engleski

Severe hemolytic disease of fetus and newborn caused by red blood cell antibodies undetected at first-trimester screening (CME)

The objective was to determine clinical consequences of anti-D and non-RhD antibodies undetected at first trimester screening for infant/ fetus. This retrospective cohort study included all pregnancies with red blood cell (RBC) antibodies who were tested between 1993 and 2008. Data were obtained from the forms for tracking immunization at the Transfusion Department. Each form was analyzed for three data sets: the order of screening at which the antibodies were detected (initial or repeated screening), the order of pregnancy (first pregnancy or higher), and hemolytic activity of antibodies. In RhD negative women, anti-D antibody was detected in 1.3% of cases. The anti-D antibody was undetected in 72 (37%) cases on the first-trimester screening, of which eight cases were complicated by severe hemolytic disease of fetus and newborn (HDFN). In this group, three patients were primigravidae. An overall non-RhD antibody incidence of 0.2% was observed. In 16 cases, non-RhD antibodies were undetected on the first-trimester screening (10 anti-c, 2 anti-E, 2 anti-C, 1 anti-S, and 1 case of anti-Rh17). Non-RhD antibodies undetected on initial screening caused 11 cases of severe HDFN (27% of all severe non-RhD HDFN). Ten of them were in multiparous women. Seven of 11 cases with severe HDFN that were missed were caused by anti-c antibodies. The third-trimester screening may detect RBC antibodies that were not present or detected on the first-trimester screening. Such screening may be especially relevant in RhD-positive multiparous women due to the risk of HDFN.

Rh isoimmunization; blood group incompatibility; fetal erythroblastosis; fetal hydrops

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