48 results on '"isoimmunization"'
Search Results
2. Qualitative analysis of Doppler assessment used for surveillance of alloimmunized individuals.
- Author
-
Hannah, Christian M., Tessier, Katelyn M., and Contag, Stephen A.
- Abstract
Objectives: To summarize image quality variables for alloimmunized women at risk for fetal anemia. To investigate the association between image quality with the highest and median middle cerebral artery peak systolic velocity (MCA‐PSV) at the last visit and fetal anemia based on hemoglobin. Study Design: This study was a qualitative retrospective analysis of 192 Doppler ultrasound images used in the detection of fetal anemia in 26 alloimmunized women seen in a Minneapolis hospital over the past 3 years. Images were graded on seven criteria found in literature. Results: Of the images analyzed, 23 (12.0%) of the 192 met all seven image quality criteria. Using the highest MCA‐PSV value, the sensitivity, and specificity were 55.6% and 94.1%, respectively. Using the median MCA‐PSV value, the sensitivity, and specificity were 44.4% and 94.1%, respectively. Conclusions: Only a minority of Doppler images meet all suggested image criteria. This could negatively impact the accuracy of the MCA‐PSV measurements as indicated by the decreased sensitivity in our evaluations. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
3. Maternal mirror syndrome with foetal hydrops due to isoimunization by anti‐KPa antibodies: A case report and narrative literature review.
- Author
-
Pina Moreno, Juan, Ortega Abad, Virginia, Perez Corral, Ana, and Garcia‐Tizon Larroca, Santiago
- Subjects
- *
HYDROPS fetalis , *EDEMA , *LITERATURE reviews , *IMMUNOGLOBULINS , *SYNDROMES , *MIRRORS - Abstract
We present a rare case of mirror syndrome due to anti‐Kpa antibodies, which can be difficult to identify with routine screening tests. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
4. Maternal mirror syndrome with foetal hydrops due to isoimunization by anti‐KPa antibodies: A case report and narrative literature review
- Author
-
Juan Pina Moreno, Virginia Ortega Abad, Ana Perez Corral, and Santiago Garcia‐Tizon Larroca
- Subjects
fetal anemia ,hydrops fetalis ,immune hydrops ,isoimmunization ,mirror syndrome ,Medicine ,Medicine (General) ,R5-920 - Abstract
Abstract We present a rare case of mirror syndrome due to anti‐Kpa antibodies, which can be difficult to identify with routine screening tests.
- Published
- 2022
- Full Text
- View/download PDF
5. A tale of two societies: implications of conflicting Rh-immunoglobulin guidelines.
- Author
-
Heuser C, Flink-Bochacki R, Sperling J, Simmons K, and Salmeen K
- Abstract
National guidance conflicts regarding the use of RhD immune globulin administration <12w. Recent Society for Maternal Fetal Medicine (SMFM) guidelines suggest liberal use of this product while other guidelines, including Society of Family Planning and the World Health Organization, propose a more conservative approach. Medicine is not practiced in a vacuum, and potential harms must include not only individual but communal and public health effects. We aim to critically examine the practical implications of the new SMFM guidelines with a focus on equity and access., (© 2024 The Authors.)
- Published
- 2024
- Full Text
- View/download PDF
6. Pathologic Unconjugated Hyperbilirubinemia–Isoimmunization, Abnormalities of Red Blood Cells, and Infections
- Author
-
Kaplan, Michael, Wong, Ronald J., Stevenson, David K., Buonocore, Giuseppe, editor, Bracci, Rodolfo, editor, and Weindling, Michael, editor
- Published
- 2018
- Full Text
- View/download PDF
7. Management and outcome of pregnancies in women with red cell isoimmunization: a 15-year observational study from a tertiary care university hospital
- Author
-
María Ángeles Sánchez-Durán, María Teresa Higueras, Cecilia Halajdian-Madrid, Mayte Avilés García, Andrea Bernabeu-García, Nerea Maiz, Nuria Nogués, and Elena Carreras
- Subjects
Isoimmunization ,Newborn hemolytic disease ,Intrauterine transfusion ,Genotype ,Fetal RhD ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background The aims of this study were to determine the prevalence of the different anti-erythrocytic alloantibodies, to describe pregnancy outcomes according to a low-risk and high-risk classification for fetal anemia and to determine the factors that influence adverse perinatal outcomes. Methods This retrospective observational study included women referred to our center following the identification of maternal anti-erythrocytic alloantibodies between 2002 and 2017. Pregnancies were classified as high risk for fetal anemia in cases with clinically significant antibodies, no fetal-maternal compatibility and titers ≥1:16 or any titration in cases of Kell system incompatibility. In high-risk pregnancies, maternal antibody titration and the fetal middle cerebral artery peak systolic velocity (MCA-PSV) were monitored. Low-risk pregnancies underwent routine pregnancy follow-up. Results Maternal antibodies were found in 337 pregnancies, and 259 (76.9%) of these antibodies were clinically significant. The most frequent antibodies were anti-D (53%) and anti-K (19%). One hundred forty-three pregnancies were classified as low risk for fetal anemia, 65 (25%) cases were classified as no fetal-maternal incompatibility, 78 had clinically nonsignificant antibodies, 4 (2.8%) resulted in first-trimester pregnancy loss, and 139 (97.2%) resulted in livebirths. Of the 194 high-risk pregnancies, 38 had titers 1.5 MoM, resulting in 3 intrauterine deaths, 6 terminations and 48 livebirths. Ninety-two intrauterine transfusions were performed in 45 fetuses (87% anti-D). Adverse outcomes were related to a MCA-PSV > 1.5 MoM (p
- Published
- 2019
- Full Text
- View/download PDF
8. Perinatal outcomes and central nervous system abnormalities following intrauterine fetal transfusion: 17 years' experience in a tertiary center.
- Author
-
Sánchez‐Durán, María Ángeles, Higueras, María Teresa, Avilés‐García, Mayte, Maiz, Nerea, Rodríguez‐Aliberas, Marta, Arévalo, Silvia, Vázquez, Elida, Ruiz Campillo, César W., and Carreras, Elena
- Subjects
- *
CENTRAL nervous system , *HYDROPS fetalis , *NEONATAL death , *ABORTION , *SURVIVAL analysis (Biometry) , *ERYTHROCYTES , *RED blood cell transfusion , *FETAL surgery - Abstract
Background: This study aimed to describe the perinatal outcome and central nervous system (CNS) anomalies in fetuses undergoing red blood cell (RBC) intrauterine transfusion (IUT). Methods and Materials: This was an observational single‐cohort study carried out at Vall d'Hebron University Hospital in Barcelona, Spain, between 2002 and 2018 in women undergoing RBC IUT for suspected fetal anemia. Primary outcomes were adverse perinatal outcome (intrauterine or neonatal death and termination of pregnancy [TOP]), prenatal or postnatal CNS anomalies, and significant neurological impairment. Results: A total of 145 RBC transfusions were performed in 68 pregnancies of 60 women. The median gestational age for the first transfusion was 26 weeks (range, 18‐32). Twenty‐two (32%) fetuses were hydropic at the first transfusion. Fifty‐eight pregnancies (85.3%) resulted in live births and 10 (14.7%) in adverse perinatal outcomes. Adverse perinatal outcomes were associated with hydrops (odds ratio [OR], 6.69; 95% confidence interval [CI], 1.53‐29.23; P =.012) and gestational age at first transfusion (OR, 0.69; 95% CI, 0.54‐0.89; P =.04). Four (5.9%) cases of cerebellar hemorrhage were diagnosed prenatally. In 14 (35%) of the 41 neonates undergoing brain ultrasound and/or magnetic resonance imaging (MRI) abnormalities were reported. The median follow‐up was 6.5 years (range, 3 months to 19 years). Significant neurological impairment was reported in two cases (4.2%). Conclusion: In fetuses undergoing intrauterine RBC transfusion, the survival rate is high, particularly in the absence of hydrops and if the gestational age at first transfusion is above 22 weeks. Significant neurological impairment is uncommon, despite the fact that postnatal CNS anomalies at ultrasound or MRI are frequent. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
9. Preventive Effects of Probiotic Supplementation on Neonatal Hyperbilirubinemia Caused by Isoimmunization.
- Author
-
Mutlu, Mehmet, Aslan, Yakup, Kader, Şebnem, and Aktürk Acar, Filiz
- Subjects
- *
THERAPEUTIC use of probiotics , *BILIRUBIN , *DIETARY supplements , *NEONATAL jaundice , *MECONIUM , *STATISTICAL sampling , *RANDOMIZED controlled trials , *TREATMENT effectiveness , *PRE-tests & post-tests , *RH isoimmunization , *CHILDREN - Abstract
Objective Probiotic supplementation can help to improve recovery from jaundice by reducing enterohepatic circulation through the regulation of intestinal microbial flora. The aim of our study was to investigate the effect of probiotic supplementation on neonatal hyperbilirubinemia caused by isoimmunization alone. Study Design Sixty neonates were randomly divided into a placebo group and a probiotic group (Lactobacillus rhamnosus GG). Serum total bilirubin (STB) levels were measured at birth and at 4, 8, 16, 24, and 36 hours of treatment (and at 48, 60, and 72 hours if necessary). Duration of phototherapy, rephototherapy requirements, and daily meconium evacuation were recorded. Results STB and rebound STB levels at 36 hours were lower in the probiotic group than in the placebo group (p = 0.01 and p = 0.006, respectively). Meconium evacuation was more frequent in the probiotic group than in the placebo group on the second and third days of life (p = 0.002 and 0.009, respectively). Conclusion Probiotics do not affect STB levels in the first 24 hours of life or duration of phototherapy in neonates with jaundice caused by blood group incompatibility. The effect of probiotic supplementation by reducing enterohepatic circulation occurs at 36 hours of life in newborns with isoimmunization. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
10. Severe Platelet Transfusion Refractoriness in Association with Antibodies Against CD36.
- Author
-
Schmidt, Amy E, Sahai, Tanmay, Refaai, Majed A, Sullivan, Mia, and Curtis, Brian R
- Subjects
- *
ANEMIA , *ANTHRACYCLINES , *BLOOD platelets , *BLOOD platelet transfusion , *GENE expression , *GLYCOPROTEINS , *IMMUNOGLOBULINS , *THROMBOCYTOPENIA , *HLA-B27 antigen , *ACUTE myeloid leukemia , *CYTARABINE - Abstract
Platelet-transfusion refractoriness (PTR) is common in patients with hematological malignancies. The etiology of immune PTR is typically human leukocyte antigen (HLA) antibodies (Abs) from pregnancy or previous transfusion. Herein, we report PTR in the setting of induction chemotherapy for acute myelogenous leukemia (AML) from Abs against CD36/glycoprotein (GP)IV. A 66-year-old African American woman presented with anemia and thrombocytopenia. She was found to have transfusion-dependent AML, and a 7 + 3 regimen (7 days of standard-dose cytarabine and 3 days of an anthracycline antibiotic or an anthracenedione, most often daunorubicin) was initiated. The patient developed profound thrombocytopenia, with platelet nadir of 0 by day 13. The results of HLA antibody screening were negative. However, the results of a screening test for platelet-specific antibodies screen showed Abs against cluster of differentiation (CD)36. The platelets of the patient lacked expression of CD36, and DNA analysis showed mutations in the CD36 gene. HLA Ab–mediated PTR is common in patients with hematological malignancies. However, once HLA Abs are excluded, other less-frequent Abs should be considered, particularly in patient populations of Asian, African, or Middle Eastern descent. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
11. A Multicenter, Randomized, Open-Label Trial Comparing the Efficacy and Safety of Monoclonal Anti-Rh (D) Immunoglobulin with Polyclonal Anti-Rh (D) Immunoglobulin for the Prevention of Maternal Rh-Isoimmunization.
- Author
-
Chauhan, Anahita R., Nandanwar, Yogeshwar S., Ramaiah, Aruna, Yelikar, Kanan A., Rashmi, M. D., Sachan, Rekha, Mayekar, Rahul V., Trivedi, Yamini N., Paradkar, Gopalkrishna V., and Patole, Kiran P.
- Abstract
Objectives: To compare the efficacy and safety of monoclonal anti-Rhesus (anti-D) immunoglobulin (IgG) with polyclonal anti-D IgG in the prevention of maternal Rh-isoimmunization. Methods: This was a randomized, multicenter, open-label, comparative clinical trial conducted in the obstetric in-patient departments of nine tertiary care hospitals in India. 206 Rhesus (D)-negative women, not sensitized to Rh antigen, and delivering Rh positive babies, received postpartum intramuscular administration of monoclonal or polyclonal anti-D IgG. The main outcome measures were the proportion of subjects protected from Rh-isoimmunization, identified by a negative indirect Coombs test (ICT) result, at day 180 after anti-D IgG administration, and incidence of adverse events. Results: 105 subjects were randomized to the monoclonal group and 101 to the polyclonal group. 94 from the monoclonal group had a negative ICT result and none had a positive ICT result at day 180, whereas 87 from the polyclonal group had a negative ICT result and one had a positive ICT result; the rest (11 and 13 subjects respectively) were lost to follow-up. A total of 5 adverse events were reported (3 in the monoclonal group and 2 in the polyclonal group); only one of these was serious. All the adverse events were judged to be unrelated to the interventional drug. None of the subjects in the monoclonal group developed immunogenic reaction to the monoclonal anti-D. Conclusion: The efficacy and safety of the monoclonal preparation of anti-D was comparable to the polyclonal preparation of anti-D when used in the prevention of maternal Rh-isoimmunization. Trial registration Clinical Trial Registration Number: CTRI/2015/09/006172. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
12. Severe hemolytic disease of the newborn – an unacceptable event in the 21st century.
- Author
-
Conea, Ileana-Maria, Loghin, Mihai-George, Bobei, Tina, and Pleş, Liana
- Subjects
- *
ERYTHROBLASTOSIS fetalis , *HYDROPS fetalis , *FETAL diseases , *POLYHYDRAMNIOS , *ABORTION , *CORD blood , *UTERINE contraction - Abstract
Introduction. Isoimmunization in the Rhesus (Rh) system was a health system issue until methods of diagnosis and especially prevention by immunoglobulin administration were introduced at the beginning of the 21st century. Fetal disease is caused by antibodies against the fetal red cells when there is an Rh incompatibility (Rh negative mother and Rh-positive fetus). Since antibodies are produced by fetal maternal hemorrhage, the immune response starts with a false pregnancy event and is enhanced by subsequent pregnancies, unless prophylaxis is performed. The disease has many degrees, the more severe being fetal hydrops caused by hemolytic anemia, cardiac failure and hepatomegaly. After birth, the most obvious condition is determined by the high values of bilirubinemia that can cause jaundice and neurological damage, with long-term consequences. Materials and method. We present the case of a 24-year-old pregnant woman admitted in our unit, reporting the lack of fetal movement. Results and conclusions. The 24-year-old patient, with one previous caesarian section and three abortions on request, now being 34-week pregnant, diagnosed with RH incompatibility at 24 weeks, was monitored by ultrasound, and antibody anti-D determination that did not reveal isoimmunization. At 32 weeks, she was admitted in the hospital for uterine contractility, and the blood test performed revealing antibody anti-D titer of 1:8. Ultrasound scan was normal, without signs of fetal anemia (normal PSV on MCA). At 34 weeks, the patient was admitted in our unit, reporting absent fetal movement for 24 hours. Ultrasound examination identified: mild polyhydramnios (AFI=25 cm), fetal ascites, cardiomegaly and high PSV and IP on MCA, pulsatility index (IP) on the middle cerebral artery (MCA) of 3.35, and PSV of 120 cm/s. The biological test identified: maternal mild anemic syndrome, normocytic normochromic form, without signs of iron deficiency (hemoglobin=8.8 g/dl). Repeated CTG and biophysical profile (BP) revealed a non-assuring fetal pattern with absent variability and lack of reactivity, with BP five. Emergency delivery was decided, and caesarean section was performed, considering the previous birth with a uterine scar. A 2600-gram female fetus was extracted, with an Apgar score of 4. The fetal blood count revealed severe anemia (Hb=3 g/dl), and the fetus showed sign of hydrops, ascites, cardiomegaly and hepatomegaly requiring neonatal intensive care and exsanguino transfusion. The outcome was favorable, and the baby was discharged after 14 days. The case identifies the necessity of correct screening and prophylaxis of isoimmunization whenever Rh incompatibility is present, even in pregnancies that are terminated in an early stage. This problem should be questioned and addressed in the facilities that perform abortion on request. [ABSTRACT FROM AUTHOR]
- Published
- 2023
13. MATERNAL-FETAL INCOMPATIBILITY ISOIMMUNIZATION IN Rh SYSTEM.
- Author
-
Neamțu, Simona-Daniela, Novac, Marius-Bogdan, Fortofoiu, Maria, Fortofoiu, Mircea-Catalin, and Siminel, Mirela
- Subjects
- *
PREGNANCY complications , *IMMUNIZATION , *RH factor , *OBSTETRICS -- History , *FETUS - Abstract
Introduction: Loaded obstetric history (abortion, ectopic pregnancy, births), transfusions, hemoteraphy, grafts are risk factors for isoimmunization in Rh system. Patients and method: A special case of Rh isoimmunization is the girls having Rh negative from mothers with Rh positive, which can be izoimunizate without any obstetrical or transfusion history; isoimmunization occurs by transfer of maternal red blood cells Rh positive in the circulation of the Rh negative fetus; in terms of pregnancy with Rh positive fetus, amnestic reactions occur with significant increases in anti Rh antibody titer - theory "grandmother troublesome". Results: Rh negative pregnant woman with Rh-positive homozygous husband will certainly have Rh positive fetus. If the mother and fetus have ABO incompatibility, red blood cells Rh positive are destroyed by its group of agglutinins and Rh antigenic sites are masked for maternal immune system. Conclusions: Rh iso-immunization once installed can`t be influenced downward by antibody titer, it is having irreversible changes. [ABSTRACT FROM AUTHOR]
- Published
- 2016
14. Management of Rhesus Isoimmunized Pregnant Woman in Low Resource Setting: A Case Report
- Author
-
Isah, AD, Agida, TE, Nongo, BH, Mohammed, BR, Jibril, AO, and Itanyi, UD
- Subjects
Pregnancy ,Isoimmunization ,Management - Abstract
Rh isoimmunization of pregnant mothers may be responsible for varying severity of anaemia in fetuses and newborns. Usually, it is in the second or subsequent pregnancies that the fetus is affected. Management of this patient in a low resource setting posed serious challenges as various interventions levels. A 28-year-old G6P5+0 1alive at 17weeks of gestation, in her six pregnancy who had developed Anti-D antibodies after her first pregnancy. pregnancy was unbooked, carried to term and had spontaneous vaginal delivery at home to a live female neonate. She was unaware of her blood group and Rhesus typing and did not received Anti-D immunoglobulin. Subsequently, she had recurrent intrauterine stillbirth and early neonatal death. Current pregnancy was carried to 31weeks of gestation when it was noticed the fetus had severe anaemia following evaluation with middle cerebral artery-peak systolic velocity and had Caeserean section. The neonate had exchange blood transfusion and phototherapy following delivery. Close fetal monitoring with middle cerebral artery- peak systolic velocity and timely delivery can lead to a favorable outcome in low resource setting.
- Published
- 2021
- Full Text
- View/download PDF
15. Evolving Trends: Hyperbilirubinemia Among Newborns Delivered to Rh Negative Mothers in Southern India
- Author
-
GIRISH N, SANTOSH S, and KESHAVAMURTHY SR
- Subjects
neonatal jaundice ,isoimmunization ,Medicine - Abstract
Introduction: Neonatal jaundice is the commonest abnormal physical finding in the new born nursery and hemolytic disease of the newborn (HDN) among babies born to Rh negative mothers is the most formidable etiology. During last few decades considerable evolution has been observed in this entity secondary to development of several novel preventive, diagnostic and therapeutic modalities. Objective: To study the current trends in presentation, management and outcome of hyperbilirubinemia among newborns delivered to Rh negative mothers. Methodology: This observational descriptive study with prospective data collection included one hundred live born term babies born to Rh negative mothers in our hospital. A predesigned proforma was used to record antenatal and postnatal data .Cord blood collected during delivery for assessment of bilirubin,hematocrit and direct coombs test.Serum bilirubin levels were estimated in babies with clinical jaundice and treated for the same if required.All babies were regularly followed up weekly for one month. Chi square test/Fisher Exact test and Student “t” test has been used to find the significant association of jaundice(incidence,treatment) and study characteristics. Results: Out of 100 babies enrolled, 57 babies developed jaundice. Jaundice is 2.7 times more likely associated with babies born to multiparous Rh-ve mothers with p=0.017*. Jaundice is 3 times more likely associated with Rh+ve babies born to multiparous mothers with p=0.020*. Jaundice is 3.97 times more likely associated with Rh+ve babies born to multiparous mothers who have not received Anti-D with p=0.154. Treatment of jaundice is 2.75 times more likely in Rh+ve babies born to multiparous mothers who have not received Anti-D with p=0.162. Duration of phototherapy is significantly more in Rh+ve babies born to multiparous mothers who had not received Anti-D with p=0.0097*.Exchange transfusion was required in two babies. Conclusion: Although the incidence of Rh isoimmunization has declined dramatically over the years ,it is still an important cause of neonatal morbidity and mortality emphasizing the need for more vigorous preventive efforts and up-to-date management skills.
- Published
- 2013
- Full Text
- View/download PDF
16. Guidelines for the obstetric management of an alloimmune mother and her newborn
- Author
-
Ismael Rodríguez, Fernanda Blasina, Grazzia Rey, Florencia Garat, Virginia Marcalain, Jimena Bentos, Gabriela Rivas, Juan Recouso, Cordano, Valentina Silveira, Marcelo De Agostini, Luis Miguel Gómez, Valeria Correa, Mariana Sauleda, and Valeria Alonso
- Subjects
Medicine (General) ,Isoimunização ,Embarazo ,Energy Engineering and Power Technology ,Doença hemolítica do recém-nascido ,Anemia neonatal ,Aloimunização ,R5-920 ,Aloinmunización ,FLUJOMETRÍA POR LÁSER-DOPPLER ,Pregnancy ,Imunoprofilaxia anti D ,ANEMIA NEONATAL ,Isoimmunization ,Fluxometria por laser-Doppler ,Alloimmunization ,Anemia, neonatal ,Enfermedad hemolítica del recién nacido ,ISOINMUNIZACIÓN ,ENFERMEDAD HEMOLÍTICA DEL FETO ,Laser-Doppler flowmetry ,Flujometría por láser-Doppler ,EMBARAZO ,Isoinmunización ,Immunoprofilaxis anti D ,Doença hemolítica do feto ,ENFERMEDAD HEMOLÍTICA DEL RECIÉN NACIDO ,Fuel Technology ,Hemolytic disease of the newborn ,Hemolytic disease of the fetus ,Medicine ,Gravidez ,Anti D immunoprophylaxis ,Enfermedad hemolítica del feto - Abstract
Resumen: La aloinmunización es una respuesta biológica frente a la exposición de antígenos no propios. La gestación, las transfusiones de hemocomponentes, los trasplantes de órganos sólidos y células hematopoyéticas, así como el consumo de drogas intravenosas exponen a las pacientes al desarrollo de aloanticuerpos antieritrocitarios. El hallazgo de los mismos debe cumplir con las instancias diagnósticas para identificar la probabilidad de estar asociados a enfermedad hemolítica feto neonatal (EHFN) y su oportuna derivación a policlínica de alto riesgo obstétrico (ARO) para su correcto seguimiento. Es fundamental que sean los laboratorios de inmunohematología de los servicios de hemoterapia y medicina transfusional los encargados de los estudios diagnósticos de aloinmunización eritrocitaria(1). En este sentido hemos elaborado esta guía con el objetivo de protocolizar de manera multidisciplinaria el manejo de las embarazadas aloinmunizadas y sus recién nacidos. 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. Resumo: A aloimunização é uma resposta biológica à exposição a antígenos não próprios. A gravidez, as transfusões de hemocomponentes, os transplantes de órgãos sólidos e células hematopoiéticas, bem como o uso de drogas intravenosas expõem os pacientes ao desenvolvimento de anticorpos antieritrocitários. O achado destes deve obedecer a critérios diagnósticos para identificar a doença e a probabilidade de estarem associados a doença hemolítica feto neonatal (DHPN) e seu encaminhamento oportuno para uma unidade de alto risco obstétrico para acompanhamento adequado. É fundamental que os laboratórios de imuno-hematologia dos serviços de Hemoterapia e Medicina Transfusional se encarreguem dos estudos diagnósticos da aloimunização eritrocitária. Elaboramos este guia com o objetivo de estabelecer um protocolo multidisciplinar para o manejo de gestantes aloimunizadas e seus recém-nascidos.
- Published
- 2021
17. Management and outcome of pregnancies in women with red cell isoimmunization: a 15-year observational study from a tertiary care university hospital
- Author
-
Nuria Nogués, Elena Carreras, María Teresa Higueras, María Ángeles Sánchez-Durán, Cecilia Halajdian-Madrid, Andrea Bernabeu-García, Mayte Avilés García, Nerea Maiz, [Sánchez-Durán MA, Higueras MT, Halajdian-Madrid C, Avilés García M, Bernabeu-García A, Maiz N, Carreras E] Unitat de Medicina maternal i fetal, Vall d’Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
- Subjects
Middle Cerebral Artery ,enfermedades de los genitales femeninos y complicaciones del embarazo::complicaciones del embarazo::enfermedades fetales [ENFERMEDADES] ,Erythrocytes ,Anèmia ,Blood Transfusion, Intrauterine ,030204 cardiovascular system & hematology ,Reaccions antígen-anticòs ,Hospitals, University ,0302 clinical medicine ,Isoantibodies ,Pregnancy ,Other subheadings::/therapeutic use [Other subheadings] ,Fetal RhD ,030219 obstetrics & reproductive medicine ,aminoácidos, péptidos y proteínas::proteínas::proteínas sanguíneas::inmunoproteínas::inmunoglobulinas::anticuerpos::isoanticuerpos [COMPUESTOS QUÍMICOS Y DROGAS] ,biology ,Obstetrics ,Pregnancy Outcome ,Obstetrics and Gynecology ,Gestational age ,Anemia ,Fetal Diseases ,Female ,Hemic and Lymphatic Diseases::Hematologic Diseases::Anemia [DISEASES] ,enfermedades hematológicas y linfáticas::enfermedades hematológicas::anemia [ENFERMEDADES] ,Antibody ,Blood Flow Velocity ,Research Article ,Adult ,medicine.medical_specialty ,Genotype ,Reproductive medicine ,Gestational Age ,lcsh:Gynecology and obstetrics ,Ultrasonography, Prenatal ,03 medical and health sciences ,medicine ,Humans ,Isoimmunization ,lcsh:RG1-991 ,Retrospective Studies ,Fetus ,Red Cell ,Otros calificadores::/uso terapéutico [Otros calificadores] ,business.industry ,Infant, Newborn ,Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Immunoproteins::Immunoglobulins::Antibodies::Isoantibodies [CHEMICALS AND DRUGS] ,Retrospective cohort study ,Ultrasonography, Doppler ,medicine.disease ,Newborn hemolytic disease ,Intrauterine transfusion ,Female Urogenital Diseases and Pregnancy Complications::Pregnancy Complications::Fetal Diseases [DISEASES] ,biology.protein ,Observational study ,Immunization ,business ,Fetus - Malalties ,Follow-Up Studies ,Forecasting - Abstract
Background The aims of this study were to determine the prevalence of the different anti-erythrocytic alloantibodies, to describe pregnancy outcomes according to a low-risk and high-risk classification for fetal anemia and to determine the factors that influence adverse perinatal outcomes. Methods This retrospective observational study included women referred to our center following the identification of maternal anti-erythrocytic alloantibodies between 2002 and 2017. Pregnancies were classified as high risk for fetal anemia in cases with clinically significant antibodies, no fetal-maternal compatibility and titers ≥1:16 or any titration in cases of Kell system incompatibility. In high-risk pregnancies, maternal antibody titration and the fetal middle cerebral artery peak systolic velocity (MCA-PSV) were monitored. Low-risk pregnancies underwent routine pregnancy follow-up. Results Maternal antibodies were found in 337 pregnancies, and 259 (76.9%) of these antibodies were clinically significant. The most frequent antibodies were anti-D (53%) and anti-K (19%). One hundred forty-three pregnancies were classified as low risk for fetal anemia, 65 (25%) cases were classified as no fetal-maternal incompatibility, 78 had clinically nonsignificant antibodies, 4 (2.8%) resulted in first-trimester pregnancy loss, and 139 (97.2%) resulted in livebirths. Of the 194 high-risk pregnancies, 38 had titers 1.5 MoM, resulting in 3 intrauterine deaths, 6 terminations and 48 livebirths. Ninety-two intrauterine transfusions were performed in 45 fetuses (87% anti-D). Adverse outcomes were related to a MCA-PSV > 1.5 MoM (p p p = 0.029) Conclusion Anti-D remains the most common antibody in fetuses requiring intrauterine transfusion. A low or high-risk classification for fetal anemia based on the type of antibody, paternal phenotype and fetal antigen allows follow-up of the pregnancy accordingly, with good perinatal outcomes in the low-risk group. In the high-risk group, adverse perinatal outcomes are related to high MCA-PSV, hydrops and early gestational age at first transfusion.
- Published
- 2019
18. Transfusão intra-uterina em fetos afetados pela doença hemolítica perinatal grave: um estudo descritivo Intrauterine transfusion in fetuses affected by severe perinatal hemolytic disease: a descriptive study
- Author
-
Dorival Antônio Vitorello, Luiz Miguel Mitri Parente, Rodolfo João Ramos, Luís Flávio de Andrade Gonçalves, Cláudia Diniz Baumgarten, and Jorge Abi Saab Neto
- Subjects
Transfusão intra-uterina ,Doença hemolítica perinatal ,Cordocentese ,Isoimunização ,Intrauterine transfusion ,Hemolytic disease ,Cordocentesis ,Fetal blood sampling ,Isoimmunization ,Gynecology and obstetrics ,RG1-991 - Abstract
Objetivo: analisar 54 transfusões intravasculares intra-uterinas (TIVs), ressaltando complicações do procedimento e morbimortalidade perinatal. Material e Métodos: fetos submetidos a TIVs na Clínica Materno-Fetal e Maternidade Carmela Dutra (Florianópolis, SC), entre janeiro de 1992 e agosto de 1997, foram incluídos no estudo. As características das gestantes, dados relativos ao procedimento e ao recém-nascido foram tabulados para análise e apresentados de forma descritiva, utilizando-se percentagem, média, desvio padrão, mediana, variação e risco relativo (RR) com intervalo de confiança de 95% (IC) conforme apropriado. Resultados: foram realizadas 50 TIVs e quatro ex-sangüíneo transfusões em 21 fetos. Houve quatro óbitos (20%), três dos quais (75%) ocorridos em fetos hidrópicos. A idade gestacional média quando da primeira transfusão foi de 29,1 semanas. A concentração média de hemoglobina foi de 5,69 mg/dl. A taxa de mortalidade decorrente do procedimento foi de 7,4%. A idade gestacional média ao nascimento foi 33,9 semanas e o peso médio foi 2.437 gramas. Sessenta e cinco por cento dos recém-nascidos receberam ex-sangüíneo transfusão complementar. Conclusão: a taxa de mortalidade por procedimento (7,4%) foi semelhante à relatada na literatura mundial. A taxa de mortalidade perinatal (20%) foi mais elevada do que a relatada na literatura estrangeira, mas inferior à relatada em estudo conduzido no Brasil, no qual a prevalência de fetos hidrópicos foi semelhante.Objective: to report 54 intrauterine intravascular transfusions (IITs), describing procedure related complications and associated perinatal morbidity and mortality. Methods: fetuses undergoing IITs at Clínica Materno-Fetal and Maternidade Carmela Dutra, Florianópolis, SC, between January 1992 and August 1997 were included in the study. Patients demographics, procedure and newborn related data were tabulated for analysis and presented in descriptive form, using percentage, mean, standard deviation, median, range and relative risk (RR) with 95% confidence interval as appropriate. Results: fifty IITs and four exchange transfusions were performed in twenty-one fetuses. There were four deaths (20%), three of which occurred (75%) in hydropic fetuses. Mean gestational age at the time of the first IIT was 29.1 weeks, the mean hemoglobin concentration was 7.1 mg/dl and the mean rise in hemoglobin level per procedure was 5.69 mg/dl. Procedure related mortality rate was 7.4%. Mean gestational age at birth was 33.9 weeks and mean birth weight was 2,437 grams. Sixty-five percent of the newborns received complementary exchange transfusions. Conclusion: the procedure related mortality rate was 7.4%, similar to the mortality rate reported in the world literature. The perinatal mortality rate (20%) was higher than that reported in other countries but lower than the perinatal mortality rate reported in a study conducted in Brazil, with a similar prevalence of hydropic fetuses.
- Published
- 1998
- Full Text
- View/download PDF
19. Manejo de la embarazada con isoinmunización por anticuerpos irregulares.
- Author
-
Fuenzalida C., Javiera and Carvajal C., Jorge A.
- Abstract
Copyright of Revista Chilena de Obstetricia y Ginecología is the property of Revista Chilena de Obstetricia y Ginecologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2014
- Full Text
- View/download PDF
20. La Importancia de las Guías de Enfermería para mujeres embarazadas com Enfermedad Hemolítica Perinatal: uma revisión integradora
- Author
-
Cunha, Thayná Anselmo de Araújo, Santos, Julianna Carolinne Chrysostomo, SantAnna, Andréia Neves de, and Cruz, Vanessa Vianna
- Subjects
Pré-natal ,Isoimunização ,High-risk pregnancy ,Enfermagem ,Embarazo de alto riesgo ,Prenatal ,Isoinmunización ,Enfermería ,Isoimmunization ,Nursing ,Gravidez de alto risco - Abstract
This study aims to identify the guidelines provided by the nurse to the pregnant woman during prenatal care and to describe the influence of these guidelines in the construction of knowledge of the pregnant woman with Perinatal Hemolytic Disease. This is an integrative review conducted in the Virtual Health Library database, where data from LILACS, SciELO and Bdenf are available. Were included 03 publications between 2011 and 2018 in the category Importance of the education of clients and health professionals in the care of Perinatal Hemolytic Disease. We have noticed that there is a vast lack of access to information relevant to prenatal care and about the pathology in question. In view of this, the study rescues the significance of a high-risk prenatal care performed concomitantly by the medical professional and the nurse, since the nurse, as an educator, can be a key element in the process of remodeling care. Este estudio tiene como objetivo identificar las pautas previstas por la enfermera a la mujer embarazada, durante el cuidado prenatal y describir la influencia de estas pautas en la construcción del conocimiento de la mujer embarazada con la Enfermedad Hemolítica Perinatal. Se trata de una revisión integradora realizada en la base de datos de la Biblioteca Virtual de Salud, donde están disponibles los datos de LILACS, SciELO y Bdenf. Incluyeron se tres publicaciones entre 2011 y 2018 en la categoría Importancia de la educación de los clientes y los profesionales de la salud en el cuidado de la enfermedad hemolítica perinatal. Hemos observado que hay una gran falta de acceso a la información relevante para el cuidado prenatal y acerca de la patología en cuestión. En vista de ello, el estudio rescata la importancia de un cuidado prenatal de alto riesgo realizado concomitantemente por el profesional médico y la enfermera, ya que la enfermera, como educadora, puede ser un elemento clave en el proceso de remodelación del cuidado. O presente estudo visa identificar as orientações fornecidas pelo enfermeiro à gestante, durante o pré-natal e descrever a influência dessas orientações na construção do conhecimento da gestante portadora da Doença Hemolítica Perinatal. Trata-se de uma revisão integrativa realizada na base de dados da Biblioteca Virtual de Saúde, onde se encontram disponíveis dados do LILACS, SciELO e Bdenf. Foram incluídas 03 publicações entre o período de 2011 a 2018 na categoria Importância da educação de clientes e profissionais da saúde no cuidado da Doença Hemolítica Perinatal. Percebemos que há uma vasta deficiência de acesso às informações pertinentes ao pré-natal e a patologia em questão. Á vista disto, o estudo resgata a significância da realização de um pré-natal de alto risco realizado concomitantemente pelo profissional médico e enfermeiro, visto que o enfermeiro, enquanto educador, pode ser um elemento chave no processo de remodelação da assistência.
- Published
- 2020
21. Management and outcome of pregnancies in women with red cell isoimmunization: a 15-year observational study from a tertiary care university hospital
- Author
-
Sánchez-Durán, María Ángeles, Higueras, María Teresa, Halajdian-Madrid, Cecilia, Avilés García, Mayte, Bernabeu-García, Andrea, Maiz, Nerea, Nogués, Nuria, and Carreras, Elena
- Published
- 2019
- Full Text
- View/download PDF
22. Natural history of platelet antibody formation against αIIbβ3 in a French cohort of Glanzmann thrombasthenia patients.
- Author
-
FIORE, M., FIRAH, N., PILLOIS, X., NURDEN, P., HEILIG, R., and NURDEN, A. T.
- Subjects
- *
BLOOD platelets , *IMMUNOGLOBULINS , *BLOOD donors , *BLOOD transfusion , *IMMUNE system - Abstract
. Treatment of the bleeding syndrome in Glanzmann thrombasthenia (GT) is often complicated by naturally occurring isoantibodies directed against the αIIbβ3 integrin that cause the removal of or render ineffective transfused donor platelets. Such antibodies are produced after transfusion or pregnancy when the patient's immune system comes into contact with normal platelets. Despite many reports of anti-αIIbβ3 antibodies in GT patients, there is no consensus pertaining to their frequency, their long-term evolution in the circulation, or their formation in relation to either (i) the extent of the αIIbβ3 deficiency in the patient's platelets or (ii) the nature of the genetic defect ( ITGA2B or ITGB3 genes). Antibody screening was performed on a large series of 24 GT patients in South-West France dividing the patients into two cohorts: (i) 16 patients with the French gypsy mutation (c.1544 + 1G >A) within ITGA2B that gives platelets totally lacking αIIbβ3 and (ii) 8 patients carrying other defects of ITGA2B or ITGB3 with different expression levels of αIIbβ3. Our results confirm that patients with premature termination mutations resulting in platelets lacking αIIbβ3 are the most susceptible to form isoantibodies, a finding that may be useful in deciding the choice of therapy between platelet transfusion and the use of recombinant factor VIIa (FVIIa). [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
23. Correlation between the RhD genotyping and RhD serotyping in isoimmunized pregnancies.
- Author
-
El Din, Sahar M. Nour, ARamy, Ahmed R. M., and Ali, Mohamed S.
- Subjects
- *
SEROTYPING , *PREGNANCY , *POLYMERASE chain reaction , *ULTRASONIC imaging , *POSTNATAL care - Abstract
Alloimmunisation was one of the most important causes of perinatal mortality and morbidity by the middle of the last century. The objective of the present study was to investigate the presence of the RHD gene in fetal cells (amniocytes) obtained from amniotic fluid by genotyping to compare it with the RhD serotyping. Also to correlate the presence of RhD gene with the neonatal outcome. This work was carried out at Maternity hospital and Medical Genetics center, while PCR testing was done at the Medical Research center, Faculty of Medicine, Ain Shams University in the period from 2008 to 2010. The present study included recruiting of 20 RhD negative (sensitized to the RhD antigen) pregnant mothers. The entire study group was subjected to complete general, obstetric and a detailed obstetric ultrasonographic examination. Rh typing and indirect Coomb's test were also done. Amniocentesis was performed with a 20-gauge needle under continuous ultrasound guidance. RhD serotyping of the fetuses showed that, 14 fetuses (70%) were positive and six fetuses (30%) were negative. While using RhD gentyping 13 cases (65%) were positive and seven cases (35%) were negative (P value = 0.002). Among fetuses positive for RhD genotyping six fetuses (46%) had received postnatal treatment, while among fetuses negative for RhD genotyping, neither of them had received postnatal treatment (P value =0.032), which is statistically significant. From the present study we can conclude that, the identification of an antigen-negative fetus on the basis of the blood group genotype provides significant advantages in managing the pregnancy at risk for HDFN. [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
- View/download PDF
24. Anti-D in Rh positive pregnancies.
- Author
-
Prasad, Mona R., Krugh, Dave, Rossi, Karen Q., and O'Shaughnessy, Richard W.
- Subjects
PREGNANCY ,NEWBORN infants ,ERYTHROBLASTOSIS fetalis ,DIRECT Coombs' test ,COOMBS' test ,IMMUNIZATION - Abstract
Objective: The purpose of this study was to review the clinical outcomes of anti-D isoimmunization in a series of women who typed Rh positive or Rh weak positive. Study design: This was a review of The Ohio State University Medical Center Fetal Therapy Program Database. Results: Of 1068 pregnancies affected by anti-D, 5 pregnancies (0.47%) occurred in 4 women between 1994 and 2004, who were serologically typed as Rh positive or Rh weak positive. All 5 pregnancies delivered at term. All newborns were confirmed affected either by a positive direct antiglobulin test (DAT) or were Rh positive. Newborns were not anemic at birth and subsequently did not require transfusion. No newborns were treated for jaundice. All newborns were discharged home with their mothers. Conclusion: Anti-D hemolytic disease of the fetus and newborn (HDFN) is a rare complication of Rh positive and Rh weak positive pregnancies. Although the potential for severe HDFN exists in this clinical scenario, our experience suggests that in Rh positive or Rh weak positive pregnancies with anti-D isoimmunization, clinical HDFN is mild. Nonetheless, Rh positive or Rh weak positive patients with anti-D should be monitored for potentially significant HDFN. [ABSTRACT FROM AUTHOR]
- Published
- 2006
- Full Text
- View/download PDF
25. A retrospective review of isoimmunized pregnancies managed by middle cerebral artery peak systolic velocity.
- Author
-
McLean, Lynn K., Hedriana, Herman L., Lanouette, Jan M., and Haesslein, Hanns C.
- Subjects
PREGNANCY ,IMMUNIZATION ,CEREBRAL arteries ,CARDIAC contraction ,ULTRASONICS ,ERYTHROCYTES - Abstract
Objective: The purpose of this study was to determine the clinical outcome of isoimmunized pregnancies managed primarily by middle cerebral artery peak systolic velocity. Study design: A retrospective chart review was conducted of isoimmunized pregnancies that underwent ultrasound examinations from January 1, 2001, through May 1, 2003. Ultrasound reports, laboratory tests, and maternal and neonatal charts were reviewed. Results: Women with a clinically significant red blood cell antibody and titer value were included. The study population consisted of 39 women (40 pregnancies, 42 fetuses). Patients with a middle cerebral artery peak systolic velocity of ≥1.5 MoM were offered amniocentesis. Seven pregnancies had an abnormal middle cerebral artery peak systolic velocity. Three of these infants had significant anemia. Six of the 7 pregnancies required an exchange transfusion. None of the 33 pregnancies (35 neonates) with normal middle cerebral artery peak systolic velocity measurements resulted in a neonate with significant anemia or severe hyperbilirubinemia. Conclusion: The clinical outcome of these pregnancies supports the use of middle cerebral artery peak systolic velocity measurements in the management of isoimmunized pregnancies. [ABSTRACT FROM AUTHOR]
- Published
- 2004
- Full Text
- View/download PDF
26. The continuing burden of Rh disease 50 years after the introduction of anti-Rh(D) immunoglobin prophylaxis: call to action
- Author
-
Gerard H.A. Visser, Gian Carlo Di Renzo, Steven L. Spitalnik, Diogo Ayres-de-Campos, Maria Fernanda Escobar, Eytan Barnea, P.K. Shah, Anwar Nasser, Luc de Bernis, Luming Sun, Wanda Kay Nicholson, Isabel Lloyd, Salimah Walani, Gerhard Theron, and William Stones
- Subjects
medicine.medical_specialty ,fetal anemia ,Internationality ,hyperbilirubinemia ,Rho(D) Immune Globulin ,Disease ,isoimmunization ,Rh Isoimmunization ,blood groups ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,Fetal anemia ,prevention ,Pregnancy ,medicine ,alloimmunization ,hemolysis ,hemolytic disease of the fetus and newborn ,Rh disease ,Female ,Humans ,Immunologic Factors ,Prenatal Care ,Rh-Hr Blood-Group System ,030212 general & internal medicine ,Intensive care medicine ,030219 obstetrics & reproductive medicine ,biology ,business.industry ,Obstetrics and Gynecology ,Call to action ,biology.protein ,Severe morbidity ,Antibody ,business ,Perinatal Deaths - Abstract
Severe morbidity and death because of Rh disease have only been reduced by approximately 50% globally during the last 50 years, despite the advent of anti-Rh(D) immunoglobin prophylaxis, which has resulted in >160,000 perinatal deaths and 100,000 disabilities annually. This apparent failure to take appropriate preventive measures is of great concern. Thus, there is a great need to do much better. We wish to draw attention to the unnecessary continuing burden of Rh disease, to discuss some of the reasons for this failure, and to provide suggestions for a better way forward.
- Published
- 2019
27. Isoimmunization of man by recrystallized human insulin.
- Author
-
Deckert, T., Andersen, O., Grundahl, E., and Kerp, L.
- Abstract
Copyright of Diabetologia is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 1972
- Full Text
- View/download PDF
28. The antigenicity of pig insulin.
- Author
-
Deckert, Torsten and Grundahl, Else
- Abstract
Copyright of Diabetologia is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 1970
- Full Text
- View/download PDF
29. Treatment and Prevention of Rh Isoimmunization
- Author
-
Agarwal, Krishna, Rana, Anubhuti, and Ravi, Anoosha K.
- Published
- 2014
- Full Text
- View/download PDF
30. Correlation between the RhD genotyping and RhD serotyping in isoimmunized pregnancies
- Author
-
Sahar M. Nour El Din, Ahmed R.M. ARamy, and Mohamed S. Ali
- Subjects
Gynecology ,Fetus ,medicine.medical_specialty ,Pregnancy ,RHD ,Amniotic fluid ,medicine.diagnostic_test ,Obstetrics ,business.industry ,Rhesus ,medicine.disease ,Hydrops fetalis ,Rh negative ,medicine ,Amniocentesis ,Medical genetics ,Isoimmunization ,Genetics(clinical) ,business ,Genotyping ,Rh blood group system ,Genetics (clinical) ,Maternal alloimmunization - Abstract
Alloimmunisation was one of the most important causes of perinatal mortality and morbidity by the middle of the last century. The objective of the present study was to investigate the presence of the RHD gene in fetal cells (amniocytes) obtained from amniotic fluid by genotyping to compare it with the RhD serotyping. Also to correlate the presence of RhD gene with the neonatal outcome. This work was carried out at Maternity hospital and Medical Genetics center, while PCR testing was done at the Medical Research center, Faculty of Medicine, Ain Shams University in the period from 2008 to 2010. The present study included recruiting of 20 RhD negative (sensitized to the RhD antigen) pregnant mothers. The entire study group was subjected to complete general, obstetric and a detailed obstetric ultrasonographic examination. Rh typing and indirect Coomb’s test were also done. Amniocentesis was performed with a 20-gauge needle under continuous ultrasound guidance. RhD serotyping of the fetuses showed that, 14 fetuses (70%) were positive and six fetuses (30%) were negative. While using RhD gentyping 13 cases (65%) were positive and seven cases (35%) were negative (P value = 0.002). Among fetuses positive for RhD genotyping six fetuses (46%) had received postnatal treatment, while among fetuses negative for RhD genotyping, neither of them had received postnatal treatment (P value =0.032), which is statistically significant. From the present study we can conclude that, the identification of an antigen-negative fetus on the basis of the blood group genotype provides significant advantages in managing the pregnancy at risk for HDFN.Keywords: Maternal alloimmunization; Rhesus; RHD; Isoimmunization; Hydrops fetalis; Fetus; Rh negative
- Published
- 2011
- Full Text
- View/download PDF
31. Evolving Trends: Hyperbilirubinemia Among Newborns Delivered to Rh Negative Mothers in Southern India
- Author
-
Santosh S, Keshavamurthy, and Girish N
- Subjects
Pediatrics ,medicine.medical_specialty ,neonatal jaundice ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,Clinical Biochemistry ,lcsh:R ,lcsh:Medicine ,General Medicine ,Jaundice ,Hematocrit ,isoimmunization ,medicine.disease ,symbols.namesake ,Hemolytic disease of the newborn (ABO) ,Etiology ,symbols ,Medicine ,Original Article ,Rh Isoimmunization ,medicine.symptom ,business ,Rh blood group system ,Fisher's exact test - Abstract
Introduction: Neonatal jaundice is the commonest abnormal physical finding in the new born nursery and hemolytic disease of the newborn (HDN) among babies born to Rh negative mothers is the most formidable etiology. During last few decades considerable evolution has been observed in this entity secondary to development of several novel preventive, diagnostic and therapeutic modalities. Objective: To study the current trends in presentation, management and outcome of hyperbilirubinemia among newborns delivered to Rh negative mothers. Methodology: This observational descriptive study with prospective data collection included one hundred live born term babies born to Rh negative mothers in our hospital. A predesigned proforma was used to record antenatal and postnatal data .Cord blood collected during delivery for assessment of bilirubin,hematocrit and direct coombs test.Serum bilirubin levels were estimated in babies with clinical jaundice and treated for the same if required.All babies were regularly followed up weekly for one month. Chi square test/Fisher Exact test and Student “t” test has been used to find the significant association of jaundice(incidence,treatment) and study characteristics. results: Out of 100 babies enrolled, 57 babies developed jaundice. Jaundice is 2.7 times more likely associated with babies born to multiparous Rh-ve mothers with p=0.017*. Jaundice is 3 times more likely associated with Rh+ve babies born to multiparous mothers with p=0.020*. Jaundice is 3.97 times more likely associated with Rh+ve babies born to multiparous mothers who have not received Anti-D with p=0.154. Treatment of jaundice is 2.75 times more likely in Rh+ve babies born to multiparous mothers who have not received Anti-D with p=0.162. Duration of phototherapy is significantly more in Rh+ve babies born to multiparous mothers who had not received Anti-D with p=0.0097*.Exchange transfusion was required in two babies. conclusion: Although the incidence of Rh isoimmunization has declined dramatically over the years ,it is still an important cause of neonatal morbidity and mortality emphasizing the need for more vigorous preventive efforts and up-to-date management skills.
- Published
- 2013
32. The continuing burden of Rh disease 50 years after the introduction of anti-Rh(D) immunoglobin prophylaxis: call to action.
- Author
-
Visser, Gerard H.A., Di Renzo, Gian Carlo, Spitalnik, Steven L., and FIGO Committee Safe Motherhood and Newborn Health
- Subjects
PERINATAL death ,PREVENTIVE medicine ,ERYTHROBLASTOSIS fetalis ,HEALTH services accessibility ,IMMUNOLOGICAL adjuvants ,PRENATAL care ,RH factor ,RHO(D) immune globulin ,RH isoimmunization - Abstract
Severe morbidity and death because of Rh disease have only been reduced by approximately 50% globally during the last 50 years, despite the advent of anti-Rh(D) immunoglobin prophylaxis, which has resulted in >160,000 perinatal deaths and 100,000 disabilities annually. This apparent failure to take appropriate preventive measures is of great concern. Thus, there is a great need to do much better. We wish to draw attention to the unnecessary continuing burden of Rh disease, to discuss some of the reasons for this failure, and to provide suggestions for a better way forward. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
33. Fluxo no ducto venoso e na veia cava inferior dos fetos em gestações isoimunizadas Assess flow velocity in the ductus venosus and inferior vena cava in fetuses in isoimmunized pregnancies
- Author
-
Eura Martins Lage, Antônio Carlos Vieira Cabral, and Henrique Vitor Leite
- Subjects
lcsh:R5-920 ,Isoimunização ,Fetal anemia ,Ductus venosus ,Veia cava inferior ,Ducto venoso ,Doppler flowmetry ,embryonic structures ,cardiovascular system ,Dopplerfluxometria ,Anemia fetal ,Isoimmunization ,cardiovascular diseases ,Inferior vena cava ,lcsh:Medicine (General) ,reproductive and urinary physiology - Abstract
OBJETIVO: Avaliar a velocidade de fluxo na veia cava inferior e no ducto venoso em fetos, nas gestações isoimunizadas. MÉTODOS: De junho de 1999 a junho de 2004, foram avaliados 61 fetos, entre 27 e 35 semanas, de gestantes portadoras de isoimunização por antígenos eritrocitários. Em todos os fetos foram avaliadas as velocidades de fluxo na veia cava inferior e no ducto venoso. Obteve-se amostra de sangue fetal para determinação dos valores da hemoglobina e calculou-se o déficit da concentração de hemoglobina. Esses fetos foram divididos em quatro grupos, de acordo com o déficit da concentração de hemoglobina: fetos não anêmicos, anêmicos leves, anêmicos moderados e anêmicos graves. Utilizou-se o teste Qui-quadrado para comparar os quatro grupos de fetos quanto à proporção da alteração da velocidade média de fluxo na veia cava inferior e no ducto venoso. RESULTADOS: A velocidade de fluxo na veia cava inferior estava alterada em 3,8% dos fetos não anêmicos, em 3,1% dos fetos com anemia leve, em 40% dos anêmicos moderados e em 76% dos fetos com anemia grave. Já a velocidade de fluxo no ducto venoso estava alterada em 7,7% dos fetos não anêmicos, em 3,1% dos fetos com anemia leve, em 32,5% dos anêmicos moderados e em 68% dos fetos com anemia grave. O valor p foi inferior a 0,001. CONCLUSÃO: Verificou-se aumento da freqüência de alteração da velocidade de fluxo na veia cava inferior e no ducto venoso à medida que a anemia se agravava.OBJECTIVE: Ductus venosus and inferior vena cava flow velocity was assessed in fetuses in isoimmunized pregnancies. METHODS: Examination of 61 fetuses aged 27 to 35 weeks from Rh-erythrocyte antigen isoimmunized women was carried out from June 1999 to June 2004. All fetuses were submitted to the examination of ductus venosus and inferior vena cava flow velocity. Blood samples were collected to determine hemoglobin values and hemoglobin concentration deficits. Accordingly, fetuses were grouped as follows: non-anemic; mildly anemic; moderately anemic and severely anemic fetuses. Comparison of the variation of average flow velocity in the inferior vena cava and ductus venosus across the four groups was carried out using the chi-square test. RESULTS: Inferior vena cava flow velocity was found to be altered in 3.8% of non-anemic fetuses; in 3.1% of the mildly anemic, in 40.0% of those moderately anemic; and in 76.0% of the severely anemic ones. Alteration in ductus venosus flow velocity, in turn, was identified in 7.7% of non-anemic fetuses; 3.1% of mildly anemic; 32.5% of moderately anemic and 68.0% of those severely anemic. Results were statistically significant with p < 0.001. CONCLUSION: The study shows that alteration of flow velocity in the inferior vena cava and ductus venosus increased with the severity of anemia.
- Published
- 2006
34. Manejo de la embarazada con isoinmunización por anticuerpos irregulares
- Author
-
Fuenzalida C, Javiera and Carvajal C, Jorge A
- Subjects
perinatal hemolytic disease ,hemic and lymphatic diseases ,irregular antibodies ,Isoinmunización ,enfermedad hemolítica perinatal ,Isoimmunization ,anticuerpos irregulares - Abstract
La isoinmunización eritrocitaria feto-materna se define como la presencia de anticuerpos maternos dirigidos contra antígenos presentes en los glóbulos rojos fetales. Los anticuerpos maternos pueden atravesar la barrera placentaria y provocar hemólisis de los glóbulos rojos fetales produciendo anemia hemolítica e hiperbilirrubinemia, características de la enfermedad hemolítica perinatal (EHP). La principal causa de EHP es la incompatibilidad ABO, seguida de la isoinmunización por RhD; esta última ha disminuido su incidencia dado el amplio uso de inmunoglobulina anti D. Sin embargo, el glóbulo rojo tiene más de 400 antígenos, muchos de ellos (>50) capaces de producir isoinmunización y EHP. En este artículo, revisamos la evidencia y proponemos un algoritmo de manejo y seguimiento de las embarazadas con isoinmunización por anticuerpos irregulares. En la isoinmunización por anticuerpos irregulares, los títulos de anticuerpos maternos no se correlacionan con la gravedad de la enfermedad. La anemia en la EHP por anticuerpos anti-Kell es secundaria a una supresión de la eritroblastosis fetal a diferencia del resto de los sistemas que producen anemia hemolítica. Recomendamos efectuar tamizaje de todas las pacientes en el control prenatal, solicitando grupo sanguíneo, Rh y test de Coombs indirecto. En las pacientes Rh (+) con test de Coombs indirecto positivo es necesario identificar los anticuerpos irregulares. En caso de tener isoinmunización por anticuerpos irregulares con riesgo de EHP, derivar a una unidad de alto riesgo obstétrico para realizar seguimiento de la aparición de anemia fetal midiendo de modo seriado el peak sistólico de la arteria cerebral media. Si se detecta anemia fetal, debemos planificar una cordocentesis para confirmar el diagnóstico y tratar la anemia. The fetomaternal erythrocyte isoimmunization is defined as the presence of maternal antibodies directed against antigens present in fetal red blood cells. Maternal antibodies can cross the placenta and cause hemolysis of fetal red blood cells causing hyperbilirubinemia and hemolytic anemia, known as perinatal hemolytic disease (PHD). The main cause of PHD is ABO incompatibility, followed by RhD isoimmunization. The latter has decreased its incidence since the widespread use of anti-D immunoglobulin. However, the red cell has more than 400 antigens; many of them (>50) can lead to isoimmunization and PHD. In this article, we review the evidence and propose an algorithm for the management and monitoring of pregnant women with irregular antibodies isoimmunization. In the isoimmunization by irregular antibodies, maternal antibody titers do not correlate with the severity of the disease. Anemia in PHD by anti-Kell is secondary to suppression of fetal erythroblastosis unlike other systems that produce hemolytic anemia. We suggest the screening of all patients in the prenatal control with blood group, Rh and indirect Coombs test. In the Rh (+) patients with positive indirect Coombs test, irregular antibodies should be identified. In case of immunization by irregular antibodies in risk of PHD, the women should be referred to a high-risk obstetrics where the appearance of fetal anemia should be seek by measuring systolic peak of middle cerebral artery. If anemia is detected full confirmation of diagnosis and treatment should be effected by cordocentesis.
- Published
- 2014
35. Comparison between two treatment protocols with recombinant human erythropoietin (rHuEpo) in the treatment of late anemia in neonates with Rh-isoimmunization
- Author
-
Maria Cavani, Costantino Romagnoli, Giovanni Alighieri, Piero Catenazzi, Annamaria D'Antuono, Antonio Alberto Zuppa, Riccardo Riccardi, and Annalisa Fracchiolla
- Subjects
medicine.medical_specialty ,Pediatrics ,rHuEpo ,Anemia ,Injections, Subcutaneous ,lcsh:Surgery ,isoimmunization ,Hematocrit ,Rh Isoimmunization ,Gastroenterology ,anti c ,Cohort Studies ,Reticulocyte Count ,newborn ,Internal medicine ,late anemia ,Medicine ,Humans ,Platelet ,Erythropoietin ,medicine.diagnostic_test ,business.industry ,Anemia, Neonatal ,Incidence (epidemiology) ,lcsh:RJ1-570 ,Infant, Newborn ,lcsh:Pediatrics ,lcsh:RD1-811 ,medicine.disease ,Treatment Outcome ,Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA ,Pediatrics, Perinatology and Child Health ,Cohort ,Surgery ,business ,Algorithms ,medicine.drug ,Cohort study - Abstract
Objectve. The Rh-hemolytic disease can lead to a late anemia by hemolytic and hyporigenerative mechanism. We compared the effectiveness of rHuEPO in two care protocols that differ for doses of rHuEPO administrated and for timing of administration. Methods. A cohort of 14 neonates was investigated. The neonates were treated with two different protocols. Protocol A: a dose of 200 U/kg/day of rHuEpo administered subcutaneously starting from the end of the second week of life; Protocol B: a dose of 400 U/kg/day of rHuEpo administered subcutaneously starting from the end of the first week of life. Results. The hematocrit values in the protocol A group decreased during treatment (32,5% vs 25,2%), whereas the hematocrit value in protocol B group remained almost stable (38,7% vs 42,8%). The mean numbers of platelets remained stable in both groups while neutrophils increased in protocol A group and decreased in protocol B (p
- Published
- 2012
36. Anti-Rh(c), 'Little C,' Isoimmunization: The Role of rHuEpo in Preventing Late Anemia
- Author
-
Annamaria D'Antuono, Piero Catenazzi, Antonio Alberto Zuppa, Valentina Cardiello, Francesco Cota, Giovanni Alighieri, Costantino Romagnoli, and Riccardo Riccardi
- Subjects
medicine.medical_specialty ,Pediatrics ,Blood transfusion ,rHuEpo ,Anemia ,medicine.medical_treatment ,Blood Transfusion, Intrauterine ,isoimmunization ,Rh Isoimmunization ,Gastroenterology ,Erythroblastosis, Fetal ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Humans ,Recombinant erythropoietin ,Cation Transport Proteins ,Erythropoietin ,Membrane Glycoproteins ,biology ,business.industry ,Infant, Newborn ,Hematology ,medicine.disease ,Recombinant Proteins ,Membrane glycoproteins ,Oncology ,Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA ,Pediatrics, Perinatology and Child Health ,biology.protein ,Female ,business - Abstract
The overall prevalence of non-Rh-D isoimmunization seems to lie between 0.15% and 1.1%. Anti-Rh(c) alloimmunization, "little c," occurs in 0.07% of pregnancies and shows a quite broad clinical presentation. Late anemia is a frequent problem occurring in the setting of isoimmunization. It occurs more frequently after intrauterine blood transfusions or exsanguinotransfusion, and it can be thought as a hyporegenerative anemia. The authors describe the use of human recombinant erythropoietin in preventing late anemia in a case of anti-Rh(c) isoimmunization. The use of human recombinant erythropoietin is a valid tool for preventing late-onset anemia due to either anti-Rh-D or non-anti-Rh-D isoimmunization.
- Published
- 2012
37. Isoimmune thrombocytopenic purpura in newborn piglets: a case report
- Author
-
Galletti, Elena, Merialdi, G, Antonelli, A, Brini, E, Fusaro, L, Sarli, G, Fontana, Mc, Spaggiari, B, Martelli, P., SYLVIE D’ALLAIRE AND ROBERT FRIENDSHIP, GALLETTI E., MERIALDI G., ANTONELLI A., BRINI E., FUSARO L., SARLI G., FONTANA M.C., SPAGGIARI B., and MARTELLI P.
- Subjects
PURPURA ,ISOIMMUNIZATION ,TROMBOCYTOPENIA ,PIGLET - Abstract
vedi allegato
- Published
- 2010
38. Anti-Rh(c), 'Little C,' Isoimmunization: The Role of rHuEpo in Preventing Late Anemia
- Author
-
Zuppa, Antonio Alberto, Cardiello, Valentina, Alighieri, Giovanni, Cota, Francesco, D'Antuono, Annamaria, Riccardi, R, Catenazzi, P, Romagnoli, C., Zuppa, Antonio Alberto (ORCID:0000-0001-8139-2576), Cota, Francesco (ORCID:0000-0002-9009-3997), Zuppa, Antonio Alberto, Cardiello, Valentina, Alighieri, Giovanni, Cota, Francesco, D'Antuono, Annamaria, Riccardi, R, Catenazzi, P, Romagnoli, C., Zuppa, Antonio Alberto (ORCID:0000-0001-8139-2576), and Cota, Francesco (ORCID:0000-0002-9009-3997)
- Abstract
The overall prevalence of non-Rh-D isoimmunization seems to lie between 0.15% and 1.1%. Anti-Rh(c) alloimmunization, "little c," occurs in 0.07% of pregnancies and shows a quite broad clinical presentation. Late anemia is a frequent problem occurring in the setting of isoimmunization. It occurs more frequently after intrauterine blood transfusions or exsanguinotransfusion, and it can be thought as a hyporegenerative anemia. The authors describe the use of human recombinant erythropoietin in preventing late anemia in a case of anti-Rh(c) isoimmunization. The use of human recombinant erythropoietin is a valid tool for preventing late-onset anemia due to either anti-Rh-D or non-anti-Rh-D isoimmunization.
- Published
- 2012
39. Comparison between two treatment protocols with recombinant human erythropoietin (rHuEpo) in the treatment of late anemia in neonates with Rh-isoimmunization
- Author
-
Zuppa, Antonio Alberto, Fracchiolla, Annalisa, Catenazzi, Piero, D'Antuono, Annamaria, Riccardi, Riccardo, Cavani, M, Romagnoli, C., Zuppa, Antonio Alberto (ORCID:0000-0001-8139-2576), Riccardi, Riccardo (ORCID:0000-0001-7515-6622), Zuppa, Antonio Alberto, Fracchiolla, Annalisa, Catenazzi, Piero, D'Antuono, Annamaria, Riccardi, Riccardo, Cavani, M, Romagnoli, C., Zuppa, Antonio Alberto (ORCID:0000-0001-8139-2576), and Riccardi, Riccardo (ORCID:0000-0001-7515-6622)
- Abstract
OBJECTVE: The Rh-hemolytic disease can lead to a late anemia by hemolytic and hyporigenerative mechanism. We compared the effectiveness of rHuEPO in two care protocols that differ for doses of rHuEPO administrated and for timing of administration. METHODS: A cohort of 14 neonates was investigated. The neonates were treated with two different protocols. Protocol A: a dose of 200 U/kg/day of rHuEpo administered subcutaneously starting from the end of the second week of life; Protocol B: a dose of 400 U/kg/day of rHuEpo administered subcutaneously starting from the end of the first week of life. RESULTS: The hematocrit values in the protocol A group decreased during treatment (32,5% vs 25,2%), whereas the hematocrit value in protocol B group remained almost stable (38,7% vs 42,8%). The mean numbers of platelets remained stable in both groups while neutrophils increased in protocol A group and decreased in protocol B (p<0,05). Reticulocyte count increased during treatment in both groups, although only in protocol B group it was statistically significative (p<0,05). CONCLUSIONS: Our results suggest a similar efficacy between the two treatment protocols. Increasing doses of rHuEPO do not seem enhancing their effectiveness and the incidence of side effects.
- Published
- 2012
40. Fluxo no ducto venoso e na veia cava inferior dos fetos em gestações isoimunizadas
- Author
-
Lage, Eura Martins, Cabral, Antônio Carlos Vieira, and Leite, Henrique Vitor
- Subjects
Isoimunização ,Fetal anemia ,Ductus venosus ,Veia cava inferior ,Ducto venoso ,Doppler flowmetry ,embryonic structures ,cardiovascular system ,Dopplerfluxometria ,Anemia fetal ,Isoimmunization ,cardiovascular diseases ,Inferior vena cava ,reproductive and urinary physiology - Abstract
OBJETIVO: Avaliar a velocidade de fluxo na veia cava inferior e no ducto venoso em fetos, nas gestações isoimunizadas. MÉTODOS: De junho de 1999 a junho de 2004, foram avaliados 61 fetos, entre 27 e 35 semanas, de gestantes portadoras de isoimunização por antígenos eritrocitários. Em todos os fetos foram avaliadas as velocidades de fluxo na veia cava inferior e no ducto venoso. Obteve-se amostra de sangue fetal para determinação dos valores da hemoglobina e calculou-se o déficit da concentração de hemoglobina. Esses fetos foram divididos em quatro grupos, de acordo com o déficit da concentração de hemoglobina: fetos não anêmicos, anêmicos leves, anêmicos moderados e anêmicos graves. Utilizou-se o teste Qui-quadrado para comparar os quatro grupos de fetos quanto à proporção da alteração da velocidade média de fluxo na veia cava inferior e no ducto venoso. RESULTADOS: A velocidade de fluxo na veia cava inferior estava alterada em 3,8% dos fetos não anêmicos, em 3,1% dos fetos com anemia leve, em 40% dos anêmicos moderados e em 76% dos fetos com anemia grave. Já a velocidade de fluxo no ducto venoso estava alterada em 7,7% dos fetos não anêmicos, em 3,1% dos fetos com anemia leve, em 32,5% dos anêmicos moderados e em 68% dos fetos com anemia grave. O valor p foi inferior a 0,001. CONCLUSÃO: Verificou-se aumento da freqüência de alteração da velocidade de fluxo na veia cava inferior e no ducto venoso à medida que a anemia se agravava. OBJECTIVE: Ductus venosus and inferior vena cava flow velocity was assessed in fetuses in isoimmunized pregnancies. METHODS: Examination of 61 fetuses aged 27 to 35 weeks from Rh-erythrocyte antigen isoimmunized women was carried out from June 1999 to June 2004. All fetuses were submitted to the examination of ductus venosus and inferior vena cava flow velocity. Blood samples were collected to determine hemoglobin values and hemoglobin concentration deficits. Accordingly, fetuses were grouped as follows: non-anemic; mildly anemic; moderately anemic and severely anemic fetuses. Comparison of the variation of average flow velocity in the inferior vena cava and ductus venosus across the four groups was carried out using the chi-square test. RESULTS: Inferior vena cava flow velocity was found to be altered in 3.8% of non-anemic fetuses; in 3.1% of the mildly anemic, in 40.0% of those moderately anemic; and in 76.0% of the severely anemic ones. Alteration in ductus venosus flow velocity, in turn, was identified in 7.7% of non-anemic fetuses; 3.1% of mildly anemic; 32.5% of moderately anemic and 68.0% of those severely anemic. Results were statistically significant with p < 0.001. CONCLUSION: The study shows that alteration of flow velocity in the inferior vena cava and ductus venosus increased with the severity of anemia.
- Published
- 2006
41. Transfusión intrauterina intravascular
- Author
-
González Arias, Freddy, Paravisini, Iván, Morales, Jazmín, and Vásquez de Martínez, Nelly
- Subjects
Aloinmunización ,Transfusion ,Transfusión ,Anemia ,Anaemia ,Isoimmunization - Abstract
Objetivo: Evaluar los resultados de 90 transfusiones intrauterinas intravasculares realizadas en 45 fetos afectados por aloinmunización Rh. Método: Descripción del procedimiento de transfusiones intrauterinas intravasculares y presentación de la evaluación y seguimiento prospectivo de 90 transfusiones llevadas a cabo entre el período 1995- 2002. Ambiente: Unidad de Alto Riesgo del Servicio de Prenatal de la Maternidad “Concepción Palacios”. Caracas. Resultados: La edad promedio de las pacientes fue 25,8 años; se realizaron en promedio 2 transfusiones por paciente, con un mínimo de 1 y un máximo de 4; la mayoría de las pacientes tenían antecedentes de importancia como mortinato anterior e historia de enfermedad hemolítica; la principal indicación para realizar la el procedimiento fue la lectura de densidad óptica seguida por el hidrops fetal; la edad promedio para realizar la primera transfusión fue de 25,6 semanas con un mínimo de 20 semanas; los valores de hemoglobina fetal previa a la primera oscilaron entre 2 y 11,3 g/dL ascendiendo posterior a la transfusión a valores entre 5 y 15,3 g/dL; la sobrevida total fue de 69 % y al analizar sólo los fetos sin hidrops la sobrevida ascendió a 84,37 %. Conclusiones: La prevención con el uso de inmunoglobulina anti Rh D es definitivamente el mejor protocolo para evitar la anemia fetal por aloinmunización Rh, cuando se produce la enfermedad hemolítica intrauterina el mejor tratamiento es la reposición de sangre a través del cordón umbilical. En nuestro trabajo confirmamos que se debe adquirir una amplia experiencia en el manejo de las transfusiones intrauterinas para de esta forma prolongar la vida intrauterina y así alcanzar mayor madurez y probabilidad de sobrevida neonatal con menores riesgos y complicaciones. Objective: To present the results of 90 intrauterine intravascular transfusions performed in 45 Rh isoinmunized fetuses. Method: Description of the intrauterine intravascular transfusion´s procedure and presentation of evaluation and prospective floow up of 90 transfusions practiced from 1995 to 2002. Setting: High Risk Unit of Prenatal Service at Maternidad Concepción Palacios. Caracas. Results: The mean age of patients was 25.8 years; the number of transfusions ranged from one to tour (the mean was two); most patients had important records of fetal death and hemolytic disease; transfusion was mainly prescribed after optical density values followed by fetal hydrops. Gestational age for the first procedure was 25.6 weeks with a minimum of 20 weeks; fetal haemoglobin values prior to the first transfusion ranged between 2-11.3 g/dL increasing to 5-15.3 g/dL post transfusion. Total survival was 69 % and increased to 84.37 % in the nonhydropic group. Conclusion: Prevention using antiRhD inmunoglobulin is definitively the best protocol when avoiding fetal anaemia due to Rh isoimmunization. When intrauterine hemolytic disease occurs, blood transfusion through umbilical cord seems to be the best option. In our experience, we confirmed that the accumulation of experience in intrauterine intravascular transfusion is needed in order to extend intrauterine life and so achieve a higher neonatal outcome along with less risk and complications.
- Published
- 2006
42. Accuracy of Doppler assessment velocimetric maximum peak systolic velocity of the middle cerebral artery in the detection of fetal anemia in hemolytic disease: a systematic review
- Author
-
Gonçalves Júnior, Mauro Arenázio, Faerstein, Eduardo, Lenza, Giovanni Fraga, Lourenço, Paulo Mauricio Campanha, and Sá, Renato Augusto Moreira de
- Subjects
Isoimunização ,Doppler ,Middle cerebral artery ,Isoimmunization ,Fetal anemia ,Anemia fetal ,Artéria cerebral media ,CIENCIAS DA SAUDE::SAUDE COLETIVA::EPIDEMIOLOGIA [CNPQ] - Abstract
Submitted by Boris Flegr (boris@uerj.br) on 2020-07-05T16:06:48Z No. of bitstreams: 1 MauroArenazio-dissertacao.pdf: 1165804 bytes, checksum: 674249594e9f3291e4a2421ea6b2f52e (MD5) Made available in DSpace on 2020-07-05T16:06:49Z (GMT). No. of bitstreams: 1 MauroArenazio-dissertacao.pdf: 1165804 bytes, checksum: 674249594e9f3291e4a2421ea6b2f52e (MD5) Previous issue date: 2006-03-31 Study context is the prediction of fetal anemia in pregnant women with perinatal haemolitical disease and it has like objective to appraise the accuracy of middle cerebral artery peak systolic velocity (MCA-PSV) in fetal anemia prediction. Papers identification was identified using general bibliographic databases (MEDLINE and LILACS), and by checking reference lists of other authors. Studies were selected if observe type, pregnant woman with indirect coombs higher than 1:8, adequate technic, MCA-PSV ≥ 1,5MOM, presence of gold standard (fetal or newborn hemoglobin), and hierarchy of evidence higher or equal than four. Data from the selected studies were abstracted as 2 x 2 tables comparing the diagnostic teste result with the reference standard. Diagnostic accuracy was expressed as likelihood ratios. The review included eleven studies with a total sample of 688. Prospective patient recruitment and hierarchy of evidence one were reported in three studies. The test performance presented reasonable variation. Mari et al (2000) study was applied like best quality, with a LR(+) 8,45 and LR(-) 0,02. MCA-PSV like a fetal anemia predictor in perinatal haemolitical disease is consolidated. However, some points have to be cleared up., like the best exams interval in severe cases and method validity in after transfusional situation. O contexto do estudo é a predição da anemia fetal em gestantes portadoras da doença hemolítica perinatal e tem como objetivo avaliar a acurácia da medida doppler velocimétrica da velocidade máxima do pico sistólico da artéria cerebral média na detecção da anemia fetal na doença hemolítica perinatal. A identificação dos estudos foi realizada com a adoção de bancos de dados gerais (MEDLINE e LILACS) e a partir de referências bibliográficas de outros autores. Os estudos selecionados tinham como critérios serem do tipo observacionais, com gestantes apresentando coombs indireto maior do que 1:8, técnica de insonação do vaso adequada, Vmax-ACM ≥ 1,5MOM, presença obrigatória de comparação com o padrão-ouro (hemoglobina fetal e/ou neonatal), e nível de evidência diagnóstica acima ou igual a 4. Os dados dos estudos selecionados foram alocados em tabelas 2x2 comparando o resultado do teste com o padrão-ouro. A acurácia diagnóstica foi expressa principalmente através da razão de verossimilhança. A revisão incluiu onze estudos, com uma amostra total de 688. Três estudos apresentaram delineamento do tipo prospectivo e nível de evidência diagnóstica categoria 1. A performance do teste em questão apresentou variação razoável. O estudo de Mari et al (2000) foi considerado o de melhor qualidade metodológica, apresentando uma RV(+) de 8,45 e uma RV(-) de 0,02. A medida do doppler da Vmax da ACM como preditor da anemia fetal na doença hemolítica perinatal está consolidada. Porém, alguns pontos precisam ser melhor esclarecidos, como o intervalo ideal dos exames em casos graves e a validade do método em fetos que já foram submetidos a transfusões intra-uterinas.
- Published
- 2006
43. Avaliação da Velocidade Média na Aorta Torácica Descendente em Fetos com Anemia
- Author
-
Marcos Roberto Taveira, Antônio Carlos Vieira Cabral, Isabela Gomes de Melo, Alim Alves Demian, Henrique Vitor Leite, and Ana Paula Brum
- Subjects
Isoimunização ,lcsh:Gynecology and obstetrics ,Umbilical cord ,symbols.namesake ,medicine.artery ,Dopplerfluxometria ,medicine ,Thoracic aorta ,Isoimmunization ,Rh Isoimmunization ,lcsh:RG1-991 ,Fisher's exact test ,Aorta ,Fetus ,business.industry ,Obstetrics and Gynecology ,Fetal anemia ,medicine.anatomical_structure ,Doppler flowmetry ,Cordocentese ,Anesthesia ,Cord blood ,symbols ,Anemia fetal ,Hemoglobin ,Cordocentesis ,business - Abstract
Objetivo: verificar se existe correlação significativa entre a velocidade média na dopplerfluxometria da artéria aorta torácica descendente e o grau de anemia fetal. Métodos: estudo prospectivo, transversal, no qual foram analisados 66 fetos de gestantes isoimunizadas, em que se realizou a cordocentese para a realização de transfusões intra-uterinas pela via intravascular (66,7%). Nos fetos que foram submetidos à transfusão intra-uterina pela via intraperitoneal, ou naqueles casos em que não houve necessidade de tratamento intra-uterino (33,3%), a determinação da concentração de hemoglobina do cordão foi realizada pela punção do cordão umbilical, no momento da interrupção da gestação. Neste grupo de fetos estudados, foi realizado exame dopplerfluxométrico da artéria aorta torácica descendente, sendo calculada a velocidade média de fluxo. Foi realizado estudo de associação entre as variáveis. Foram também calculados os valores de sensibilidade, especificidade, valores preditivos positivo e negativo. Resultados: observou-se correlação significativa e inversa entre a velocidade média na artéria aorta torácica descendente e o nível de hemoglobina fetal. A velocidade média na dopplerfluxometria da artéria aorta torácica descendente apresentou sensibilidade de 47,5% para anemia fetal moderada (Hg
- Published
- 2001
44. Transfusão Intra-uterina na Isoimunização Materna pelo Fator Rh
- Author
-
Cabral, Antonio Carlos Vieira, Taveira, Marcos Roberto, Lopes, Ana Paula Brum Miranda, Pereira, Alamanda Kfoury, and Leite, Henrique Vitor
- Subjects
Transfusão intra-uterina ,Terapia fetal ,Fetal therapy ,Intrauterine transfusion ,Isoimunização Rh ,Isoimmunization - Abstract
Objetivos: avaliar os resultados do tratamento intra-útero de fetos anêmicos devido a isoimunização materna pelo fator Rh. Pacientes e Métodos: foram acompanhados 61 fetos submetidos a transfusão intra-uterina seja por via intraperitoneal, intravascular ou combinada. Os casos de fetos hidrópicos corresponderam a 19,7% do total, sendo que nestes a via de tratamento sempre foi a intravascular. Foram realizadas em média 2,7 transfusões por feto, com um total de 163 procedimentos. A indicação para a transfusão se baseou na espectrofotometria do líquido amniótico (método de Liley) ou quando a dosagem de hemoglobina em sangue de cordão obtido por cordocentese fosse menor que 10 g/dl. Resultados: em metade dos casos submetidos a transfusão intra-uterina, empregou-se a via intravascular. Em relação aos casos de fetos hidrópicos a sobrevida foi de 46% e nos fetos não-hidrópicos, de 84%. Não ocorreram complicações maternas relacionadas ao procedimento. A idade média da interrupção da gestação foi de 34,8 semanas. Conclusões: apesar da melhora do resultado com a transfusão intra-uterina guiada pelo ultra-som e da cordocentese, a isoimunização materna pelo fator Rh permanece como causa de elevada morbimortalidade perinatal. Purpose: to evaluate the intrauterine treatment of anemic fetuses that underwent intrauterine transfusions due to rhesus isoimmunization. Methods: the authors studied sixty-one fetuses undergoing intrauterine transfusions by the intravascular, intraperitoneal or both routes. The hydropic fetuses (19.7%) received only intravascular intrauterine transfusions. There was an overall number of 163 intrauterine transfusions with a mean of 2.7 procedures for each case. The indications for intrauterine transfusions were high values of bilirubin in amniotic fluid analyses by the Liley method or a hemoglobin concentration of cord blood below 10.0 g/mL. Results: the overall perinatal survival rate was 46% for hydropic fetuses and 84% for the nonhydropic ones. There were no maternal side effects related to the procedures. Half of the intrauterine transfusions were performed by the intravascular route. The mean gestational age at the delivery was 34.8 weeks. Conclusions: despite better perinatal results with intrauterine transfusions guided by ultrasound, especially using intravascular procedures, rhesus isoimmunization remains as an important cause of high rates of perinatal morbidity and mortality.
- Published
- 2001
45. When anti-G and anti-C antibodies masquerade as anti-D antibody.
- Author
-
Muller, Corinna L., Schucker, Jodi L., and Boctor, Fouad N.
- Subjects
- *
CASE studies , *PREGNANT women , *ANTI-antibodies , *RHO(D) immune globulin , *DENTAL prophylaxis - Abstract
We describe a case of a pregnant woman with anti-C/anti-G antibodies masquerading as anti-D antibodies. Further, confirmation of anti-D antibody is recommended with adsorption-elution studies to confirm the true antibody status. This will avoid the consequence of withholding Rh immunoglobulin prophylaxis in cases when anti-D antibodies are not present. [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
- View/download PDF
46. Intrauterine transfusion in fetuses affected by severe perinatal hemolytic disease: a descriptive study
- Author
-
Jorge Abi Saab Neto, Luís Flávio de Andrade Gonçalves, Rodolfo João Ramos, Cláudia Diniz Baumgarten, Luiz Miguel Mitri Parente, and Dorival Antônio Vitorello
- Subjects
Gynecology ,medicine.medical_specialty ,Isoimunização ,business.industry ,Hemolytic disease ,Obstetrics and Gynecology ,Transfusão intra-uterina ,Doença hemolítica perinatal ,Intrauterine transfusion ,Cordocentese ,Fetal blood sampling ,medicine ,Isoimmunization ,Cordocentesis ,business - Abstract
Objetivo: analisar 54 transfusões intravasculares intra-uterinas (TIVs), ressaltando complicações do procedimento e morbimortalidade perinatal. Material e Métodos: fetos submetidos a TIVs na Clínica Materno-Fetal e Maternidade Carmela Dutra (Florianópolis, SC), entre janeiro de 1992 e agosto de 1997, foram incluídos no estudo. As características das gestantes, dados relativos ao procedimento e ao recém-nascido foram tabulados para análise e apresentados de forma descritiva, utilizando-se percentagem, média, desvio padrão, mediana, variação e risco relativo (RR) com intervalo de confiança de 95% (IC) conforme apropriado. Resultados: foram realizadas 50 TIVs e quatro ex-sangüíneo transfusões em 21 fetos. Houve quatro óbitos (20%), três dos quais (75%) ocorridos em fetos hidrópicos. A idade gestacional média quando da primeira transfusão foi de 29,1 semanas. A concentração média de hemoglobina foi de 5,69 mg/dl. A taxa de mortalidade decorrente do procedimento foi de 7,4%. A idade gestacional média ao nascimento foi 33,9 semanas e o peso médio foi 2.437 gramas. Sessenta e cinco por cento dos recém-nascidos receberam ex-sangüíneo transfusão complementar. Conclusão: a taxa de mortalidade por procedimento (7,4%) foi semelhante à relatada na literatura mundial. A taxa de mortalidade perinatal (20%) foi mais elevada do que a relatada na literatura estrangeira, mas inferior à relatada em estudo conduzido no Brasil, no qual a prevalência de fetos hidrópicos foi semelhante. Objective: to report 54 intrauterine intravascular transfusions (IITs), describing procedure related complications and associated perinatal morbidity and mortality. Methods: fetuses undergoing IITs at Clínica Materno-Fetal and Maternidade Carmela Dutra, Florianópolis, SC, between January 1992 and August 1997 were included in the study. Patients demographics, procedure and newborn related data were tabulated for analysis and presented in descriptive form, using percentage, mean, standard deviation, median, range and relative risk (RR) with 95% confidence interval as appropriate. Results: fifty IITs and four exchange transfusions were performed in twenty-one fetuses. There were four deaths (20%), three of which occurred (75%) in hydropic fetuses. Mean gestational age at the time of the first IIT was 29.1 weeks, the mean hemoglobin concentration was 7.1 mg/dl and the mean rise in hemoglobin level per procedure was 5.69 mg/dl. Procedure related mortality rate was 7.4%. Mean gestational age at birth was 33.9 weeks and mean birth weight was 2,437 grams. Sixty-five percent of the newborns received complementary exchange transfusions. Conclusion: the procedure related mortality rate was 7.4%, similar to the mortality rate reported in the world literature. The perinatal mortality rate (20%) was higher than that reported in other countries but lower than the perinatal mortality rate reported in a study conducted in Brazil, with a similar prevalence of hydropic fetuses.
- Published
- 1998
47. Alloimmune Red Blood Cell Antibodies: Prevalence and Pathogenicity in a Canadian Prenatal Population.
- Author
-
Zwingerman R, Jain V, Hannon J, Zwingerman N, and Clarke G
- Subjects
- Adult, Canada, Female, Humans, Pregnancy, Pregnancy Outcome, Retrospective Studies, Autoantibodies blood, Erythrocytes immunology
- Abstract
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. Cases of anti-Kell as the sole antibody were excluded. Fetal and neonatal outcome data were then collected and analyzed., Results: The population prevalence of a positive antibody screen was 0.36%. Anti-E was the most frequent antibody at 48.5%, followed by anti-c and anti-Jka. Anti-D made up 6.8% of cases, but had significantly higher titres and was responsible for the majority of severely affected fetuses. Sixteen cases in our series experienced severe adverse fetal or neonatal outcomes. All severe outcomes occurred in cases that had a maximum titre of ≥ 8., Conclusion: Despite the decreasing incidence of anti-D alloimmunization, anti-D remains responsible for the majority of severe cases of hemolytic disease of the fetus and newborn.
- Published
- 2015
- Full Text
- View/download PDF
48. Evolving trends: hyperbilirubinemia among newborns delivered to rh negative mothers in southern India.
- Author
-
N G, S S, and Sr K
- Abstract
Introduction: Neonatal jaundice is the commonest abnormal physical finding in the new born nursery and hemolytic disease of the newborn (HDN) among babies born to Rh negative mothers is the most formidable etiology. During last few decades considerable evolution has been observed in this entity secondary to development of several novel preventive, diagnostic and therapeutic modalities., Objective: To study the current trends in presentation, management and outcome of hyperbilirubinemia among newborns delivered to Rh negative mothers., Methodology: This observational descriptive study with prospective data collection included one hundred live born term babies born to Rh negative mothers in our hospital. A predesigned proforma was used to record antenatal and postnatal data .Cord blood collected during delivery for assessment of bilirubin,hematocrit and direct coombs test.Serum bilirubin levels were estimated in babies with clinical jaundice and treated for the same if required.All babies were regularly followed up weekly for one month. Chi square test/Fisher Exact test and Student "t" test has been used to find the significant association of jaundice(incidence,treatment) and study characteristics., Results: Out of 100 babies enrolled, 57 babies developed jaundice. Jaundice is 2.7 times more likely associated with babies born to multiparous Rh-ve mothers with p=0.017*. Jaundice is 3 times more likely associated with Rh+ve babies born to multiparous mothers with p=0.020*. Jaundice is 3.97 times more likely associated with Rh+ve babies born to multiparous mothers who have not received Anti-D with p=0.154. Treatment of jaundice is 2.75 times more likely in Rh+ve babies born to multiparous mothers who have not received Anti-D with p=0.162. Duration of phototherapy is significantly more in Rh+ve babies born to multiparous mothers who had not received Anti-D with p=0.0097*.Exchange transfusion was required in two babies., Conclusion: Although the incidence of Rh isoimmunization has declined dramatically over the years ,it is still an important cause of neonatal morbidity and mortality emphasizing the need for more vigorous preventive efforts and up-to-date management skills.
- Published
- 2013
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.