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Tytuł pozycji:

Impact of red blood cell alloimmunization on fetal and neonatal outcomes: A single center cohort study.

Tytuł:
Impact of red blood cell alloimmunization on fetal and neonatal outcomes: A single center cohort study.
Autorzy:
Lieberman L; Department of Clinical Pathology, University Health Network, Toronto, Ontario, Canada.; Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada.; Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.; Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.
Callum J; Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada.; Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.; Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.
Cohen R; Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Cserti-Gazdewich C; Department of Clinical Pathology, University Health Network, Toronto, Ontario, Canada.; Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada.; Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.
Ladhani NNN; Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada.; Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Buckstein J; Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Pendergrast J; Department of Clinical Pathology, University Health Network, Toronto, Ontario, Canada.; Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada.; Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.
Lin Y; Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada.; Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.; Education and Safety in Transfusion (QUEST) Research Program, University of Toronto Quality in Utilization, Toronto, Ontario, Canada.
Źródło:
Transfusion [Transfusion] 2020 Nov; Vol. 60 (11), pp. 2537-2546. Date of Electronic Publication: 2020 Sep 07.
Typ publikacji:
Journal Article; Research Support, Non-U.S. Gov't
Język:
English
Imprint Name(s):
Original Publication: Arlington, Va. : American Association Of Blood Banks
MeSH Terms:
Blood Transfusion, Intrauterine*
Erythroblastosis, Fetal*/blood
Erythroblastosis, Fetal*/immunology
Erythroblastosis, Fetal*/prevention & control
Erythrocyte Transfusion*
Exchange Transfusion, Whole Blood*
Isoantibodies*/blood
Isoantibodies*/immunology
Rh-Hr Blood-Group System*/blood
Rh-Hr Blood-Group System*/immunology
Transfusion Reaction*
Adult ; Female ; Humans ; Infant, Newborn ; Male ; Pregnancy ; Retrospective Studies
References:
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White J, Qureshi H, Massey E, et al. Guideline for blood grouping and red cell antibody testing in pregnancy. Transfus Med. 2016;26:246-263.
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Belfrage P, Thomassen P, Floberg J, Akerblom O, Broberger U. Allo-immunization during pregnancy. Clinical results from 1983 to 1989 in a Scandinavian university hospital. Acta Obstet Gynecol Scand. 1992;71:273-277.
Filbey D, Hanson U, Wesstrom G. The prevalence of red cell antibodies in pregnancy correlated to the outcome of the newborn: a 12 year study in Central Sweden. Acta Obstet Gynecol Scand. 1995;74:687-692.
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Canadian Society for Transfusion Medicine. Canadian Survey of perinatal Transfusion Practice. (2018). https://www.transfusion.ca/Members/Committees/Canadian-Obstetric-and-Pediatric-Transfusion-Netwo/Research. Accessed August 31, 2020.
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Grant Information:
Laboratory Medicine and Pathology Summer Student Research Grant, University of Toronto; Canadian Blood Services, Transfusion Medicine Research Program Support Award
Substance Nomenclature:
0 (Isoantibodies)
0 (Rh-Hr Blood-Group System)
Entry Date(s):
Date Created: 20200907 Date Completed: 20210628 Latest Revision: 20210628
Update Code:
20240105
DOI:
10.1111/trf.16061
PMID:
32893897
Czasopismo naukowe
Background: Alloimmunization can impact both the fetus and neonate.
Study Objectives: (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 and Methods: 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.
(© 2020 AABB.)

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