DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20214714

The changing trend of alloimmunization in antenatal females: experience from a tertiary care centre in north-western India

Anshika Yadav, C. S. Joshi, G. N. Gupta, Rounak Dubey

Abstract


Background: Haemolytic disease of the foetus and new-born (HDFN) is a major concern during the antenatal period, especially in countries with low human development index (HDI). The guidelines for antenatal screening and management significantly vary from one geographical region to another. Since the introduction of RhIG immunoprophylaxis, the incidence of HDFN caused by alloimmunization to D antigen has markedly reduced, while that caused by other minor blood group antigens has not been addressed significantly and needs to be given due consideration.

Methods: The study was carried out to evaluate the incidence of alloimmunization and analyse various factors associated with HDFN in north-western India. A total of 1700 antenatal cases were evaluated over a period of 20 months, antibody screening and identification was performed on their samples and results were analysed.

Results: Out of the 1700 cases, 21 were detected to have the presence of an alloantibody with a prevalence of 1.24%. Out of these, 11 were Rh (D) negative while the remaining 10 were Rh (D) positive. The rate for alloimmunization was higher in females who had a history of blood transfusion (1.24%), bad obstetric history (1.24%), and multigravida status (1.24%).

Conclusions: Screening all pregnant females for alloimmunization to RBC antigens, irrespective of their Rh status will help in minimizing the incidence of the HDFN. The practice of providing partial phenotype matched blood to the females of the childbearing age group should be encouraged to reduce the overall incidence of alloimmunization and HDFN.


Keywords


Alloimmunization, Antenatal screening, HDFN, Rh-negative pregnancy

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References


White J, Qureshi H, Massey E, Needs M, Byrne G, Daniels G, et al. British Committee for Standards in Haematology Guidelines for blood grouping and red cell antibody testing during pregnancy. Transfus Med. 1996;6:71-4.

Bowman JM. RhD haemolytic disease of the newborn. N Engl J Med. 1998;339:1775-7.

Semmekrot BA, De Man AJ, Boekkooi PF. Irregular blood group antibodies during pregnancy: screening is mandatory. Ned Tijdschr Geneeskd. 1999;143:1449-52.

Klein HG, Anstee DJ Mollison’s blood transfusion in clinical medicine: Haemolytic disease of the foetus and newborn. 11thn edn. Oxford: Blackwell Publication; 2005:496.

Grenache DG. Haemolytic disease of the newborn. In: Gronowski AM, edr. Current clinical pathology: handbook of clinical laboratory testing during pregnancy. Totowa (NJ): Humana Press; 2004:219-241.

Chavez GF, Mulinare J, Edmonds LD. Epidemiology of Rh haemolytic disease of the newborn in the United States. JAMA. 1991;265:3270-4.

Moise KJ. Foetal anaemia due to non-Rhesus-D red-cell alloimmunization. Semin Foet Neonat Med. 2008;13:207-14.

Nordvall M, Dziegiel M, Hegaard HK, et al M. Red blood cell antibodies in pregnancy and their clinical consequences: synergistic effects of multiple specificities. Transfusion. 2009;49:2070-5.

Suresh B, Sreedhar Babu KV, Arun R, Jothibai DS, Bharathi T. Prevalence of “unexpected antibodies” in the antenatal women attending the Government Maternity Hospital, Tirupati. J Clin Sci Res. 2015;4:22-30.

Dada RA, Beck D, Schmitz G. Automation and data processing in blood banking using the Ortho Autovue Innova system. Transfus Med Hemother. 2007;34:341-6.

Bharucha ZS, Jolly JG, Ghosh K. Compatibility testing. Standards for blood banks and blood transfusion services. National AIDS Control Organisation, Ministry of Health and Family Welfare, Government of India, New Delhi; 2007.p. 59-62.

Roback JD, Combs MR, Grossman BJ, Hillyer CD. Antibody detection, identification, and compatibility testing. Technical Manual 16th edn. American Association of Blood Banking; 2008:899-917.

Saran RK. Transfusion Medicine Technical Manual. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. 2nd edn. 2003.

Sidhu M, Bala R, Akhtar N, Sawhney V. Prevalence, specificity and titration of red cell alloantibodies in multiparous antenatal females at a tertiary care centre from north India. Indian J Hematol Blood Transfus. 2016;32(3):307-11.

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.

Periyavan S, Sangeetha S, Marimuthu P, Manjunath B, Seema D. Distribution of ABO and Rhesus-D blood groups in and around Bangalore. Asian J Transfus Sci. 2010;4(1):41.

Varghese J, Chacko MP, Rajaiah M, Daniel D. Red cell alloimmunization among antenatal women attending a tertiary care hospital in south India. Indian J Med Res. 2013;138:68-71.

Sankarlingam P, Jain A, Bagga R, Kumar P, Marwaha N. Red cell alloimmunization in RhD positive women and neonatal outcome. Transfus Apheres Sci. 2016;55:153-8.