High additional maternal red cell alloimmunization after Rhesus- and K-matched intrauterine intravascular transfusions for hemolytic disease of the fetus.
OBJECTIVE
Intrauterine transfusion (IUT) is a life-saving therapy for the severely anemic fetus with hemolytic disease. However, maternal additional antibody formation is a complication of the procedure. In this study, we determined antibody formation after introduction of preventive Rh-D, -C, -c, -E, and -e and K matching of IUT donors.


METHODS
This was a retrospective follow-up study.


RESULTS
During an 11-year period, 686 Rhesus- and K-matched IUTs were performed in 233 pregnancies and in 95% (652/686) posttransfusion antibody testing was performed after a median interval of 21 days. Twenty-five percent (53/212) of the women formed 64 new antibodies and, compared to our previous study, this incidence was not decreased by the use of Rhesus- and K-matched donors. After delivery, 72% (153/212) of the women had multiple RBC antibodies. Additional antibodies were in 48% (31/64) directed against Rhesus and K antigens, induced by the fetus, or as natural antibodies. In 52% (33/64) the antibodies were directed against non-Rhesus and -K antigens and in 65% (11/17) of eligible cases the IUT donor and not the fetus expressed the corresponding antigen(s).


CONCLUSIONS
Despite Rhesus- and K-matching, women treated with IUTs still show strikingly broad red cell alloimmunization. More extensive IUT donor red cell matching, including FY, JK, and S antigens, to reduce the formation of new red cell antibodies should be explored.
Schonewille
Henk
H
Sanquin Blood Bank, South West Region, Leiden, The Netherlands.
Klumper
Frans J C M
FJ
van de Watering
Leo M G
LM
Kanhai
Humphrey H H
HH
Brand
Anneke
A
D000328:Adult; D001787:Blood Group Incompatibility / Q000097:blood / Q000276:immunology*; D001805:Blood Transfusion, Intrauterine / Q000009:adverse effects*; D004899:Erythroblastosis, Fetal / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007626:Kell Blood-Group System / Q000276:immunology; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D012203:Rh Isoimmunization / Q000097:blood / Q000276:immunology*; D012204:Rh-Hr Blood-Group System / Q000276:immunology
D007626:Kell Blood-Group System; D012204:Rh-Hr Blood-Group System