131 results match your criteria Erythrocyte Alloimmunization and Pregnancy


Red Blood Cell Alloimmunization in the Pregnant Patient.

Transfus Med Rev 2018 10 19;32(4):213-219. Epub 2018 Jul 19.

Children's National Health System, Washington, D.C., USA; The George Washington University, Departments of Pediatrics & Pathology, Washington, DC, USA.

Alloimmunization to red blood cell (RBC) antigens represents a challenge for physicians caring for women of child bearing potential. Exposure to non-self RBC antigens may occur during transfusion or pregnancy leading to the development of antibodies. If a subsequent fetus bears that antigen, maternal antibodies may attack the fetal red blood cells causing red cell destruction and clinically significant hemolytic disease of the fetus and newborn (HDFN). Read More

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https://linkinghub.elsevier.com/retrieve/pii/S08877963183001
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http://dx.doi.org/10.1016/j.tmrv.2018.07.002DOI Listing
October 2018
26 Reads

Maternal red blood cell alloimmunization requiring intrauterine transfusion: a comparative study on management and outcome depending on the type of antibody.

Transfusion 2018 05 6;58(5):1199-1205. Epub 2018 Mar 6.

Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France.

Background: The antibody primarily responsible for fetal anemia may influence treatment and prognosis. The primary objective was to compare ante- and postnatal management and the outcomes of maternal red blood cell (RBC) alloimmunizations according to the antibody involved. The secondary objective was to compare anti-D alloimmunizations according to associated number of antibodies. Read More

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http://dx.doi.org/10.1111/trf.14542DOI Listing
May 2018
11 Reads

Management of red blood cell alloimmunization in pregnancy.

J Gynecol Obstet Hum Reprod 2018 May 21;47(5):197-204. Epub 2018 Feb 21.

CHU de Lille, department of obstetrics, 59000 Lille, France.

The main cause of fetal anemia is maternal red blood cell alloimmunization (AI). The search of maternal antibodies by indirect antiglobulin test allows screening for AI during pregnancy. In case of AI, fetal genotyping (for Rh-D, Rh-c, Rh-E and Kell), quantification (for anti-rhesus antibodies) and antibody titration, as well as ultrasound monitoring, are performed. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S24687847183006
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http://dx.doi.org/10.1016/j.jogoh.2018.02.001DOI Listing
May 2018
3 Reads

Evaluation of a Decision Tree for Efficient Antenatal Red Blood Cell Antibody Screening.

Epidemiology 2018 05;29(3):453-457

Background: Hemolytic disease of the fetus and newborn due to maternal red blood cell alloimmunization can have serious consequences. Because early detection enables careful monitoring of affected pregnancies, programs to routinely screen all pregnant women have been widely adopted. Due to the low prevalence of alloimmunization, these require large investments of resources to detect a small number of cases. Read More

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http://dx.doi.org/10.1097/EDE.0000000000000805DOI Listing
May 2018
5 Reads

Successful management of severe red blood cell alloimmunization in pregnancy with a combination of therapeutic plasma exchange, intravenous immune globulin, and intrauterine transfusion.

Transfusion 2018 03 17;58(3):677-684. Epub 2017 Dec 17.

Department of Pathology and Laboratory Medicine, University of Texas McGovern Medical School at Houston, Houston, Texas.

Background: Antibodies to Rhesus and Kell antigens have been associated with severe hemolytic disease of the fetus and newborn (HDFN) necessitating intrauterine transfusion (IUT) of red blood cells (RBCs). We report a case series of five women with severe HDFN secondary to maternal RBC alloimmunization who were successfully managed with therapeutic plasma exchange (TPE), intravenous immune globulin (IVIG), and IUT.

Study Design And Methods: This is a retrospective case series of five women with severe HDFN who underwent a total of three TPE procedures during Weeks 10 to 13 of pregnancy, followed by weekly IVIG infusions. Read More

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http://dx.doi.org/10.1111/trf.14453DOI Listing
March 2018
10 Reads

Successful management of a severe anti-M alloimmunization during pregnancy.

Eur J Obstet Gynecol Reprod Biol 2017 Oct 4;217:175-176. Epub 2017 Aug 4.

Division of Obstetrics, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), B-1200 Bruxelles, Belgium.

We report the successful outcome of a patient with anti-M antibodies with a previous history of severe hemolysis of erythrocytes. Serial plasma exchange from the first trimester combined with ultrasound monitoring of the fetal middle cerebral artery blood velocity was implemented. This management allowed a favorable pregnancy outcome of an infant born by an elective caesarean section at 32 weeks 6/7 with a normal Apgar score at 8/9/10. Read More

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http://dx.doi.org/10.1016/j.ejogrb.2017.07.024DOI Listing
October 2017
10 Reads

Red blood cell alloimmunization in pregnancy during the years 1996-2015 in Iceland: a nation-wide population study.

Transfusion 2017 11 24;57(11):2578-2585. Epub 2017 Aug 24.

University of Iceland, Faculty of Medicine, Reykjavik, Iceland.

Background: Red blood cell (RBC) alloimmunization during pregnancy is still a major problem. Historically, anti-D antibodies are most likely to cause severe hemolysis, but other antibodies are also important. In Iceland, postnatal RhIg prophylaxis was implemented in 1969, universal RBC antibody screening was implemented in 1978, but antenatal RhIg prophylaxis is not yet routine. Read More

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http://dx.doi.org/10.1111/trf.14262DOI Listing
November 2017
10 Reads

High Levels of CXCL8 and Low Levels of CXCL9 and CXCL10 in Women with Maternal RhD Alloimmunization.

Front Immunol 2017 3;8:700. Epub 2017 Jul 3.

Hematology and Hemotherapy Foundation of Pernambuco (HEMOPE), Recife, Brazil.

Maternal RhD alloimmunization is an inflammatory response against protein antigens in fetal red blood cells (RBC). However, not all women become alloimmunized when exposed to RhD fetal RBC. Thus, this study aimed to evaluate levels of inflammatory chemokines in RhD pregnant women with erythrocyte alloimmunization. Read More

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http://dx.doi.org/10.3389/fimmu.2017.00700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494496PMC

Risks and trends of red blood cell transfusion in obstetric patients: a retrospective study of 45,213 deliveries using administrative data.

Transfusion 2017 09 22;57(9):2197-2205. Epub 2017 Jun 22.

Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

Background: Transfusion data for obstetric patients are scarce. Identifying characteristics associated with red blood cell transfusion (RBCT) is of importance to better identify patients who would benefit from blood conservation strategies as the risk of alloimmunization from RBCT has the potential to affect the fetus and newborn.

Study Design And Methods: We conducted a retrospective cohort study using hospital administrative data to identify trends and risk factors of RBCT in obstetric patients. Read More

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http://dx.doi.org/10.1111/trf.14184DOI Listing
September 2017
16 Reads

[Identification of alloantibodies and their associations: Balance sheet of 3 years at the Regional Center of Blood Transfusion in Rabat/Morocco and difficult in transfusion management].

Transfus Clin Biol 2017 Nov 31;24(4):422-430. Epub 2017 May 31.

Centre régional de transfusion sanguine, immuno-hématologie, Bab-El-Irfane, rue M'FadeL-Cherka, 10000 Rabat, Maroc.

Red blood cell immunization can lead to delays or even an impasse in a transfusion.

Objectives: Determine the specificities of the most common of alloantibodies and their associations to correct management of red blood cell transfused.

Methods And Materials: A retrospective study between 2013 and 2015 in immunohematology laboratories at the Blood Transfusion Center of Rabat in Morocco. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S12467820173006
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http://dx.doi.org/10.1016/j.tracli.2017.04.006DOI Listing
November 2017
22 Reads

Modeling alloantibody formation to high-incidence red blood cell antigens in immune responders using genotypic data.

Immunohematology 2017 Jan;33(1):9-14

Technical Specialist II, Department of Pathology, Division of Transfusion Medicine, The Johns Hopkins Hospital, Baltimore, MD.

Conclusions: Alloimmunization to red blood cell antigens is unpredictable and poorly understood. Patients who are negative for high-incidence antigens (HIAs) are at risk for developing the corresponding antibodies. Molecular methods can easily predict the lack of an antigen and thus, the risk of an individual to become immunized. Read More

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January 2017
4 Reads

Clinical Significance of an Alloantibody against the Kell Blood Group Glycoprotein.

Transfus Med Hemother 2017 Jan 2;44(1):53-57. Epub 2016 Nov 2.

IDICER-CONICET, Rosario, Argentina; Laboratorio de Inmunohematología - Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina.

Background: Kell null (K) individuals can produce anti-Ku, an antibody against many epitopes in the Kell glycoprotein, after transfusion and/or pregnancy. Since sensitized K patients are rare, little is known about anti-Ku clinical relevance and in particular about its association to hemolytic disease of the fetus and newborn.

Case Report: This work describes a case of neonatal hyperbilirubinemia due to immune-mediated erythrocyte destruction by an alloantibody directed against the Kell glycoprotein. Read More

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http://dx.doi.org/10.1159/000448381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318919PMC
January 2017
7 Reads

Acoustic radiation force impulse elastosonography of placenta in maternal red blood cell alloimmunization: a preliminary and descriptive study.

Med Ultrason 2017 Jan;19(1):73-78

Department of Obstetrics and Gynecology, Van, Turkey.

Aims: Maternal red blood cell alloimmunization is an important cause of fetal morbidity and mortality in the perinatal period, despite well-organized prophylaxis programs. The objective of the study was to evaluate placental elasticity by using Acoustic Radiation Force Impulse (ARFI) in Rhesus (Rh) alloimmunized pregnant women with hydropic and nonhydropic fetuses and to compare those with healthy pregnant women.

Material And Methods: This case-control and descriptive study comprised twenty-eight healthy pregnant women, 14 Rh alloimmunized pregnant women with nonhydropic fetuses, and 16 Rh alloimmunized pregnant women with hydropic fetuses in the third trimester of pregnancy. Read More

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http://dx.doi.org/10.11152/mu-924DOI Listing
January 2017
10 Reads

Maternal red blood cell alloantibodies identified in blood samples obtained from Iranian pregnant women: the first population study in Iran.

Transfusion 2017 01 7;57(1):97-101. Epub 2016 Nov 7.

Department of Immunology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Background: The objective was to determine the frequency of occurrence of alloantibodies among pregnant women in Iran.

Study Design And Methods: This was a prospective cross-sectional study, which was carried out in the immunohematology reference laboratory of the Iranian Blood Transfusion Organization in Tehran, Iran, in 2008 to 2015. Screening and identification of red blood cell (RBC) alloantibodies was done on the sera of 7340 pregnant females using the standard tube method and gel column agglutination technique. Read More

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http://doi.wiley.com/10.1111/trf.13867
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http://dx.doi.org/10.1111/trf.13867DOI Listing
January 2017
11 Reads

Association of HLA-DRB1 and HLA-DQB1 with red-blood-cell alloimmunization in the Czech population.

Vox Sang 2017 Feb 4;112(2):156-162. Epub 2017 Jan 4.

Blood Centre, University Hospital, Ostrava, Czech Republic.

Background And Objectives: Alloimmune antibodies against red-blood-cell (RBC) antigens induced in susceptible individuals (responders) by transfusion, pregnancy or transplantation may have serious clinical consequences. The aim of this study was to investigate association of alloimmunization against selected RBC antigens with HLA-Class II.

Materials And Methods: A total of 230 responders (106 monoresponders and 124 multiresponders) were enrolled into the study. Read More

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http://dx.doi.org/10.1111/vox.12478DOI Listing
February 2017
5 Reads

Understanding red blood cell alloimmunization triggers.

Hematology Am Soc Hematol Educ Program 2016 Dec;2016(1):446-451

Department of Laboratory Medicine and.

Blood group alloimmunization is "triggered" when a person lacking a particular antigen is exposed to this antigen during transfusion or pregnancy. Although exposure to an antigen is necessary for alloimmunization to occur, it is not alone sufficient. Blood group antigens are diverse in structure, function, and immunogenicity. Read More

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http://dx.doi.org/10.1182/asheducation-2016.1.446DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142457PMC
December 2016
25 Reads

Hyperhemolytic Syndrome Complicating a Delayed Hemolytic Transfusion Reaction due to anti-P1 Alloimmunization, in a Pregnant Woman with HbO-Arab/β-Thalassemia.

Mediterr J Hematol Infect Dis 2016 18;8(1):e2016053. Epub 2016 Oct 18.

Department of Pediatrics, Democritus University of Thrace Faculty of Medicine, Alexandroupolis, Greece.

Background: Hyperhemolytic Syndrome or Hyperhemolytic Transfusion Reaction (HHTR), a life-threatening subset of Delayed Hemolytic Transfusion Reaction (DHTR) is characterized by destruction of both transfused and autologous erythrocytes evidenced by a fall in post transfusion hemoglobin below the pre-transfusion level.

Case Report: We describe a case of DHTR due to anti-P1 alloimmunization manifesting with hyperhemolysis in a 30-year-old Greek Pomak woman with thalassemia intermedia (HbO-Arab/β-thalassemia), during the11 week of her first gestation. She was successfully managed with avoidance of further transfusions and administration of IVIG and corticosteroids. Read More

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http://dx.doi.org/10.4084/MJHID.2016.053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5111518PMC
October 2016
42 Reads

Red blood cell alloimmunization: new findings at the bench and new recommendations for the bedside.

Curr Opin Hematol 2016 11;23(6):543-549

aDepartment of Laboratory Medicine bDepartment of Pediatrics cDepartment of Immunobiology, Yale University School of Medicine, New Haven dPathology & Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, Connecticut, USA.

Purpose Of Review: To summarize recent discoveries from clinical studies and animal models that contribute to understanding the alloimmune response to non-ABO blood group antigens.

Recent Findings: Several studies have confirmed high rates of alloimmunization among patients requiring chronic red blood cell (RBC) transfusion. Moreover, 'triggers' for alloantibody development in the transfusion setting have been identified, with a number of investigations linking recipient inflammation to a higher likelihood of alloimmunization. Read More

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http://dx.doi.org/10.1097/MOH.0000000000000277DOI Listing
November 2016
19 Reads

Antigen modulation as a potential mechanism of anti-KEL immunoprophylaxis in mice.

Blood 2016 12 29;128(26):3159-3168. Epub 2016 Sep 29.

Department of Laboratory Medicine and.

Red blood cell (RBC) alloimmunization is a serious complication of transfusion or pregnancy. Despite the widespread use of Rh immune globulin to prevent pregnancy associated anti-D alloimmunization, its mechanism of action remains elusive. We have previously described a murine model in which immunoprophylaxis with polyclonal anti-KEL sera prevents alloimmunization in wild-type recipients transfused with transgenic murine RBCs expressing the human KEL glycoprotein. Read More

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http://dx.doi.org/10.1182/blood-2016-06-724732DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5201095PMC
December 2016
40 Reads

Therapeutic Apheresis in Pregnancy: Three Differential Indications With Positive Maternal and Fetal Outcome.

Ther Apher Dial 2016 Dec 14;20(6):677-685. Epub 2016 Jul 14.

Extracorporeal Therapeutic Techniques Unit, Immunohematology and Transfusion Medicine, Lipid Clinic and Atherosclerosis Prevention Centre, Department of Molecular Medicine, 'Umberto I' Hospital, 'Sapienza' University of Rome, Rome, Italy.

Therapeutic apheresis (TA) is a complex extracorporeal procedure for the treatment of several acute and chronic diseases. TA in pregnancy is considered safe for both mother and fetus and has the same indications of non-pregnant patients. TA can be used during the entire course of the pregnancy with the following purposes: (i) to treat several maternal acute and chronic conditions; (ii) to treat fetal conditions; (iii) to avoid administration of drugs potentially harmful to the fetus; and (iv) to reach a more advanced gestational age in order to prevent fetal prematurity. Read More

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http://dx.doi.org/10.1111/1744-9987.12422DOI Listing
December 2016
14 Reads

Hemolytic Disease of the Fetus and Newborn: Modern Practice and Future Investigations.

Transfus Med Rev 2016 10 26;30(4):159-64. Epub 2016 May 26.

Laboratory Medicine, Seattle Children's Hospital, Seattle, WA; Bloodworks NW, Seattle, WA.

Red blood cell (RBC) sensitization occurs in some women in response to exposure to paternally derived RBC antigens during pregnancy or to nonself antigens on transfused RBCs during their lifetime. Once sensitized, future pregnancies may be at risk for hemolytic disease of the fetus and newborn. Although great strides have been made over the past few decades in terms of identifying blood group antigens and in predicting fetal anemia through the use of noninvasive monitoring, many questions remain in terms of understanding RBC alloimmunization risk factors, preventative therapies, and treatment strategies. Read More

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http://dx.doi.org/10.1016/j.tmrv.2016.05.008DOI Listing
October 2016
79 Reads

Red Blood Cell Antigen Genotyping for Sickle Cell Disease, Thalassemia, and Other Transfusion Complications.

Transfus Med Rev 2016 10 28;30(4):197-201. Epub 2016 May 28.

Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Electronic address:

Since the discovery of the ABO blood group in the early 20th century, more than 300 blood group antigens have been categorized among 35 blood group systems. The molecular basis for most blood group antigens has been determined and demonstrates tremendous genetic diversity, particularly in the ABO and Rh systems. Several blood group genotyping assays have been developed, and 1 platform has been approved by the Food and Drug Administration as a "test of record," such that no phenotype confirmation with antisera is required. Read More

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http://dx.doi.org/10.1016/j.tmrv.2016.05.011DOI Listing
October 2016
6 Reads

Red cell alloimmunization in RhD positive pregnant women and neonatal outcome.

Transfus Apher Sci 2016 Aug 13;55(1):153-8. Epub 2016 Jun 13.

Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.

The frequency of red blood cell (RBC) alloimmunization in RhD positive pregnant women is not known in our population. We planned to determine its frequency and correlation with neonatal outcome. We included 1000 RhD positive pregnant women: 500 had 'normal pregnancy' (Group I) and another 500 had 'high risk pregnancy' (Group II). Read More

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https://linkinghub.elsevier.com/retrieve/pii/S14730502163006
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http://dx.doi.org/10.1016/j.transci.2016.06.002DOI Listing
August 2016
10 Reads
1.070 Impact Factor

Clinically significant anti-KEL RBC alloantibodies are transferred by breast milk in a murine model.

Vox Sang 2016 Jul 7;111(1):79-87. Epub 2016 Mar 7.

Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA.

Background And Objectives: Fetuses affected by maternal RBC alloantibodies may have prolonged anaemia after birth, leading one to question whether maternal alloantibody transfer may occur outside the placenta. In response to a recent publication describing breast milk transfer of clinically significant amounts of maternal antiplatelet IgA antibodies from mother to nursing infant, we hypothesized that maternal RBC alloantibodies may also be capable of being transferred in breast milk.

Materials And Methods: The presence and clinical significance of breast milk alloantibody transfer were tested through a series of pregnancy, fostering and transfusion experiments, using a murine model in which transgenic RBCs express the human KEL glycoprotein. Read More

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http://dx.doi.org/10.1111/vox.12387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4938760PMC
July 2016
4 Reads

[Difficulties of the care of public antigen alloimmunization].

Transfus Clin Biol 2016 May 27;23(2):103-5. Epub 2016 Jan 27.

CRTS de Sfax, 99/UR/08-33, université de Sfax, Sfax, Tunisie.

Alloimmunization against high-frequency erythrocyte antigens is a problematic situation in terms of laboratory diagnosis, transfusion and obstetrical management. We report the case of a pregnant woman alloimmunized against public Ag. We detail the difficulties of alloantibody (Ab) identification and transfusion management of the deliveries. Read More

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http://dx.doi.org/10.1016/j.tracli.2015.12.008DOI Listing
May 2016
5 Reads

[Spontaneous antepartal RhD alloimmunization].

Ceska Gynekol 2015 Dec;80(6):401-4

Aim Of The Study: Assess the incidence of spontaneous antepartal RhD alloimmunization in RhD negative pregnant women with an RhD positive fetus.

Design: Clinical study.

Setting: Department of Obstetrics and Gynecology, Medical School and University Hospital Olomouc. Read More

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December 2015
6 Reads

Alloimmune Red Blood Cell Antibodies: Prevalence and Pathogenicity in a Canadian Prenatal Population.

J Obstet Gynaecol Can 2015 Sep;37(9):784-790

Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton AB.

Objective: The goals of this study were to determine the prevalence and relative frequencies of red blood cell antibodies in a Canadian prenatal population, and to evaluate the fetal and neonatal outcomes of affected pregnancies.

Methods: We conducted a retrospective review of pregnancies that screened positive for red cell antibodies between 2006 and 2010. The following antibodies were included: anti-D, -C, -c, -E, -e, -Fya, -Fyb, -Jka, and-Jkb. Read More

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http://dx.doi.org/10.1016/S1701-2163(15)30148-1DOI Listing
September 2015
60 Reads

Kell and Kx blood group systems.

Immunohematology 2015 ;31(1):14-9

PhD, FCSMLS(D), Director of Immunohematology and Transfusion Services, Diagnostic Laboratories, Blood Center of Wisconsin, 638 N. 18th Street, PO Box 2178, Milwaukee, WI 53201-2178.

The Kell and Kx blood group systems are expressed as covalently linked molecules on red blood cells (RBCs). The Kell blood group system is very polymorphic, with 35 antigens assigned to the system. The expression of Kell glycoprotein on RBCs is not critical to the erythrocyte function. Read More

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November 2015
10 Reads

Management of severe fetal anemia by Doppler measurement of middle cerebral artery: are there other benefits than reducing invasive procedures?

Eur J Obstet Gynecol Reprod Biol 2015 Sep 23;192:27-30. Epub 2015 Jun 23.

Department of Obstetrics, Pôle Femme Mère Nouveau-né, Jeanne de Flandre Hospital, CHRU de Lille, France; University of Lille North of France, France.

Objective: Doppler measurement of peak velocity of systolic blood flow in the middle cerebral artery (PVS-MCA) can safely replace invasive testing in the diagnosis of fetal anemia in Rh-alloimmunized pregnancies and PSV-MCA is now the reference technique. However, no study has evaluated its impact in antenatal care and in survival rate. Our objective was to evaluate the impact of the measurement of PVS-MCA in antenatal management and neonatal outcome in maternal red cell alloimmunization requiring in utero transfusion (IUT). Read More

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http://dx.doi.org/10.1016/j.ejogrb.2015.06.016DOI Listing
September 2015
2 Reads

Hemolytic disease of the fetus and newborn due to multiple maternal antibodies.

Am J Obstet Gynecol 2015 Jul 30;213(1):68.e1-68.e5. Epub 2015 Jan 30.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wexner Medical Center, The Ohio State University, Columbus, OH.

Objective: The objective of the study was to determine whether women with combinations of red blood cell antibodies are more likely to develop significant hemolytic disease of the fetus and newborn than those with single antibodies.

Study Design: A retrospective exposure cohort study was conducted of pregnant women with red blood cell antibodies. The development of significant hemolytic disease of the fetus and newborn was then compared between patients with single antibodies and those with multiple antibodies. Read More

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http://dx.doi.org/10.1016/j.ajog.2015.01.049DOI Listing
July 2015
18 Reads

Rh(O)D immune globulin products for prevention of alloimmunization during pregnancy.

Am J Health Syst Pharm 2015 Feb;72(4):267-76

Samuel L. Aitken, Pharm.D., BCPS, is Clinical Pharmacy Specialist in Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston. Eric M. Tichy, Pharm.D., FCCP, BCPS, is Senior Clinical Pharmacy Specialist, Solid Organ Transplantation, and Director, Postgraduate Year 2 Residency, Department of Pharmacy Services, Yale-New Haven Hospital, New Haven, CT.

Purpose: The pharmacologic properties of Rhesus (Rh) immune globulin (RhIG) and clinical data on its effectiveness in preventing Rh-antigen alloimmunization in pregnant women are reviewed.

Summary: RhIG is a human plasma derivative that targets red blood cells (RBCs) positive for Rh(O) antigen (also called D antigen). In the United States and other countries, the widespread use of RhIG has markedly reduced the occurrence of hemolytic disease of the fetus and newborn (HDFN), a devastating condition caused by D-antigen sensitization of a pregnant woman via exposure to fetal RBCs (usually during detachment of the placenta in labor) that results in a maternal immune response leading to severe hemolysis in the fetus. Read More

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http://dx.doi.org/10.2146/ajhp140288DOI Listing
February 2015
2 Reads

Risk of maternal alloimmunization in Southern Pakistan - a study in a cohort of 1000 pregnant women.

Transfus Apher Sci 2015 Feb 11;52(1):99-102. Epub 2014 Dec 11.

Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi, Pakistan.

Background: Haemolytic disease of the fetus and the newborn [HDFN] is caused by incompatibility of maternal and fetal erythrocytes. Red blood cell alloimmunization is a well-known cause of HDFN. Due to heterogeneity of populations, the spectrum of alloimmunization varies around the world. Read More

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http://dx.doi.org/10.1016/j.transci.2014.12.002DOI Listing
February 2015
8 Reads
3 Citations
1.072 Impact Factor

Factors associated with persistence of red blood cell antibodies in woman after pregnancies complicated by fetal alloimmune haemolytic disease treated with intrauterine transfusions.

Br J Haematol 2015 Feb 22;168(3):443-51. Epub 2014 Sep 22.

Centre for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands; Department of Immunohematology and Blood Transfusion, Leiden University Medical Centre, Leiden, the Netherlands; Jon J van Rood Centre for Clinical Transfusion Research, Sanquin-Leiden University Medical Centre, Leiden, the Netherlands.

Red blood cell (RBC) antibodies can persist for decades or decrease quickly to undetectable levels. Antibody persistence has not been systematically studied. Women whose children are treated with intrauterine transfusions (IUT) for haemolytic disease of the fetus (HDFN) often produce additional antibodies, which can be evoked by the intrauterine transfusion or by fetomaternal haemorrhage during the procedure. Read More

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http://doi.wiley.com/10.1111/bjh.13130
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http://dx.doi.org/10.1111/bjh.13130DOI Listing
February 2015
27 Reads

Provision of KEL1-negative blood to obstetric patients: a 3-year single-institution retrospective review.

Transfusion 2015 Mar 13;55(3):599-604; quiz 598. Epub 2014 Aug 13.

Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Pathology, Harvard Medical School, Boston, Massachusetts.

Background: KEL1 alloimmunization is a major cause of hemolytic disease of the fetus and newborn (HDFN). While select countries have guidelines for preventing transfusion-associated KEL1 alloimmunization, the United States does not. Beth Israel Deaconess Medical Center instituted a policy in April 2009 whereby women not more than 50 years of age on the obstetric service were transfused KEL1-negative red blood cells (RBCs). Read More

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http://dx.doi.org/10.1111/trf.12814DOI Listing
March 2015
14 Reads

Is intrauterine exchange transfusion a safe procedure for management of fetal anaemia?

Eur J Obstet Gynecol Reprod Biol 2014 Aug 20;179:83-7. Epub 2014 May 20.

Department of Obstetrics, Pôle Femme Mère Nouveau-né, Jeanne de Flandre Hospital, CHRU Lille, France; University of Lille North of France, France.

Objective: To study modalities and complications of intrauterine exchange transfusion (IUET) for the management of severe fetal anaemia.

Study Design: Retrospective study of all IUET procedures performed between January 1999 and January 2012 at a regional centre. Characteristics of each procedure were studied to identify risk factors for complications. Read More

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http://dx.doi.org/10.1016/j.ejogrb.2014.05.008DOI Listing
August 2014
7 Reads

Transfusion therapy and alloimmunization in Thalassemia Intermedia: a 10 year experience at a tertiary care university hospital.

Transfus Apher Sci 2014 Aug 21;51(1):42-6. Epub 2014 Apr 21.

Department of Hematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman. Electronic address:

Background: Thalassemia Intermedia (TI) has a wide clinical profile with many patients requiring only occasional transfusions. To prevent alloimmunization, we adopted a policy of issuing phenotype matched red blood cells in 2009. We examined transfusion indications and alloimmunization rate in TI patients. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S14730502140008
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http://dx.doi.org/10.1016/j.transci.2014.04.009DOI Listing
August 2014
8 Reads

Associations of Rhesus and non-Rhesus maternal red blood cell alloimmunization with stillbirth and preterm birth.

Int J Epidemiol 2014 Aug 5;43(4):1123-31. Epub 2014 May 5.

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden, Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19102, USA, Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, S-14183 Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet and Department of Neonatology, Sachs' Children and Youth Hospital, 118 83 Stockholm, Sweden

Background: Although the risks of adverse pregnancy outcomes associated with anti-D antibodies are well-recognized, much less is known concerning alloimmunization with other red blood cell antibodies detected during routine maternal screening. To date, most reports of adverse pregnancy outcomes associated with non-anti-D antibodies have been from small case studies. The aim of this study was to examine the associations of maternal alloimmunization with specific red blood cell antibodies and the risks of preterm birth and stillbirth in the Swedish population. Read More

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http://dx.doi.org/10.1093/ije/dyu079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258779PMC
August 2014
11 Reads
9.180 Impact Factor

[Severe hemolytic disease of the newborn as a result of late and undiagnosed alloimmunization--case report].

Ginekol Pol 2014 Mar;85(3):226-9

We report a case of a hemolytic disease in a newborn from the first pregnancy due to anti-D antibodies. The maternal blood group was A Rhesus negative. She had an antibody screening test twice during the pregnancy (in the second trimester) and it was negative. Read More

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March 2014
9 Reads

Granulocyte-reactive antibodies are associated with red blood cell alloimmunization.

Vox Sang 2014 Aug 8;107(2):200-3. Epub 2014 Apr 8.

Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria.

Granulocyte-reactive antibodies may cause transfusion-related acute lung injury (TRALI) and immune neutropenias. Risk factors for their acquisition other than previous alloexposition are largely unknown. In addition to the known association between human leucocyte antigen alloantibodies and red blood cell alloimmunization in selected cohorts of transfused patients, this study investigated a possible extension of this association to granulocyte-reactive antibodies in women with a history of pregnancy. Read More

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http://doi.wiley.com/10.1111/vox.12152
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http://dx.doi.org/10.1111/vox.12152DOI Listing
August 2014
4 Reads

HLA-DRB1 associations in individuals with single and multiple clinically relevant red blood cell antibodies.

Transfusion 2014 Aug 24;54(8):1971-80. Epub 2014 Mar 24.

Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands; Jon J. van Rood Center for Clinical Transfusion Research, Sanquin-Leiden University Medical Center, Leiden, The Netherlands.

Background: A minority of red blood cell (RBC) alloantigen-exposed persons form antibodies. Responders are at high risk of developing additional antibodies upon subsequent transfusions. Several studies showed an association between particular HLA-DRB1 phenotypes and the development of specific RBC antibodies. Read More

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http://dx.doi.org/10.1111/trf.12624DOI Listing
August 2014
7 Reads

Chimerism in transfusion medicine: the grandmother effect revisited.

Chimerism 2013 Oct-Dec;4(4):119-25. Epub 2013 Nov 6.

Department of Pathology; The Johns Hopkins Hospital; Baltimore, MD USA.

Transfusion therapy is complicated by the production of alloantibodies to antigens present in the donor and lacking in the recipient through the poorly-understood but likely multi-factorial process of alloimmunization. The low prevalence of alloimmunization in transfused patients (6.1%) (1) suggests that processes central to immunologic tolerance may be operating in the vast majority of transfused patients who do not produce alloantibodies. Read More

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http://dx.doi.org/10.4161/chim.26912DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921192PMC
November 2014
13 Reads

Frequency & specificity of RBC alloantibodies in patients due for surgery in Iran.

Indian J Med Res 2013 ;138:252-6

Medical Laboratory Hematology & Blood Banking Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences/Pediatric Congenital Hematologic Disorders Research Center/Blood Transfusion Research Center, High Institute for Research & Education in Transfusion Medicine, Tehran, Iran.

Background & Objectives: Red blood cell alloimmunization is common in patients receiving multiple blood transfusions. Since the probability of repeat transfusion increases with longer life expectancy, it is important to study to which extent alloimmunized patients with a history of transfusion are prone to form alloantibodies after transfusion events. The aim of this study was to retrospectively analyze the alloimmunization against RBCs among transfused patients who were to undergo elective surgery in Tehran, Iran. Read More

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3788212PMC
April 2014
27 Reads
2 Citations
1.661 Impact Factor

Red cell alloimmunization among antenatal women attending a tertiary care hospital in south India.

Indian J Med Res 2013 ;138:68-71

Department of Transfusion Medicine & Immunohaematology, Christian Medical College & Hospital, Vellore, India.

Background & Objectives: Detection of maternal alloimmunization against red cell antigens is vital in the management of haemolytic disease of the foetus and newborn (HDFN). This study was conducted to measure the presence of allosensitization to blood group antibodies in the antenatal women attending a tertiary care hospital and to observe the proportion of minor blood group antibodies to assess the benefit of screening for the same.

Methods: All antenatal women registered in the hospital between January 2008 and January 2009, were screened for irregular antibodies using a commercial 3-cell antibody screening panel. Read More

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http://icmr.nic.in/ijmr/2013/july/0708.pdf
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767264PMC
April 2014
9 Reads

Alloantibodies to a paternally derived RBC KEL antigen lead to hemolytic disease of the fetus/newborn in a murine model.

Blood 2013 Aug 25;122(8):1494-504. Epub 2013 Jun 25.

Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Children’s Healthcare of Atlanta, Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA.

Exposure to nonself red blood cell (RBC) antigens, either from transfusion or pregnancy, may result in alloimmunization and incompatible RBC clearance. First described as a pregnancy complication 80 years ago, hemolytic disease of the fetus and newborn (HDFN) is caused by alloimmunization to paternally derived RBC antigens. Despite the morbidity/mortality of HDFN, women at risk for RBC alloimmunization have few therapeutic options. Read More

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http://dx.doi.org/10.1182/blood-2013-03-488874DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3750342PMC
August 2013
19 Reads

Antenatal immunoglobulin for fetal red blood cell alloimmunization.

Cochrane Database Syst Rev 2013 May 31(5):CD008267. Epub 2013 May 31.

Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, Parkville, Australia.

Background: Red blood cell alloimmunization in pregnancy can lead to fetal anaemia with potentially disastrous consequences. Traditional management involves the use of intrauterine transfusion, which is associated with significant procedure-related risks. An alternative treatment that has been trialled is the use of immunoglobulin administered intravenously to the mother. Read More

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http://dx.doi.org/10.1002/14651858.CD008267.pub2DOI Listing
May 2013
7 Reads

[Guideline for prevention of RhD alloimmunizationin RhD negative women].

Ceska Gynekol 2013 Apr;78(2):132-3

Porodnicko-gynekologická Klinika LF UP a FN, Olomouc, Prednosta prof. MUDr. R. Pilka, PhD.

Events following which immunoglobulin (Ig) G anti-D should be given to all RhD negative women with no anti-D alloantibodies: First trimester indications (IgG anti-D sufficient dose of 50 μg*) - termination of pregnancy, spontaneous abortion followed by instrumentation, ectopic pregnancy, chorionic villus sampling, partial molar pregnancy; Second and third trimester indications (IgG anti-D sufficient dose of 100 μg*) - amniocentesis, cordocentesis, other invasive prenatal diagnostic or therapeutic procedures, spontaneous or induced abortion, intrauterine fetal death, attempt at external cephalic version of a breech presentation, abdominal trauma, obstetric hemorrhage; Antenatal prophylaxis at 28th weeks of gestation (IgG anti-D sufficient dose of 250 μg*); Delivery of an RhD positive infant** (IgG anti-D sufficient dose of 100 μg*); Minimal dose*: before 20 weeks gestation - 50 μg (250 IU), after 20 weeks gestation*** - 100 μg (500 IU); Timing: as soon as possible, but no later than 72 hours after the event. In cases where prevention of RhD alloimmunization is not performed within 72 hours of a potentially sensitising event, it is still reasonable to administer IgG anti-D within 13 days, and in special cases, administration is still recommended up to a maximum interval of 28 days postpartum; Legend: *administration of a higher dose of IgG anti-D is not a mistake, ** also if the D type is not known, *** simultaneous assessment of the volume of fetomaternal hemorrhage (FMH) to specify the dose is suitable; The FMH volume assessment - If the volume of fetal erythrocytes (red bood cells, RBCs) which entered maternal circulation is assessed, intramuscular administration of IgG anti-D in a dose of 10 μg per 0.5 mL of fetal RBCs or 1 mL of whole fetal blood is indicated. Read More

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April 2013
21 Reads

The risk assessment study for hemolytic disease of the fetus and newborn in a University Hospital in Turkey.

Transfus Apher Sci 2013 Jun 22;48(3):377-80. Epub 2013 Apr 22.

Department of Neonatology, Gazi University, Faculty of Medicine, Ankara, Turkey.

Maternal red-cell alloimmunization occurs when a woman's immune system is sensitized to foreign red-blood cell surface antigens, leading to the production of alloantibodies. The resulting antibodies often cross the placenta during pregnancies in sensitized women and, if the fetus is positive for red-blood-cell surface antigens, this will lead to hemolysis of fetal red-blood cells and anemia. The most severe cases of hemolytic disease in the fetus and newborn baby are caused by anti-D, anti-c, anti-E and anti-K antibodies. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S14730502130010
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http://dx.doi.org/10.1016/j.transci.2013.04.021DOI Listing
June 2013
19 Reads
3 Citations
1.072 Impact Factor

[Erythrocyte alloimmunization in pregnant women, clinical importance and laboratory diagnostics].

Ceska Gynekol 2013 Jan;78(1):89-99

Tranzfuzní oddelení FN a LF UP, Olomouc.

Objective: The aim of this review is to give comprehensive summary of erythrocyte alloimunization of pregnant women, laboratory dignostics and clinical importance.

Design: Review.

Setting: University Hospital Olomouc, Transfusion Department, Department of Obstetrics and Gynecology. Read More

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January 2013
12 Reads

[Incidence of erythrocyte alloimmunization in pregnant women in olomouc region].

Ceska Gynekol 2013 Jan;78(1):56-61

Transfuzní oddelní FN a LF UP, Olomouc.

Objective: To determine the incidence of clinically significant anti-erythrocyte alloantibodies in pregnant women, which can cause severe hemolytic disease in the fetus and newborn.

Design: Retrospective-prospecitive clinical study.

Setting: Transfusion Department, University Hospital Olomouc, Department of Obstetrics and Gynecology, University Hospital Olomouc. Read More

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January 2013
5 Reads

DEL RBC transfusion should be avoided in particular blood recipient in East Asia due to allosensitization and ineffectiveness.

J Zhejiang Univ Sci B 2012 Nov;13(11):913-8

Shenzhen Blood Center, Shenzhen 518035, China; Department of Blood Transfusion, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710060, China; Shaanxi Blood Center, Xi'an 710061, China; College of Laboratory Medicine, Dalian Medical University, Dalian 116044, China.

Previously, both primary and secondary anti-D alloimmunizations induced by "Asian type" DEL (RHD1227A allele) were observed in two incidents. We investigated how often these alloimmunization events occur. The transfusions of any D-negative patients were investigated in the First Affiliated Hospital of Xi'an Jiaotong University Medical College, China, during the entire 2009. Read More

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http://dx.doi.org/10.1631/jzus.B1100348DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494030PMC
November 2012
21 Reads