Ghesquière Louise, Leroy Julie, Deken Valérie, Tournier Alexane, Vaast Pascal, Subtil Damien, Delsalle Anne, Alluin Gauthier, Garabedian Charles, Houfflin-Debarge Véronique
Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France.
Univ. Lille, CHU Lille, ULR 2694 - METRICS - Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France.
Transfusion. 2023 Mar;63(3):629-637. doi: 10.1111/trf.17264. Epub 2023 Feb 3.
To define a threshold of maternal antibodies at risk of severe fetal anemia in patients followed for anti-RH1 alloimmunization (AI).
STUDY, DESIGN, AND METHODS: We conducted a retrospective study of patients followed for anti-RH1 AI at the Lille University Hospital. The first group, severe anemia, included patients who received one or more in utero transfusions (IUT) or who were induced before 37 weeks of pregnancy for suspected severe fetal anemia. The second group, absence of severe anemia, corresponded to patients without intervention during pregnancy related to AI. Sensitivities, specificities, and positive and negative predictive values for screening for severe fetal anemia were calculated for the antibody thresholds of 3.5 and 5 IU/ml for the quantification.
Between 2000 and 2018, 207 patients were included 135 in the severe anemia group and 72 in the no severe anemia group. No severe anemia was observed for an antibody titer below 16. For an antibody threshold of 3.5 IU/ml, the sensitivity was 98.2%, with 30.2% false positives. All severe anemias were detected in the second trimester; two cases of severe anemia were not detected in the third trimester. For an antibody threshold of 5 IU/ml, the sensitivity was lower at 95.6%, with five cases of severe anemia not detected.
The antibody threshold of 3.5 IU/ml for the quantification and 16 for the titration allow targeting patients requiring close monitoring by an experienced team in case of anti-RH1 AI.
为确定接受抗RH1同种免疫（AI）监测的患者中，发生严重胎儿贫血风险的母体抗体阈值。
研究、设计与方法：我们对里尔大学医院接受抗RH1 AI监测的患者进行了一项回顾性研究。第一组为严重贫血组，包括接受过一次或多次宫内输血（IUT）的患者，或因疑似严重胎儿贫血在妊娠37周前引产的患者。第二组为无严重贫血组，对应于孕期未因AI进行干预的患者。针对3.5和5 IU/ml的抗体阈值进行定量，计算筛查严重胎儿贫血的敏感性、特异性、阳性预测值和阴性预测值。
2000年至2018年期间，共纳入207例患者，其中严重贫血组135例，无严重贫血组72例。抗体滴度低于16时未观察到严重贫血。抗体阈值为3.5 IU/ml时，敏感性为98.2%，假阳性率为30.2%。所有严重贫血均在孕中期被检测到；孕晚期有2例严重贫血未被检测到。抗体阈值为5 IU/ml时，敏感性较低，为95.6%，有5例严重贫血未被检测到。
定量抗体阈值为3.5 IU/ml，滴定抗体阈值为16时，可确定在抗RH1 AI情况下需要经验丰富的团队密切监测的患者。
