Guidelines for the obstetric management of an alloimmune mother and her newborn
Keywords:
ISOIMMUNIZATION, HEMOLYTIC DISEASE OF THE NEWBORN, HEMOLYTIC DISEASE OF THE FETUS, LASER-DOPPLER FLOWMETRY, NEONATAL ANEMIA, PREGNANCY, ALLOIMMUNIZATION, ANTI D IMMUNOPROPHYLAXIS
Abstract
Alloimmunization is the biological response to exposure to non-HLA antigens. Pregnancy, transfusion of blood components, solid organ and hematopoietic cell transplantation, as well as intravenous drug use expose patients to the development of anti-erythrocyte antibodies. When the latter are found, they must match diagnostic criteria to identify the potential association to hemolytic disease of the fetus and newborn (HDFN) and its timely referral to the high-risk obstetric risk polyclinic for due follow-up.
It is of the essence for erythrocyte alloimmunization diagnostic tests to be carried out by the immunohematology laboratories of the Hemotherapy and Transfusional Medicine services. To that end, we have prepared these guidelines with the purpose of providing a multidisciplinary protocol for the handling of maternal alloimmunization and alloimmunization of the newborn.
References
1) White J, Qureshi H, Massey E, Needs M, Byrne G, Daniels G, et al. Guideline for blood grouping and red cell antibody testing in pregnancy. Transfus Med 2016; 26(4):246-63. doi: 10.1111/tme.12299.
2) Laplane C, Carbonne B, d’Ercole C. Aloinmunización eritrocítica fetomaterna. EMC-Ginecología-Obstetricia 2018; 54(4):1-9. doi: 10.1016/S1283-081X(18)41443-9.
3) Cortey A, Brossard Y. Aspects pratiques. J Gynecol Obstet Biol Reprod 2006; 35(Suppl 1):123-30.
4) Uruguay. Ministerio de Salud Pública. Ordenanza N° 99/011. Prevención de enfermedad hemolítica perinatal. 15 febrero 2011. Disponible en: https://www.gub.uy/ministerio-salud-publica/institucional/normativa/ordenanza-n-99011-prevencion-enfermedad-hemolitica-perinatal [Consulta: 11 diciembre 2020].
5) Sandler SG, Sathiyamoorthy S. Laboratory methods for Rh immunoprophylaxis: a review. Immunohematology 2010; 26(3):92-103.
6) Practice Bulletin No. 181: prevention of Rh D alloimmunization. Obstet Gynecol 2017; 130(2):e57-e70. doi: 10.1097/ AOG.0000000000002232.
7) Borrell A. Guías Clínicas Medicina Materno-Fetal: Isoinmunización. Barcelona: Fundación Medicina Fetal Barcelona, 2014. Disponible en: medicinafetalbarcelona/org/protocolos/es/patología-fetal/isoinminizacio-y-transfusion-intrauterina.html [Consulta: 4 enero 2021].
8) Mari G. Middle cerebral artery peak systolic velocity for the diagnosis of fetal anemia: the untold story. Ultrasound Obstet Gynecol 2005; 25(4):323-30. doi: 10.1002/uog.1882.
9) Mari G, Deter RL, Carpenter RL, Rahman F, Zimmerman R, Moise KJ Jr, et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N Engl J Med 2000; 342(1):9-14.
10) Martinez-Portilla RJ, Lopez-Felix J, Hawkins-Villareal A, Villafan-Bernal JR, Paz Y Miño F, Figueras F, et al. Performance of fetal middle cerebral artery peak systolic velocity for prediction of anemia in untransfused and transfused fetuses: systematic review and meta-analysis. Ultrasound Obset Gynecol 2019; (54):722-31. doi: 10.1002/uog.20273.
11) Detti L, Mari G, Akiyama M, Cosmi E, Moise KJ Jr, Stefor T, et al. Longitudinal assessment of the middle cerebral artery peak systolic velocity in healthy fetuses and in fetuses at risk for anemia. Am J Obstet Gynecol 2002; 187(4):937-9. doi: 10.1067/mob.2002.127310.
12) Webb J, Delaney M. Red blood cell alloimmunization in the pregnant patient. Transfus Med Rev 2018; 32(4):213-9. doi: 10.1016/j.tmrv.2018.07.002.
13) Reid ME, Lomas-Francis C, Olsson ML. The Blood Group Antigen FactsBook. 3rd ed. New York: Elsevier, 2012.
14) Sbarsi I, Isernia P, Montanari L, Badulli C, Martinetti M, Salvaneschi L. Implementing non-invasive RHD genotyping on cell-free foetal DNA from maternal plasma: the Pavia experience. Blood Transfus 2012; 10(1):34-8. doi: 10.2450/2011.0021-11.
15) Clausen FB, Barrett AN; Noninvasive Fetal RHD Genotyping EQA2017 Working Group. Noninvasive fetal RHD genotyping to guide targeted anti-D prophylaxis–an external quality assessment workshop. Vox Sang 2019; 114(4):386-93. doi: 10.1111/vox.12768.
16) Leger RM. La prueba de antiglobulina directa positiva y hemólisis de causa inmunólogica. In: American Association of Blood Banks. Manual Técnico. 17ª ed. Buenos Aires: Asociación Argentina de Hemoterapia e Inmunohematología, 2012:579-97.
17) Ree IMC, Smits-Wintjens VEHJ, van der Bom JG, van Klink JMM, Oepkes D, Lopriore E. Neonatal management and outcome in alloimmune hemolytic disease. Expert Rev Hematol 2017; 10(7):607-16. doi: 10.1080/1747408 6.2017.1331124.
18) Rabe H, Reynolds G, Diaz-Rossello J. A systematic review and meta-analysis of a brief delay in clamping the umbilical cord of preterm infants. Neonatology 2008; 93(2):138-44. doi: 10.1159/000108764.
19) Garabedian C, Rakza T, Drumez E, Poleszczuk M, Ghesquiere L, Wibaut B, et al. Benefits of delayed cord clamping in red blood cell alloimmunization. Pediatrics 2016; 137(3):e20153236. doi: 10.1542/peds.2015-3236.
20) Calkins K, Roy D, Molchan L, Bradley L, Grogan T, Elashoff D, et al. Predictive value of cord blood bilirubin for hyperbilirubinemia in neonates at risk for maternal-fetal blood group incompatibility and hemolytic disease of the newborn. J Neonatal Perinatal Med 2015; 8(3):243-50. doi: 10.3233/NPM-15814111.
2) Laplane C, Carbonne B, d’Ercole C. Aloinmunización eritrocítica fetomaterna. EMC-Ginecología-Obstetricia 2018; 54(4):1-9. doi: 10.1016/S1283-081X(18)41443-9.
3) Cortey A, Brossard Y. Aspects pratiques. J Gynecol Obstet Biol Reprod 2006; 35(Suppl 1):123-30.
4) Uruguay. Ministerio de Salud Pública. Ordenanza N° 99/011. Prevención de enfermedad hemolítica perinatal. 15 febrero 2011. Disponible en: https://www.gub.uy/ministerio-salud-publica/institucional/normativa/ordenanza-n-99011-prevencion-enfermedad-hemolitica-perinatal [Consulta: 11 diciembre 2020].
5) Sandler SG, Sathiyamoorthy S. Laboratory methods for Rh immunoprophylaxis: a review. Immunohematology 2010; 26(3):92-103.
6) Practice Bulletin No. 181: prevention of Rh D alloimmunization. Obstet Gynecol 2017; 130(2):e57-e70. doi: 10.1097/ AOG.0000000000002232.
7) Borrell A. Guías Clínicas Medicina Materno-Fetal: Isoinmunización. Barcelona: Fundación Medicina Fetal Barcelona, 2014. Disponible en: medicinafetalbarcelona/org/protocolos/es/patología-fetal/isoinminizacio-y-transfusion-intrauterina.html [Consulta: 4 enero 2021].
8) Mari G. Middle cerebral artery peak systolic velocity for the diagnosis of fetal anemia: the untold story. Ultrasound Obstet Gynecol 2005; 25(4):323-30. doi: 10.1002/uog.1882.
9) Mari G, Deter RL, Carpenter RL, Rahman F, Zimmerman R, Moise KJ Jr, et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N Engl J Med 2000; 342(1):9-14.
10) Martinez-Portilla RJ, Lopez-Felix J, Hawkins-Villareal A, Villafan-Bernal JR, Paz Y Miño F, Figueras F, et al. Performance of fetal middle cerebral artery peak systolic velocity for prediction of anemia in untransfused and transfused fetuses: systematic review and meta-analysis. Ultrasound Obset Gynecol 2019; (54):722-31. doi: 10.1002/uog.20273.
11) Detti L, Mari G, Akiyama M, Cosmi E, Moise KJ Jr, Stefor T, et al. Longitudinal assessment of the middle cerebral artery peak systolic velocity in healthy fetuses and in fetuses at risk for anemia. Am J Obstet Gynecol 2002; 187(4):937-9. doi: 10.1067/mob.2002.127310.
12) Webb J, Delaney M. Red blood cell alloimmunization in the pregnant patient. Transfus Med Rev 2018; 32(4):213-9. doi: 10.1016/j.tmrv.2018.07.002.
13) Reid ME, Lomas-Francis C, Olsson ML. The Blood Group Antigen FactsBook. 3rd ed. New York: Elsevier, 2012.
14) Sbarsi I, Isernia P, Montanari L, Badulli C, Martinetti M, Salvaneschi L. Implementing non-invasive RHD genotyping on cell-free foetal DNA from maternal plasma: the Pavia experience. Blood Transfus 2012; 10(1):34-8. doi: 10.2450/2011.0021-11.
15) Clausen FB, Barrett AN; Noninvasive Fetal RHD Genotyping EQA2017 Working Group. Noninvasive fetal RHD genotyping to guide targeted anti-D prophylaxis–an external quality assessment workshop. Vox Sang 2019; 114(4):386-93. doi: 10.1111/vox.12768.
16) Leger RM. La prueba de antiglobulina directa positiva y hemólisis de causa inmunólogica. In: American Association of Blood Banks. Manual Técnico. 17ª ed. Buenos Aires: Asociación Argentina de Hemoterapia e Inmunohematología, 2012:579-97.
17) Ree IMC, Smits-Wintjens VEHJ, van der Bom JG, van Klink JMM, Oepkes D, Lopriore E. Neonatal management and outcome in alloimmune hemolytic disease. Expert Rev Hematol 2017; 10(7):607-16. doi: 10.1080/1747408 6.2017.1331124.
18) Rabe H, Reynolds G, Diaz-Rossello J. A systematic review and meta-analysis of a brief delay in clamping the umbilical cord of preterm infants. Neonatology 2008; 93(2):138-44. doi: 10.1159/000108764.
19) Garabedian C, Rakza T, Drumez E, Poleszczuk M, Ghesquiere L, Wibaut B, et al. Benefits of delayed cord clamping in red blood cell alloimmunization. Pediatrics 2016; 137(3):e20153236. doi: 10.1542/peds.2015-3236.
20) Calkins K, Roy D, Molchan L, Bradley L, Grogan T, Elashoff D, et al. Predictive value of cord blood bilirubin for hyperbilirubinemia in neonates at risk for maternal-fetal blood group incompatibility and hemolytic disease of the newborn. J Neonatal Perinatal Med 2015; 8(3):243-50. doi: 10.3233/NPM-15814111.
Published
2021-09-17
How to Cite
1.
Rivas G, Marcalain V, Recouso J, Silveira V, Bentos J, Alonso V, Correa V, Sauleda M, Garat F, Gómez LM, De Agostini M, Cordano C, Rey G, Rodríguez I, Blasina F. Guidelines for the obstetric management of an alloimmune mother and her newborn. Rev. Méd. Urug. [Internet]. 2021Sep.17 [cited 2024Dec.18];37(3):e37316. Available from: https://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/753
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Guides
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