Naik Archana, Bhattacharya Prasun, Das Palash, Mukherjee Krishnendu, Mukhopadhyay Partha
Department of Immunohaematology and Blood Transfusion, Kolkata Medical College, Kolkata, West Bengal, India.
Department of Community Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.
Asian J Transfus Sci. 2020 Jul-Dec;14(2):119-125. doi: 10.4103/ajts.AJTS_105_18. Epub 2020 Dec 19.
Detection of maternal irregular antibodies against red blood cell antigen is vital in the management of hemolytic disease of fetus and newborn. There are no uniform guidelines related to antenatal antibody screening and identification in the developing Country like India. This study was aimed to identify such alloimmunization and its associations.
This prospective study was conducted on antenatal mothers at a tertiary care center. The mothers having a history of anti-D administration, blood transfusion, and autoimmune disorders were excluded from the study. Initial indirect antiglobulin test (IAT) was performed in all blood samples by conventional tube technique (CTT) to identify alloimmunization. IAT-positive samples were screened for irregular antibody by column agglutination technology (CAT). Antibody screen-positive samples were further analyzed in 11-cell panel by CAT. Antibody strength was measured by serial double dilution by CTT. The source of isoimmunization was identified by extended Rh phenotype of women, husband, and newborn.
A total of 12 (2.3%) women out of 530 were positive for IAT and antibody screen. Antibody could be identified in 11 women, of which anti-D (5) was the most common, followed by anti-C + anti-D (4), anti-C + anti-E (1), and anti-C (1). All four cases of anti-D + anti-C were distinguished from anti-G by differential adsorption and elution. There was a significant association with alloimmunization versus increased gravid status, antepartum hemorrhage, and past history of newborns with neonatal jaundice.
All pregnant women with history of antepartum haemorrhage, newborn with neonatal jundice should be screened for alloantibody for early detection and better management of HDFN.
检测孕妇针对红细胞抗原的不规则抗体对于胎儿和新生儿溶血病的管理至关重要。在像印度这样的发展中国家，尚无关于产前抗体筛查和鉴定的统一指南。本研究旨在确定此类同种免疫及其关联因素。
本前瞻性研究在一家三级护理中心的产前母亲中进行。有抗-D注射史、输血史和自身免疫性疾病史的母亲被排除在研究之外。通过传统试管技术（CTT）对所有血样进行初始间接抗球蛋白试验（IAT）以鉴定同种免疫。IAT阳性样本通过柱凝集技术（CAT）筛查不规则抗体。抗体筛查阳性样本通过CAT在11细胞板中进一步分析。抗体强度通过CTT系列双倍稀释法测量。通过对女性、其丈夫和新生儿的扩展Rh表型确定同种免疫的来源。
530名女性中共有12名（2.3%）IAT和抗体筛查呈阳性。11名女性的抗体可被鉴定，其中抗-D（5例）最为常见，其次是抗-C + 抗-D（4例）、抗-C + 抗-E（1例）和抗-C（1例）。所有4例抗-D + 抗-C均通过差异吸附和洗脱与抗-G区分开来。同种免疫与妊娠次数增加、产前出血以及新生儿有新生儿黄疸的既往史之间存在显著关联。
所有有产前出血史、新生儿有新生儿黄疸的孕妇均应筛查同种抗体，以便早期发现和更好地管理胎儿和新生儿溶血病。
