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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Dholakiya SK, Bharadva S, Vachhani JH, Upadhyay BS. Red cell alloimmunization among antenatal women attending tertiary care center in Jamnagar, Gujarat, India. Asian J Transfus Sci 2021; 15:52-56. [PMID: 34349457 PMCID: PMC8294445 DOI: 10.4103/ajts.ajts_72_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 12/07/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The following study was conducted to measure the presence of alloantibodies of Rh and other blood group antigens produced due to fetomaternal hemorrhage in all antenatal women as well as those leading to hemolytic disease of fetus and newborn; presenting to a tertiary care center, G.G. Government Hospital, Jamnagar, Gujarat, India, between April 2014 and March 2016 (2 years). MATERIALS AND METHODS All multiparous women irrespective of their period of gestation or obstetrics history were included whereas those having taken anti-D immunoprophylaxis or with a history of blood transfusion were excluded. Antibody screening and identification were done using Bio-Rad ID microtyping system. RESULTS Out of total 8920 multigravida females, 8488 were D-antigen positive whereas 432 were D-antigen negative. A total of 126 antibodies among 117 females (1.31%) were found; out of them, 33 were found in D-antigen positive females (0.39%) and 84 in D-antigen negative ones (19.44%) looking at overall frequency of other antibodies such as anti-C: 9, anti-c: 9, anti-E: 13, anti-Cw: 1, anti-M: 5, anti-S: 8, anti-Fya: 3, and anti-D: 78; it was found that anti-D is the most common. CONCLUSION The rate of alloimmunization in D-antigen negative women was found to be very high as compared to other studies in western region; hence, strict follow-up of immunoprophylaxis of all Rh D-negative women needs to be taken care of. Apart from this, D-antigen-positive women also show alloimmunization against various antigens giving the prevalence of 0.39%; hence, it should be mandatory that there should be one standard universal protocol for screening of all antenatal women.
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Affiliation(s)
| | - Sumit Bharadva
- Department of IHBT, Shri M. P. Shah Government Medical College, Jamnagar, Gujarat, India
| | - Jitendra H. Vachhani
- Department of IHBT, Shri M. P. Shah Government Medical College, Jamnagar, Gujarat, India
| | - B. Shweta Upadhyay
- Department of IHBT, Shri M. P. Shah Government Medical College, Jamnagar, Gujarat, India
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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: 31] [Impact Index Per Article: 5.2] [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: 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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Andersson L, Szabo F. The incidence and outcome of clinically significant antibodies detected in Rhesus-D positive pregnant women of the Northern Territory. Aust N Z J Obstet Gynaecol 2017; 58:514-517. [PMID: 29192961 DOI: 10.1111/ajo.12750] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Haemolytic disease of the fetus/newborn secondary to clinically significant non-Rhesus-D antibodies has risen in importance since the advent of immunoprophylactic anti-D administration to Rhesus-D negative women. Of interest is the incidence of these antibodies in Rhesus-D positive women, who receive less frequent antenatal alloantibody screening. This is of particular concern if the antibodies arise late in pregnancy and may go undetected. AIMS To assess the proportion of Rhesus-D positive pregnant women with late developing clinically significant antibodies for haemolytic disease of the fetus/newborn, and whether these resulted in adverse fetal outcomes. MATERIALS AND METHODS A retrospective analysis over a 12-month period at a tertiary hospital in the Northern Territory. Group and antibody screen results in addition to clinical data regarding pregnancy/newborn were collected. RESULTS Sixty-four of 2612 women (2.5%) had red blood cell antibodies detected during their pregnancy. Of these, 21 clinically significant antibodies were detected in 19 women (0.7% of initial cohort). The most common antibody detected was anti-c (28.5%). In six of these women (0.23% of initial cohort), the antibodies were late developing. Mild jaundice was noted in three newborns with phototherapy required in one. CONCLUSIONS Although clinically significant antibodies were detected during pregnancy, and in a small proportion of cases as a late developing antibody undetected in the first trimester screening, clinical outcomes for the newborn were mild. As such, the cost of retesting all Rhesus-D positive pregnant women in the third trimester would be considerable and unlikely to result in any meaningful clinical benefit.
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Affiliation(s)
- Lauren Andersson
- Department of Haematology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Ferenc Szabo
- Department of Haematology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Slootweg YM, Koelewijn JM, van Kamp IL, van der Bom JG, Oepkes D, de Haas M. Third trimester screening for alloimmunisation in Rhc-negative pregnant women: evaluation of the Dutch national screening programme. BJOG 2015; 123:955-63. [DOI: 10.1111/1471-0528.13816] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2015] [Indexed: 11/28/2022]
Affiliation(s)
- YM Slootweg
- Department of Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
| | - JM Koelewijn
- Department of Obstetrics and Gynaecology; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
- Department of Experimental Immunohaematology; Sanquin Research; Amsterdam the Netherlands
- Department of General Practice; University Medical Centre; Groningen the Netherlands
| | - IL van Kamp
- Department of Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
| | - JG van der Bom
- Centre for Clinical Transfusion Research, Sanquin Research; Department of Clinical Epidemiology; Leiden University Medical Centre; Leiden the Netherlands
| | - D Oepkes
- Department of Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
| | - M de Haas
- Department of Experimental Immunohaematology; Sanquin Research; Amsterdam the Netherlands
- Leiden University Medical Centre; Department of Translational Immunohematology; Leiden the Netherlands
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Foudoulaki-Paparizos L, Valsami S, Bournas N, Tsantes A, Grapsas P, Mantzios G, Travlou A, Politou M. Alloimmunisation during pregnancy in Greece: need for nationwide HDFN prevention programme. Transfus Med 2013; 23:254-9. [DOI: 10.1111/tme.12063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 02/22/2013] [Accepted: 06/17/2013] [Indexed: 12/01/2022]
Affiliation(s)
| | | | | | | | - P. Grapsas
- Obstetrics and Gynaecology Department; General Hospital of Nikea; Athens; Greece
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Altuntas N, Yenicesu I, Himmetoglu O, Kulali F, Kazanci E, Unal S, Aktas S, Hirfanoglu I, Onal E, Turkyilmaz C, Ergenekon E, Koc E, Atalay Y. The risk assessment study for hemolytic disease of the fetus and newborn in a University Hospital in Turkey. Transfus Apher Sci 2013; 48:377-80. [PMID: 23619329 DOI: 10.1016/j.transci.2013.04.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Maternal red-cell alloimmunization occurs when a woman's immune system is sensitized to foreign red-blood cell surface antigens, leading to the production of alloantibodies. The resulting antibodies often cross the placenta during pregnancies in sensitized women and, if the fetus is positive for red-blood-cell surface antigens, this will lead to hemolysis of fetal red-blood cells and anemia. The most severe cases of hemolytic disease in the fetus and newborn baby are caused by anti-D, anti-c, anti-E and anti-K antibodies. There are limited data available on immunization rates in pregnant women from Turkey. The aim of the present study was to provide data on the frequency and nature of maternal RBC alloimmunization in pregnant women in a tertiary care hospital. In this study, we retrospectively evaluated the indirect antiglobulin test results of Rh-negative pregnant women performed in our Blood Bank between 2006 and 2012. Indirect antiglobulin test positive women also underwent confirmatory antibody screening and identification. During the study period, 4840 women admitted to our antenatal clinics. With regards to the major blood group systems (ABO and Rh), the most common phenotype was O positive (38.67%). There were 4097 D-antigen-positive women (84.65%) and 743 women with D-antigen-negative phenotype (15.35%). The prevalence of alloimmunization was found to be 8.74% in D-antigen negative group. Despite prophylactic use of Rh immunglobulins, anti-D is still a common antibody identified as the major cause of alloimmunization in our study (anti-D antibody 68.57%, non-D antibody 31.42%). While alloimmunization rate to D antigen was 6.46%, non-D alloimmunization rate was 2.69% among Rh-negative pregnant women. Moreover, detailed identification facilities for antibodies other than anti-D are not available in most of centers across Turkey. However, large-scale studies on pregnant women need to be done in order to collect sufficient evidence to formulate guidelines and to define indications for alloantibody screening and identification.
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Affiliation(s)
- Nilgün Altuntas
- Department of Neonatology, Gazi University, Faculty of Medicine, Ankara, Turkey
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Pahuja S, Gupta SK, Pujani M, Jain M. The prevalence of irregular erythrocyte antibodies among antenatal women in Delhi. Blood Transfus 2011; 9:388-93. [PMID: 21839025 PMCID: PMC3200407 DOI: 10.2450/2011.0050-10] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Accepted: 11/18/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Universal screening of all antenatal women, including D antigen-positive pregnant ones, is mandatory in most developed countries. However, no guidelines on this issue are available for developing countries such as India. Furthermore, there is limited information on immunisation rates in pregnant women (D antigen-positive and D antigen-negative) from India. We, therefore, studied the prevalence of alloantibodies among multigravida women in India. MATERIALS AND METHODS In this prospective study, carried out to detect the prevalence of alloantibodies among multigravida women in India, 3,577 multigravida women attending antenatal clinics were typed for ABO and D antigens and screened for alloantibodies by column agglutination technology. The medical history and detailed obstetric history of these women were reviewed and information recorded on any prior haemolytic disease of the foetus and newborn among siblings and/or blood transfusions. RESULTS The overall prevalence of alloantibodies in this study was 1.25%. There was a statistically significant difference between alloimmunisation rates in the D antigen-negative and D antigen-positive groups (10.7% versus 0.12%, respectively). Anti-D antibody contributed to 78.4% of total alloimmunisations in our study. DISCUSSION Anti-D was the most common culprit responsible for alloimmunisation. Other alloantibodies found included anti-C, anti-M, anti-S and anti-c. Large-scale population-based studies are required to assess the real magnitude of alloimmunisation in pregnant women in India.
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Affiliation(s)
- Sangeeta Pahuja
- Regional Blood Transfusion Centre and Department of Pathology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
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Dajak S, Stefanović V, Čapkun V. Severe hemolytic disease of fetus and newborn caused by red blood cell antibodies undetected at first-trimester screening (CME). Transfusion 2011; 51:1380-8. [DOI: 10.1111/j.1537-2995.2010.03006.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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