Impact of red blood cell alloimmunization on fetal and neonatal outcomes: A single center cohort study.
Transfusion
; 60(11): 2537-2546, 2020 11.
Article
en En
| MEDLINE
| ID: mdl-32893897
ABSTRACT
BACKGROUND:
Alloimmunization can impact both the fetus and neonate. STUDYOBJECTIVES:
(a) calculate the incidence of clinically significant RBC isoimmunization during pregnancy, (b) review maternal management and neonatal outcomes, (c) assess the value of prenatal and postnatal serological testing in predicting neonatal outcomes. STUDY DESIGN ANDMETHODS:
A retrospective audit of consecutive alloimmunized pregnancies was conducted. Data collected included demographics, clinical outcomes, and laboratory results. Outcomes included incidence of alloimmunization; outcomes for neonates with and without the cognate antigen; and sensitivity and specificity of antibody titration testing in predicting hemolytic disease of the fetus and newborn (HDFN).RESULTS:
Over 6 years, 128 pregnant women (0.4%) were alloimmunized with 162 alloantibodies; anti-E was the most common alloantibody (51/162; 31%). Intrauterine transfusions (IUTs) were employed in 2 (3%) of 71 mothers of cognate antigen positive (CoAg+) neonates. Of 74 CoAg+ neonates, 58% required observation alone, 23% intensive phototherapy, 9% top up transfusion, and 3% exchange transfusion; no fetal or neonatal deaths occurred. HDFN was diagnosed in 28% (21/74) of neonates; anti-D was the most common cause. The sensitivity and specificity of the critical gel titer >32 in predicting HDFN were 76% and 75%, respectively (negative predictive value 95%; positive predictive value 36%). The sensitivity and specificity of a positive direct antiglobulin test (DAT) in predicting HDFN were 90% and 58%, respectively (NPV 97%; PPV 29%).CONCLUSION:
Morbidity and mortality related to HDFN was low; most alloimmunized pregnancies needed minimal intervention. Titers of >32 by gel warrant additional monitoring during pregnancy.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Sistema del Grupo Sanguíneo Rh-Hr
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Transfusión de Sangre Intrauterina
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Recambio Total de Sangre
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Transfusión de Eritrocitos
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Eritroblastosis Fetal
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Reacción a la Transfusión
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Isoanticuerpos
Tipo de estudio:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Idioma:
En
Revista:
Transfusion
Año:
2020
Tipo del documento:
Article
País de afiliación:
Canadá