Consequences for fetus and neonate of maternal red cell allo-immunisation.
OBJECTIVE
To study the distribution of clinically important red cell antibodies in pregnancy, and the associated fetal and neonatal morbidity and mortality.


METHODS
The case notes of women with clinically important red cell antibodies identified in their serum during pregnancy were reviewed.


RESULTS
During a 12 month period 22,264 women were referred for antenatal screening. Clinically important red cell antibodies were detected in 244 (1%). Of these, 100 were anti-D and 144 were non-RhD antibodies. There were three intrauterine deaths, three fetuses required intrauterine transfusion, 10 neonates were transfused, 27 others had phototherapy, and 27 with a positive direct antiglobulin test received no treatment. Early fetal losses occurred in the presence of both high and low levels of anti-D.


CONCLUSIONS
Anti-D remains the most common clinically important antibody in pregnancy, and accounts for the greatest fetal and neonatal morbidity and mortality. Of the other antibodies detected, anti-c was associated with most neonatal morbidity. The production of many of the non-D antibodies detected could be avoided by the use of selected red cells when transfusing pre-menopausal women.
Howard
H
H
National Blood Service, Mersey and North Wales Centre, Liverpool.
Martlew
V
V
McFadyen
I
I
Clarke
C
C
Duguid
J
J
Bromilow
I
I
Eggington
J
J
D001789:Blood Group Antigens / Q000276:immunology*; D001803:Blood Transfusion; D004899:Erythroblastosis, Fetal / Q000276:immunology*; D005260:Female; D005313:Fetal Death; D006801:Humans; D007231:Infant, Newborn; D007518:Isoantibodies / Q000097:blood*; D008431:Maternal-Fetal Exchange; D011247:Pregnancy / Q000097:blood / Q000276:immunology*; D011256:Pregnancy Outcome; D012204:Rh-Hr Blood-Group System / Q000276:immunology; D018029:Rho(D) Immune Globulin
D001789:Blood Group Antigens; D007518:Isoantibodies; C061961:RHO(D) antibody; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin