Prenatal Genotyping of the RhD Locus to Identify Fetuses at Risk for Hemolytic Disease of the Newborn

Abstract Over the past 20 years the molecular bases of almost all the major blood group antigens have been determined. This research has enabled development of DNA-based methods for determining blood group genotype. The most notable application of these DNA-based methods has been for determining fetal blood group in pregnancies when the fetus is at risk for hemolytic disease of the fetus and newborn. The replacement of all conventional serologic methods for pretransfusion testing by molecular methods is not straightforward. For the majority of transfusion recipients matching beyond ABO and D type is unnecessary, and the minority of untransfused patients at risk of alloimmunization who would benefit from more extensively blood group–matched blood cannot be identified reliably. Even if a method to identify persons most likely to make alloantibodies were available, this would not of itself guarantee the provision of extensively phenotype-matched blood for these patients because this is determined by the size and racial composition of blood donations available for transfusion. However, routine use of DNA-based extended phenotyping to provide optimally matched donations for patients with preexisting antibodies or patients with a known predisposition to alloimmunization, such as those with sickle cell disease, is widely used.

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Placental Transport of Maternal Immunoglobulin G in Pregnancies at Risk of Rh (D) Hemolytic Disease of the Newborn

American Journal of Reproductive Immunology ◽

10.1111/j.1600-0897.1998.tb00525.x ◽

1998 ◽

Vol 39 (5) ◽

pp. 323-328 ◽

Cited By ~ 11

Author(s):

Miodrag Palfi ◽

Jan-Olof Hildén ◽

Tomas Gottvall ◽

Anders Selbing

Keyword(s):

At Risk ◽

Immunoglobulin G ◽

Hemolytic Disease ◽

Placental Transport

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ABO Hemolytic Disease in Puerto Rico and North Carolina

PEDIATRICS ◽

10.1542/peds.57.6.875 ◽

1976 ◽

Vol 57 (6) ◽

pp. 875-883

Author(s):

Carolyn C. Huntley ◽

Anne D. Lyerly ◽

Miriam P. Littlejohn ◽

Helen Rodriguez-Trias ◽

Glenn W. Bowers

Keyword(s):

At Risk ◽

North Carolina ◽

Puerto Rico ◽

Parasitic Infection ◽

Hemolytic Disease ◽

The North ◽

Abo Hemolytic Disease ◽

A Prospective Study ◽

The University ◽

Relationship Of

A prospective study was carried out at the University of Puerto Rico Hospital (UPRH) and at the North Carolina Baptist Hospital (NCBH) in order to establish the incidence of ABO hemolytic disease (ABO HD) in the two populations and to determine the relationship of intestinal parasitic infection of the mother to ABO HD in the infant. The incidence of ABO HD among UPRH at risk pregnancies (type O mother with type A or B infant) was 28.3% or 1 in 3.5 as compared with 18.4% or 1 in 5.4 of NCBH at risk pregnancies (P > .05). Indirect Coombs' tests in cord sera, representing the passive transfer from mother to fetus of antibodies directed toward antigens on the infants' erythrocytes, were positive in 58.8% of UPRH at risk infants as opposed to 40.4% of NCBH at risk infants (P < .001). Maternal isohemagglutinin titers at term were higher in type O UPRH mothers than in type O NCBH mothers (P < .01). A relationship between helminth parasitic infection of the mother and ABO HD in the infant was suspected but not proved.

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Molecular analysis of the rhd genotype in fetuses at risk for rhd hemolytic disease

Obstetrics and Gynecology ◽

10.1016/0029-7844(94)00382-n ◽

1995 ◽

Vol 85 (2) ◽

pp. 296-298 ◽

Cited By ~ 13

Author(s):

W SPENCE ◽

A MADDALENA ◽

D DEMERS ◽

D BICK

Keyword(s):

At Risk ◽

Molecular Analysis ◽

Hemolytic Disease

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Three Cases of Massive Fetomaternal Hemorrhage Presenting Without Clinical Suspicion

Archives of Pathology & Laboratory Medicine ◽

10.5858/2004-128-463-tcomfh ◽

2004 ◽

Vol 128 (4) ◽

pp. 463-465

Author(s):

Sam Pourbabak ◽

Chad R. Rund ◽

Kendall P. Crookston

Keyword(s):

At Risk ◽

Signs And Symptoms ◽

Clinical Suspicion ◽

Morbidity And Mortality ◽

Fetal Anomalies ◽

Hemolytic Disease ◽

Fetomaternal Hemorrhage ◽

Increased Risk ◽

Patients At Risk

Abstract Fetomaternal hemorrhage (FMH) is a common obstetrical occurrence most often associated with small volumes of blood transferred across the placenta. Fetomaternal hemorrhage leads to alloimmunization of Rh D-negative mothers, resulting in an increased risk of hemolytic disease of the newborn. Massive FMH involving volumes of blood greater than 30 mL can cause substantial fetal morbidity and mortality. Massive FMH may present with signs and symptoms such as decreased movement, sinusoidal heart rhythms, or fetal anomalies. We present 3 cases of clinically unexpected massive FMH of 206, 88, and 155 mL. The treating clinicians were unaware of any fetal or maternal signs or symptoms of FMH until contacted by the laboratory. These cases illustrate the necessity for FMH quantitation, even in the absence of clinical suspicion. Additional studies are needed to find better ways to identify these patients in advance. Development of criteria allowing identification of patients at risk would be of benefit to both mother and baby.

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