 778 cases of irregular antibody positive samples, 214 were from males and 564 from females. History of blood transfusion accounted for 13.1% of the total. Of the women, 96.8% had a pregnancy. A total of 131 antibodies were identified. The antibodies included 68 Rh systematic antibodies, 6 MNS systematic antibodies, 6 Lewis systematic antibodies, 2 Kidd systematic antibodies, 10 autoantibodies, and 39 antibodies of uncertain specificity. CONCLUSION Patients with blood transfusion or pregnancy history are prone to produce RBC irregular antibodies.
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Affiliation(s)
- Hui Ni
- Department of Blood Transfusion, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiaoye Sun
- Department of Blood Transfusion, Affiliated Hospital of Nantong University, Nantong, China
| | - Hui Cong
- Department of Blood Transfusion, Affiliated Hospital of Nantong University, Nantong, China
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Maruta MB, Tesfaye K, Birhanu E, Yigazu N, Yuya M, Debella A, Mussa I. Prevalence and determinants of RH alloimmunization in Rh-negative women in teaching hospitals of Addis Ababa, Ethiopia: a hospital-based cross-sectional study. Front Glob Womens Health 2023; 4:1167736. [PMID: 37645591 PMCID: PMC10461565 DOI: 10.3389/fgwh.2023.1167736] [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: 02/16/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023] Open
Abstract
Background Despite the implementation of immunization with an anti-D antigen for pregnant women, adverse pregnancy outcomes continue to occur in Ethiopia and most Sub-Saharan African countries. Consequently, the woman's obstetric care is compromised, and there is an increase in perinatal morbidity and mortality. In Ethiopia, the burden of the disease is not well understood, and no research has been conducted in the study area. Therefore, this study aims to determine the prevalence and determinants of Rh alloimmunization in Rh-negative women receiving care at Addis Ababa teaching hospitals. Methods An institutional-based cross-sectional study was conducted from 5 October 2020 to 5 May 2021, among 328 Rh-negative pregnant women who received antenatal care and delivery services at Teaching Hospitals under Addis Ababa University. Face-to-face interviews were used to gather data using a pre-tested structured questionnaire, and a chart review was performed using a checklist. The data were entered into Epidata version 3.1 and analyzed using SPSS version 22. Multivariable analysis and logistic regression were used to evaluate the predictors, and the results were presented as an adjusted odds ratio (AOR) with a 95% confidence interval. Statistical significance was declared at a p-value < 0.05. Results Among Rh-D negative individuals, 56(17.1%) were alloimunized with 95% CI (15.1%, 19.23%). The prevalence of Rh-D negative was 2.1% with 95% CI (1.56%, 2.76%). Factors such as unemployment [AOR = 2.28, 95% CI: 1.21, 4.28], failure to use anti-D prophylaxis in previous pregnancy [AOR = 2.08, 95% CI: 1.10, 3.92), and the presence of sensitizing events [AOR = 0.52, 95% CI: 0.27, 0.84] were statistically significant with the outcome variables. Conclusions This study pointed out that the prevalence of Rh was relatively large and that almost one in every five pregnant women was alloimunized. Factors such as unemployment and failure to use anti-D prophylaxis in a previous pregnancy were found to be associated with outcome variables. Therefore, all stakeholders and concerned entities should prioritize enhancing access and affordability to anti-D prophylaxis to prevent the occurrence of Rh alloimmunization and its associated adverse outcomes.
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Affiliation(s)
- Melat B. Maruta
- Obstetrics and Gynecology, Menelik Comprehensive Specialized Hospital, Addis Ababa, Ethiopia
| | - Kiflom Tesfaye
- Obstetrics and Gynecology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Esayas Birhanu
- Obstetrics and Gynecology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Mohammed Yuya
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Ibsa Mussa
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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Sam AM, Nair AR, Gupta D. Autologous blood transfusion in a neurosurgical patient with multiple alloantibodies. Asian J Transfus Sci 2023; 17:276-278. [PMID: 38274966 PMCID: PMC10807522 DOI: 10.4103/ajts.ajts_53_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/21/2022] [Accepted: 05/29/2022] [Indexed: 01/27/2024] Open
Abstract
There are many challenges to obtain antigen-negative, crossmatch compatible blood for a patient with multiple alloantibodies. We present a case report of a 31-year-old female patient with a recurrent pontine cavernoma who was to undergo a neurosurgical procedure. We identified alloantibodies anti-Fya and anti-c in her blood sample. To meet her intraoperative blood requirement, we attempted with autologous blood transfusion using both predeposit autologous donation and acute normovolemic hemodilution. Autologous blood alone was sufficient despite anticipating surgical blood loss and a postoperative surgical site infection.
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Affiliation(s)
- Angel Mary Sam
- Department of Transfusion Medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Amita Radhakrishnan Nair
- Department of Transfusion Medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Debasish Gupta
- Department of Transfusion Medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Varghese S, Prakash S, Mukherjee S, Sahu A, Mishra D. Hemolytic disease of the fetus and newborn due to minor blood group alloimmunization in a mother of sickle cell disease with multiple alloantibodies. Asian J Transfus Sci 2023; 17:291-294. [PMID: 38274971 PMCID: PMC10807515 DOI: 10.4103/ajts.ajts_161_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/28/2022] [Accepted: 01/18/2023] [Indexed: 01/27/2024] Open
Abstract
Hemolytic disease of the fetus and newborn is due to maternal IgG antibodies that transport through the placenta and destroy neonatal red cells. A mismatch of antigens between mother and fetus causes isoimmunization resulting in mild anemia, which may progress to fetal hydrops in the intrauterine period and severe hyperbilirubinemia to kernicterus in neonates. The isoimmunization is mainly caused by Rh-D and ABO antibodies. In this case report, we found neonatal hyperbilirubinemia due to the presence of anti-c alloantibody previously developed in a sickle cell disease (SCD) pregnant female. It is an unusual case of fetal hyperbilirubinemia due to minor blood group alloimmunization in a SCD needing exchange transfusion. Multi-transfused patients should be counseled regarding the need to perform antibody screening frequently before pregnancy for better treatment of both mother and child.
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Affiliation(s)
- Stephy Varghese
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Satya Prakash
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Somnath Mukherjee
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ansuman Sahu
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Debasish Mishra
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Gothwal M, Singh P, Bajpayee A, Agrawal N, Yadav G, Sharma C. Red cell alloimmunization in pregnancy: a study from a premier tertiary care centre of Western India. Obstet Gynecol Sci 2023; 66:84-93. [PMID: 36444517 PMCID: PMC10025865 DOI: 10.5468/ogs.22190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/27/2022] [Accepted: 10/19/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The study was conducted to determine the frequency of alloimmunization to various blood group antibodies in pregnant women, and the risk of hemolytic disease in the fetus and newborn. METHODS All antenatal women, irrespective of the period of gestation or obstetric history, were included, whereas those taking anti-D immune-prophylaxis or with a history of blood transfusion were excluded. Antibody screening and identification were performed using a Bio-Rad ID microtyping system. RESULTS Of 2,084 antenatal females, 1,765 were D-antigen positive and 319 D-antigen negative. Sixty-five (3.119%) women alloimmunized. Out of 54 (2.591%) who had sensitized to D-antigen, 11 (0.527%) also sensitized to other antibodies. These 11 alloantibodies identified included: anti-M (n=6; 9.23%), anti-C (n=1; 3.076%), anti-E (n=1; 1.538%), anti-e (n=1; 1.538%), anti-Lewis (a) (n=1; 1.538%), and unspecified antibodies (n=1; 1.538%). Multiple antibodies were seen in four patients that combined: anti-D and anti-C (n=2; 3.076%), anti-e and anti-c (n=1; 1.538%), and anti-D and anti-G (n=1; 1.538%). CONCLUSION The rate of alloimmunization in D-antigen-negative women was high. Apart from this, the alloimmunization rate in women with bad obstetric history was very high, at 8.1%. In developing countries such as India, universal antenatal antibody screening, though desirable, may not be justified at present, as the cost and infrastructure required would be immense because of the lower alloimmunization rates in RhD antigen-positive women. However, it is necessary to impose properly formulated protocols to screen pregnant women with bad obstetric history.
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Affiliation(s)
- Meenakshi Gothwal
- Department of Obstetrics & Gynecology, All India Institute of Medical sciences, Jodhpur, Rajasthan,
India
| | - Pratibha Singh
- Department of Obstetrics & Gynecology, All India Institute of Medical sciences, Jodhpur, Rajasthan,
India
| | - Archana Bajpayee
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical sciences, Jodhpur, Rajasthan,
India
| | - Neha Agrawal
- Department of Obstetrics & Gynecology, All India Institute of Medical sciences, Jodhpur, Rajasthan,
India
| | - Garima Yadav
- Department of Obstetrics & Gynecology, All India Institute of Medical sciences, Jodhpur, Rajasthan,
India
| | - Charu Sharma
- Department of Obstetrics & Gynecology, All India Institute of Medical sciences, Jodhpur, Rajasthan,
India
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Mbalibulha Y, Natukunda B, Okwi AL, Kalyango JN, Isaac K, Ononge S. Alloimmunization to Rh Antigen (D, C, E, C, E) Among Pregnant Women Attending Antenatal Care in South Western Uganda. J Blood Med 2022; 13:747-752. [PMID: 36471679 PMCID: PMC9719281 DOI: 10.2147/jbm.s385737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/18/2022] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Maternal red cell alloimmunization to Rh antigen in pregnant women occurs when the immune system is sensitized by foreign red blood cell surface antigens, in this case fetal red blood cells, inducing an immune response. Various antigens of blood group systems may cause alloimmunization, especially the Rh, Kel, Fy, JK, and MNS systems. This study aimed to determine alloimmunization to the different frequencies of Rh antigen among pregnant women in South Western Uganda. METHODS A total of 1369 pregnant women consented and were recruited into a cross-sectional study during their regular antenatal visits during the period August 2020 to July 2021. Samples (4 mL) of anticoagulated and coagulated blood were obtained, and Rh blood grouping including Rh antigen and the indirect antiglobulin test (IAT) was carried out using the agglutination technology of the LISS ID-Card technique in the Ortho Biovue ID-Micro Typing System. RESULTS Out of 1369 participants recruited to the study, 78 (5.7%) were D-, 1291 were D+, and 134 (9.8%) had alloantibodies. Among those with alloantibodies, 115 (85.8%) were D+ and 19 (14.2%) D-. The percentage alloimmunization according to the Rh antigens was highest in e (9.72%), c (2.48%), C (2.34%) and E (0.94%) antigens. With the ABO system, alloimmunization was highest in blood group B (10.7%), followed by A (10.6%), O (9.2%) and then AB (7.1%). Alloimmunization was more prevalent in D- (24%) than in D+ participants (8.9%). Rhesus antigen e was the most prevalent antigen (99.8%), followed by c. The alloimmunization rate of 9.8% among these participants is high, and appears in both D+ and D- women. The other Rhesus antigens are seen to cause alloimmunization, with antigen e causing the highest prevalence. In conclusion, there is a need to identify antibodies and study the outcome for clinical significance, especially in D+ women, to facilitate proper pregnancy management.
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Affiliation(s)
- Yona Mbalibulha
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bernard Natukunda
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Andrew Livex Okwi
- Department of Pathology, College of Health Science, Makerere University, Kampala, Uganda
| | - Joan N Kalyango
- Director, Clinical and Epidemiology Unit, School of Medicine, College of Health Science, Makerere University, Kampala, Uganda
| | - Kajja Isaac
- Deputy Principal, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sam Ononge
- Department of Obstetrics & Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
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Mbalibulha Y, Natukunda B, Livex OA, Ononge S, Kalyango JN, Kajja I. ABO and Rh Antigen Distribution Among Pregnant Women in South Western Uganda. J Blood Med 2022; 13:351-355. [PMID: 35769868 PMCID: PMC9234189 DOI: 10.2147/jbm.s360769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/14/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction ABO and Rh are the major blood group systems in Transfusion Medicine, the ABO system based on two red cell antigens (A, B) while the Rh has about 50 antigens of which five are highly clinically significant (D, C, c, E, e). These vary among races and ethnic groups. Blood type phenotype incompatibility between mother and fetus may result in antigen mismatch, triggering alloimmunization, and thus causing hemolytic transfusion reaction (HTR), which results in hemolytic disease of fetus and newborn (HDFN). This study aimed to determine the frequencies of ABO and rhesus blood group antigen in the pregnant women in South Western Uganda. Methods A cross-sectional study was carried out on 1369 pregnant women who were recruited and provided consent to participate during their regular antenatal visits between August 2020 and July 2021. Four milliliters (4mL) of EDTA-anti-coagulated blood samples were collected and ABO and Rh-blood grouping including Rh antigen screening was done using the agglutination technology comprised of glass beads and reagent contained in a column of the Ortho Biovue ID Micro Typing System (Ortho Clinical Diagnostics, New Jersey, USA). The Rh antigen phenotypes and frequencies were then determined. Results There was percentage distribution of 99.8%, c 99.3%, D 94.3%, C 19.2% and E 15.9%, with Rh cDe/cDe (65.1%) being the most common phenotype followed by cDe/CDe (15%), cDe/cDE (10.8%) and cDE/cDE 0.1% least common. The ABO grouping frequency was obtained as O 49.4%, A 29.5%, B 17.0% and AB 4.1%, with D positivity at 94.3%. Discussion Population genetic variations result in varied expressions of red cell antigens that may have clinical complications. Knowledge of the presence of these Rh antigen distributions and phenotype frequencies during pregnancy help in rational management of the pregnancy, alloimmunization and better approach to safe blood transfusion.
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Affiliation(s)
- Yona Mbalibulha
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bernard Natukunda
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Okwi Andrew Livex
- Department of Pathology, College of Health Science, Makerere University, Kampala, Uganda
| | - Sam Ononge
- Department of Obstetrics & Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joan N Kalyango
- Director Clinical and Epidemiology Unit, School of Medicine, College of Health Science, Makerere University, Kampala, Uganda
| | - Isaac Kajja
- Deputy Principal College of Health Sciences, Makerere University, Kampala, Uganda
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