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Kebamo TE, Kombe AT, Eticha T, Arkew M, Nigussie Bolado G, Ayalew TL, Haile K, Walano GA. Magnitude of Red Blood Cell Alloimmunization Among Pregnant Women Attending Antenatal Care at Wolaita Sodo University Comprehensive Specialized Hospital, Southwest Ethiopia. J Blood Med 2023; 14:663-669. [PMID: 38152294 PMCID: PMC10752022 DOI: 10.2147/jbm.s440952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/21/2023] [Indexed: 12/29/2023] Open
Abstract
Background Maternal red cell alloimmunization occurs when a woman's immune system becomes sensitive to unfamiliar red blood cell antigens. This leads to the production of alloantibodies, which can have serious implications for the fetus and newborn. However, there is a lack of comprehensive information about the extent of red cell alloimmunization in underdeveloped countries like Ethiopia. Therefore, this study aimed to determine the magnitude of red cell alloimmunization among pregnant women attending antenatal care at Wolaita Sodo University Comprehensive Specialized Hospital from September 01 to November 30, 2022. Methods In this institutional-based cross-sectional study, 422 pregnant women were participated and recruited using a systematic random sampling technique. Data on sociodemographic characteristics, obstetric history, and other clinical information were collected using structured questionnaires through face-to-face interview. Blood grouping and indirect antihuman globulin tests were performed. The relationship between red cell alloimmunization and the independent variables was determined using the chi-square test. P-value <0.05 was considered statistical significance. Results In this study, the blood group distributions among the participants were as follows: O, 177 (41.9%); A, 124 (29.4%); B, 76 (18%); and AB, 45 (3.86%). Among the pregnant women included in the study, a total of 51 (12.08%) were identified as RhD-negative. Out of these RhD-negative women, 5 (9.8%) were found to have developed alloimmunization with red blood cell antigens. Miscarriage and post-partum hemorrhage were found to be important factors associated with the occurrence of red cell alloimmunization in these women. Conclusion This study showed that one out of ten pregnant women was alloimmunized. Therefore, antenatal blood grouping and indirect antihuman globulin screening should be performed routinely to manage and minimize the undesirable outcomes of alloimmunization during pregnancy.
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Affiliation(s)
- Tamirat Ersino Kebamo
- School of Medical Laboratory Sciences, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Abinet Tantu Kombe
- School of Medical Laboratory Sciences, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Temesgen Eticha
- School of Medical Laboratory Sciences, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Mesay Arkew
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Getachew Nigussie Bolado
- School of Nursing, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tadele Lankrew Ayalew
- School of Nursing, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kassahun Haile
- School of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Getachew Alemu Walano
- School of Medical Laboratory Sciences, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Abstract
OBJECTIVE There is insufficient study of the association of blood groups with neonatal diseases. The aim of this study was to evaluate the blood groups associated with sepsis and blood groups in preterm infants. STUDY DESIGN This retrospective study was conducted between January 1, 2010 and November 31, 2018 in the neonatal intensive care unit (NICU). This study was done in single-center tertiary NICU. Infants born at gestational age (GA) <32 weeks with birth weight (BW) <1,500 g were included in the study. RESULTS A total of 2,548 infants were included. The culture-proven sepsis ratio (30.2%) was the lowest in the O blood group and the highest in the AB blood group (37.5%) (p = 0.045). Meningitis ratio (6.5%) was significantly higher, and hospital stay (64.1 ± 33.9 days) was significantly longer in B blood group (respectively, p = 0.005, p < 0.001). In the AB blood group, GA (27.68 ± 1.12 weeks) was the lowest and early onset sepsis (EOS) (40.1%) and mortality (28.9%) ratio were found to be statistically higher (p < 0.001 for all groups). The AB group was significantly related to higher frequency of EOS (odds ratio [OR] = 2.93, 95% confidence interval [CI] = 1.68-5.12, p = 0.000), in addition to mortality (OR = 1.1, 95% CI = 0.55-2.19, p = 0.001). The O group was found to be associated with lower risk of late onset sepsis (LOS) (OR = 1.67, 95% CI = 1.06-3.058, p = 0.003) according to the model with corrected risk factor including GA, BW, and time of hospitalization. CONCLUSION Our study was the first study showing a relationship between certain blood groups and EOS/LOS in premature infants as well as meningitis.
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Affiliation(s)
- Ufuk Cakir
- Division of Neonatology, Health Science University, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Cuneyt Tayman
- Division of Neonatology, Health Science University, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Mehmet Buyuktiryaki
- Division of Neonatology, Health Science University, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
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Okulu E, Erdeve Ö, Tuncer O, Ertuğrul S, Özdemir H, Çiftdemir NA, Zenciroğlu A, Atasay B. Exchange transfusion for neonatal hyperbilirubinemia: A multicenter, prospective study of Turkish Neonatal Society. Turk Arch Pediatr 2021; 56:121-6. [PMID: 34286320 DOI: 10.14744/TurkPediatriArs.2020.65983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/29/2020] [Indexed: 01/23/2023]
Abstract
Objective The frequency of neonatal exchange transfusion has declined in recent years, but is still performed in many countries. The procedure is associated with complications. The aim of the study was to determine the clinical features and etiologies of infants with hyperbilirubinemia who underwent exchange transfusion and evaluate the adverse events and clinical outcomes. Material and Methods We performed a secondary analysis of the multicenter Turkish Neonatal Jaundice Online Registry data. Otherwise healthy newborns born ≥35 weeks of gestation who were hospitalized for jaundice and underwent exchange transfusion were included. Results One-hundred thirty-two patients with a mean serum bilirubin level on admission of 24.9±9.1 mg/dL were enrolled in the study. The most common cause for exchange transfusion was hemolytic jaundice (63.6%), followed by lack of proper feeding (12.9%). It was found that the infants with lack of proper feeding were discharged earlier from the maternity ward (p=0.02), but they were admitted to hospital later (p<0.001) with a higher bilirubin level (p=0.001), and geater weight loss (p=0.04). The reported rate of adverse events associated with exchange transfusion was 11.4%. The most common complication was thrombocytopenia (40%). None of the infants died during the procedure. Acute bilirubin encephalopathy was reported in 13 (9.8%) patients. Conclusion Severe hyperbilirubinemia requiring exchange transfusion and acute bilirubin encephalopathy are still challenging problems in neonatal periodin our country. The policies including blood group analysis of pregnant women, programs informing parents about breastfeeding and jaundice, and monitoring bilirubin levels of high-risk newborns should be developed to reduce the necessitating for exchange transfusion and to avoid related complications.
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Özen M, Yılmaz S, Özkan T, Özer Y, Pekel AA, Sunguroğlu A, Gürman G, Arslan Ö. Incomplete Antibodies May Reduce ABO Cross-Match Incompatibility: A Pilot Study. Turk J Haematol 2018; 35:54-60. [PMID: 28533197 PMCID: PMC5843775 DOI: 10.4274/tjh.2016.0504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/22/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Any erythrocyte transfusion among humans having type A or B blood groups is impossible due to antibodies causing fatal transfusion complications. A cross-match test is performed to prevent immune transfusion complications before transfusion. Our hypothesis is that the fragment antibody (Fab) part of the antibody (incomplete antibody) may be used to prevent an immune stimulus related to the complete antibody. Therefore, we designed a pilot study to evaluate the effectiveness of these incomplete antibodies using cross-match tests. MATERIALS AND METHODS Pepsin enzyme and staphylococcal protein A columns were used to cut anti-A and anti-B monoclonal antibodies and purify their Fab (2) fragments, respectively. An Rh-positive erythrocyte suspension with purified anti-A Fab (2) solution and B Rh-positive erythrocyte suspension with purified anti-B Fab (2) solution were combined correspondingly. Cross-match tests were performed by tube and gel centrifugation methods. The agglutination levels due to the anti-A and anti-B Fab (2) antibodies and their effects on the agglutination normally observed with complete antibodies were then measured. RESULTS No agglutination for the purified incomplete anti-A Fab (2) with A Rh+ erythrocyte and anti-B Fab (2) with B Rh+ erythrocyte combinations was observed in the tube cross-match tests. These agglutination levels were 1+ in two wells in the gel centrifugation cross-match tests. Fab (2)-treated erythrocytes were also resistant to the agglutination that normally occurs with complete antibodies. CONCLUSION We determined that the Fab (2) fragments of antibodies may not only be used to obtain a mild or negative reaction when compared to complete antibodies, but they might also be used for decreasing ABO incompatibility. Incomplete antibodies might be a therapeutic option in autoimmune hemolytic anemia and they may also be used in solid organ or hematopoietic stem cell transplantation. Therefore, we have planned an in vivo study to prove these in vitro findings.
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Affiliation(s)
- Mehmet Özen
- Ufuk University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Soner Yılmaz
- University of Health Sciences, Gülhane Training and Research Hospital, Blood Bank Unit, Ankara, Turkey
| | - Tülin Özkan
- Ankara University Faculty of Medicine, Department of Medical Biology, Ankara, Turkey
| | - Yeşim Özer
- Ankara University Faculty of Medicine, Unit of Blood Bank, Ankara, Turkey
| | - Aliye Aysel Pekel
- University of Health Sciences, Gülhane Training and Research Hospital, Clinic of Immunology and Allergy Diseases, Ankara, Turkey
| | - Asuman Sunguroğlu
- Ankara University Faculty of Medicine, Department of Medical Biology, Ankara, Turkey
| | - Günhan Gürman
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Önder Arslan
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
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Erdeve O, Okulu E, Olukman O, Ulubas D, Buyukkale G, Narter F, Tunc G, Atasay B, Gultekin ND, Arsan S, Koc E. The Turkish Neonatal Jaundice Online Registry: A national root cause analysis. PLoS One 2018; 13:e0193108. [PMID: 29474382 PMCID: PMC5825038 DOI: 10.1371/journal.pone.0193108] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/05/2018] [Indexed: 11/30/2022] Open
Abstract
Background Neonatal jaundice (NNJ) is common, but few root cause analyses based on national quality registries have been performed. An online registry was established to estimate the incidence of NNJ in Turkey and to facilitate a root cause analysis of NNJ and its complications. Methods A multicenter prospective study was conducted on otherwise healthy newborns born at ≥35 weeks of gestation and hospitalized for only NNJ in 50 collaborator neonatal intensive care units across Turkey over a 1-year period. Patients were analyzed for their demographic and clinical characteristics, treatment options, and complications. Results Of the 5,620 patients enrolled, 361 (6.4%) had a bilirubin level ≥25 mg/dL on admission and 13 (0.23%) developed acute bilirubin encephalopathy. The leading cause of hospital admission was hemolytic jaundice, followed by dehydration related to a lack of proper feeding. Although all infants received phototherapy, 302 infants (5.4%) received intravenous immunoglobulin in addition to phototherapy and 132 (2.3%) required exchange transfusion. The infants who received exchange transfusion were more likely to experience hemolytic causes (60.6% vs. 28.1%) and a longer duration of phototherapy (58.5 ± 31.7 vs. 29.4 ± 18.8 h) compared to infants who were not transfused (p < 0.001). The incidence of short-term complications among discharged patients during follow-up was 8.5%; rehospitalization was the most frequent (58%), followed by jaundice for more than 2 weeks (39%), neurological abnormality (0.35%), and hearing loss (0.2%). Conclusions Severe NNJ and bilirubin encephalopathy are still problems in Turkey. Means of identifying at-risk newborns before discharge during routine postnatal care, such as bilirubin monitoring, blood group analysis, and lactation consultations, would reduce the frequency of short- and long-term complications of severe NNJ.
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Affiliation(s)
- Omer Erdeve
- Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine, Ankara, Turkey
| | - Emel Okulu
- Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine, Ankara, Turkey
- * E-mail:
| | - Ozgur Olukman
- Department of Pediatrics, Division of Neonatology, Behcet Uz Children’s Hospital, Izmir, Turkey
| | - Dilek Ulubas
- Department of Neonatology, Etlik Zubeyde Hanım Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Gokhan Buyukkale
- Department of Pediatrics, Division of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Fatma Narter
- Department of Neonatology, Kartal Lutfi Kirdar Education and Training Hospital, Istanbul, Turkey
| | - Gaffari Tunc
- Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine, Ankara, Turkey
| | - Begum Atasay
- Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine, Ankara, Turkey
| | - Nazli Dilay Gultekin
- Department of Pediatrics, Division of Neonatology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Saadet Arsan
- Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine, Ankara, Turkey
| | - Esin Koc
- Department of Pediatrics, Division of Neonatology, Gazi University School of Medicine, Ankara, Turkey
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Kahar M. Frequency of Red Cell Alloantibodies in Pregnant Females of Navsari District: An Experience that Favours Inclusion of Screening for Irregular Erythrocyte Antibody in Routine Antenatal Testing Profile. J Obstet Gynaecol India 2017; 68:300-305. [PMID: 30065546 DOI: 10.1007/s13224-017-0984-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 03/17/2017] [Indexed: 11/25/2022] Open
Abstract
Background Alloimmunisation due to irregular erythrocyte antibodies is a recognised cause of hemolytic disease of the fetus and newborn (HDFN). Prior knowledge of red cell alloimmunisation in pregnant females guides the obstetrician to monitor the foetus for HDFN and if required for appropriated intervention. As limited data are available on prevalence of red cell alloimmunisation in pregnant females in India, the current study was carried out to know the prevalence of red cell alloimmunisation in pregnant females coming at our laboratory. Methods Screening for irregular erythrocyte antibodies was performed in 1960 pregnant females after obtaining informed consent between June 2015 and June 2016. MatrixTM screening and identification reagent red cells from Tulip Diagnostics (P) Ltd were used, and column agglutination technique was employed as a method for the test. Results Twenty antibodies (all of single specificity) were detected in 1960 samples giving a prevalence rate of alloimmunisation of 1.02%. Out of the 20 antibodies, 18 were identified to be anti-D, 1 was anti-c and 1 antibody was anti-H. The results obtained were then compared with those reported in the literature. Conclusion Red cell alloimmunisation is not uncommonly observed in pregnant females; the information gained can help the obstetrician to identify high-risk cases to timely start antenatal and post-natal treatment. Obstetricians should request screening for irregular red cell antibody desirably in all pregnant females; however, if limiting factors are there, it should be done at least in select group of pregnant females having bad obstetric history.
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Affiliation(s)
- Manoj Kahar
- Bhanumati Clinical Laboratory, G-19, Devdarshan Apartment, Beside Marolia Hospital, Station Road, Navsari, Gujarat 396445 India
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Li YF, Ma YL, Nie L, Chen S, Jin MF, Wang SL. [Establishment and validation of a neonatal pig model of hemolytic jaundice]. Zhongguo Dang Dai Er Ke Za Zhi 2016; 18:431-434. [PMID: 27165593 PMCID: PMC7390372 DOI: 10.7499/j.issn.1008-8830.2016.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/28/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To establish a neonatal pig model of hemolytic jaundice. METHODS Twelve seven-day-old purebred Yorkshire pigs were randomly divided into an experimental group and a control group (n=6 each). Immunization of New Zealand white rabbits was used to prepare rabbit anti-porcine red blood cell antibodies, and rabbit anti-porcine red blood cell serum was separated. The neonatal pigs in the experimental group were given an intravenous injection of rabbit anti-porcine red blood cell serum (5 mL), and those in the control group were given an intravenous injection of normal saline (5 mL). Venous blood samples were collected every 6 hours for routine blood test and liver function evaluation. RESULTS The experimental group had a significantly higher serum bilirubin level than the control group at 18 hours after the injection of rabbit anti-porcine red blood cell serum (64±30 μmol/L vs 20±4 μmol/L; P<0.05). In the experimental group, the serum bilirubin level reached the peak at 48 hours (275±31 μmol/L), and decreased significantly at 96 hours after the injection (95±17 μmol/L), but all significantly higher than that in the control group (P<0.05). At 18 hours after the injection, the experimental group had a significantly lower red blood cell (RBC) count than the control group [(4.58±0.32)×10(12)/L vs (5.09±0.44)×10(12)/L; P<0.05]; at 24 hours, the experimental group showed further reductions in RBC count and hemoglobin level and had significantly lower RBC count and hemoglobin level than the control group [RBC: (4.21±0.24)×10(12)/L vs (5.11±0.39)×10(12)/L, P<0.05; hemoglobin: 87±3 g vs 97±6 g, P<0.05]. The differences in RBC count and hemoglobin level between the two groups were largest at 36-48 hours. CONCLUSIONS The neonatal pig model of hemolytic jaundice simulates the pathological process of human hemolytic jaundice well and provides good biological and material bases for further investigation of neonatal hemolysis.
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Affiliation(s)
- Yong-Fu Li
- Department of Neonatology, Suzhou Municipal Hospital, Suzhou, Jiangsu 215002, China.
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Zonneveld R, Schmitz P, Eppink J, Mac Donald MS, Nahar-van Venrooij LM, Kanhai HH, Zijlmans WC. RhD negativity among pregnant women in multiethnic Suriname. Transfusion 2015; 56:321-4. [DOI: 10.1111/trf.13395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 08/31/2015] [Accepted: 09/02/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Rens Zonneveld
- Scientific Research Center Suriname; Academic Hospital Paramaribo; Paramaribo Suriname
- Department of Pediatrics; Academic Hospital Paramaribo; Paramaribo Suriname
| | - Peter Schmitz
- Faculty of Medicine; Radboud University; Nijmegen the Netherlands
| | - Jedda Eppink
- Faculty of Medicine; Radboud University; Nijmegen the Netherlands
| | - M. Sigrid Mac Donald
- Scientific Research Center Suriname; Academic Hospital Paramaribo; Paramaribo Suriname
| | - Lenny M.W. Nahar-van Venrooij
- Scientific Research Center Suriname; Academic Hospital Paramaribo; Paramaribo Suriname
- Department of Public Health; Faculty of Medical Sciences; Paramaribo Suriname
| | - Humphrey H.H. Kanhai
- Anton De Kom University of Suriname; Paramaribo Suriname
- Department of Obstetrics; Leiden University Medical Center; Leiden the Netherlands
| | - Wilco C.W.R. Zijlmans
- Scientific Research Center Suriname; Academic Hospital Paramaribo; Paramaribo Suriname
- Anton De Kom University of Suriname; Paramaribo Suriname
- Department of Pediatrics; Diakonessen Hospital; Paramaribo Suriname
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Abstract
Clinical experience with Rhesus (Rh) disease and its post-icteric sequelae is limited among high-income countries because of nearly over four decades of effective prevention care. We hypothesized that Rh disease is prevalent in other regions of the world because it is likely that protection is limited or non-existent. Following a worldwide study, it has been concluded that Rh hemolytic disease is a significant public health problem resulting in stillbirths and neonatal deaths, and is a major cause of severe hyperbilirubinemia with its sequelae, kernicterus and bilirubin-induced neurologic dysfunction. Knowing that effective Rh-disease prophylaxis depends on maternal blood-type screening, healthcare afforded to the high-risk mothers needs to be free of bottlenecks and coupled with unfettered access to effective Rh-immunoglobulin. Future studies that match the universal identification of Rh-negative status of women and targeted use of immunoprophylaxis to prevent childhood bilirubin neurotoxicity are within reach, based on vast prior experiences.
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Affiliation(s)
- Alvin Zipursky
- Centre for Global Child Health, University of Toronto, Hospital for Sick Children, Toronto, ON, Canada
| | - Vinod K Bhutani
- Department of Pediatrics, Division of Neonatal‒Perinatal Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Karim F, Moiz B, Kamran N. Risk of maternal alloimmunization in Southern Pakistan – A study in a cohort of 1000 pregnant women. Transfus Apher Sci 2015; 52:99-102. [DOI: 10.1016/j.transci.2014.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/08/2014] [Indexed: 11/24/2022]
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