Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.
Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.
Transfus Med Rev. 2021 Apr;35(2):85-94. doi: 10.1016/j.tmrv.2021.02.001. Epub 2021 Mar 1.
Hemolytic disease of fetus and newborn (HDFN) imposes great healthcare burden being associated with maternal alloimmunization against parental-inherited fetal red blood cell antigens causing fetal anemia or death. Noninvasive prenatal analysis (NIPT) provides safe fetal RHD genotyping for early identification of risk pregnancies and proper management guidance. We aimed to conduct systematic review and meta-analysis on NIPT's beneficial application, in conjunction with quantitative maternal alloantibody analysis, for early diagnosis of pregnancies at risk. Search for relevant articles was done in; PubMed/Medline, Scopus, and Ovid (January 2006April 2020), including only English-written articles reporting reference tests and accuracy data. Nineteen eligible studies were critically appraised. NIPT was estimated highly sensitive/specific for fetal RHD genotyping beyond 11-week gestation. Amplifications from ≥2 exons are optimum to increase accuracy. NIPT permits cost-effectiveness, precious resources sparing, and low emotional stress. Knowledge of parental ethnicity is important for correct NIPT result interpretations and quantitative screening. Cut-off titer ≥8-up-to-32 is relevant for anti-D alloantibodies, while, lower titer is for anti-K. Alloimmunization is influenced by maternal RHD status, gravida status, and history of adverse obstetrics. In conclusion, NIPT allows evidence-based provision of routine anti-D immunoprophylaxis and estimates potential fetal risks for guiding further interventions. Future large-scale studies investigating NIPT's non-RHD genotyping within different ethnic groups and in presence of clinically significant alloantibodies are needed.
胎儿和新生儿溶血病（HDFN）给医疗保健带来了巨大负担，它与母体针对来自父母的胎儿红细胞抗原的同种免疫有关，导致胎儿贫血或死亡。非侵入性产前分析（NIPT）为胎儿 RHD 基因分型提供了安全的方法，可早期识别高危妊娠并提供适当的管理指导。我们旨在对 NIPT 的有益应用进行系统评价和荟萃分析，结合定量母体同种抗体分析，早期诊断高危妊娠。在 2006 年 1 月至 2020 年 4 月期间，我们在 PubMed/Medline、Scopus 和 Ovid 中进行了相关文章的搜索，仅包括报告参考检测和准确性数据的英文文章。对 19 项合格研究进行了批判性评价。NIPT 在 11 周妊娠后对胎儿 RHD 基因分型具有高度的敏感性/特异性。扩增来自≥2 个外显子可提高准确性。NIPT 可实现成本效益、节约宝贵资源和降低情绪压力。了解父母的种族对于正确解释 NIPT 结果和定量筛查非常重要。效价≥8 至 32 与抗-D 同种抗体相关，而效价较低与抗-K 相关。同种免疫受母体 RHD 状态、孕次和不良产科史的影响。总之，NIPT 可根据循证医学提供常规抗-D 免疫预防，并估计潜在的胎儿风险，以指导进一步干预。需要进一步进行大规模研究，以调查 NIPT 在不同种族和存在临床意义的同种抗体情况下的非 RHD 基因分型。
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