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Third-trimester screening may detect previously undetected red blood cell antibodies
Dajak S. Transfusion. 2011;doi:10.1111/j.1537-2995.2010.03006.
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A second screening of D-negative women at week 28 of pregnancy may reduce the risk for severe hemolytic disease of the fetus and newborn, according to recent findings.
Eligible participants in the retrospective cohort study were all pregnant women with red blood cell antibodies who were tested between 1993 and 2008. Forms for tracking immunization were analyzed for more than 84,000 women at several sites in Europe.
Data sets included the order of screening at which the antibodies were detected (initial or repeated screening), whether it was the first or a later pregnancy and whether severe hemolytic disease occurred in the fetus or newborn as a result of the antibodies.
Although anti-D alloantibodies were detected in 1.3% of D-negative women, they were undetected in 37% (n=72) of women during first-trimester screening. Of these 72 undetected instances, severe hemolytic disease of the fetus and newborn occurred in eight cases. Three of these patients were primigravidae.
The overall incidence rate of non-D was 0.2%. Non-D was undetected in 16 cases at first trimester screening. The breakdown was as follows: 10 anti-c, two anti-E, two anti-C, one anti-S and one anti-Rh17.
There were 11 cases of severe hemolytic disease of the fetus and newborn that resulted from undetected non-D antibodies at initial screening. This accounted for 27% of all severe non-D disease. Ten of the 11 cases occurred in multiparous women; seven of those cases were caused by anti-c.
“The third-trimester screening may detect [red blood cell] antibodies that were not present or detected on the first-trimester screening,” the researchers wrote. “Such screening may be especially relevant in D+ multiparous women due to the risk of [hemolytic disease of the fetus and newborn].”
The aim of the study was to determine clinical consequences for the infant or fetus of anti-D and non-D antibodies undetected at first-trimester screening.
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