title: Hemolytic disease of the fetus and newborn in the molecular era.
abstract: Maternal-fetal red cell antigen incompatibility can lead to alloimmunization, maternal immunoglobulin transplacental transfer, and hemolytic disease of the fetus and newborn (HDFN). The use of routine antenatal anti-D prophylaxis (RAADP) has sharply decreased the incidence of and mortality from HDFN due to RhD allosensitization. The ability to identify pregnancies/fetuses at risk of HDFN has significantly improved due to paternal molecular RHD zygosity testing, and non-invasive fetal molecular diagnostics for detecting putative antigen(s) (notably RhD) in fetuses utilizing cff-DNA in maternal plasma. Fetal RHD genotyping using cff-DNA has become increasingly accurate for fetal RHD detection, prompting some countries to implement targeted RAADP through mass screening programs of RhD-negative pregnant women. Along with middle cerebral artery Doppler ultrasonography for predicting fetal anemia, non-invasive fetal molecular diagnostics have greatly decreased the need for invasive diagnostic procedures in pregnancies at risk for severe HDFN. This review highlights these molecular advancements in HDFN-related prenatal diagnostics.
authors.affiliation: Transfusion, Tissue, and Apheresis, Children's Healthcare of Atlanta, Atlanta, GA, USA; Grady Health System Transfusion Services, Atlanta, GA, USA. Electronic address: Ross.fasano@emory.edu.
authors.forename: Ross M
authors.initials: RM
authors.lastname: Fasano
mesh_terms: D004899:Erythroblastosis, Fetal / Q000175:diagnosis* / Q000235:genetics* / Q000517:prevention & control; D005260:Female; D005819:Genetic Markers; D005820:Genetic Testing / Q000379:methods*; D060005:Genotyping Techniques; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D012204:Rh-Hr Blood-Group System / Q000235:genetics*
chemical_list: D005819:Genetic Markers; D012204:Rh-Hr Blood-Group System; C026410:Rho(D) antigen
keywords: Hemolytic disease of newborn; Molecular diagnostic testing; Rhesus blood group