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Alloimmunization pregnancy

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https://www.readbyqxmd.com/read/29097176/how-shall-we-transfuse-hippolyta
#1
Brendan C Graham, Lindsey J Graham, Carl H Rose, Jeffrey L Winters
The US Department of Defense recently made the decision to open direct ground combat roles to women. Blood product transfusion is an essential component of the US Military guidelines for tactical combat casualty care and damage control resuscitation, but blood transfusion carries with it the specific side effect of alloimmunization-a uniquely significant side effect for young women who may desire subsequent pregnancies. Presently to be considered are the changes that may need to be made to blood transfusion in the setting of battlefield medicine to optimally care for combat-injured women, as a majority of the existing data regarding the risks of transfusion in the trauma setting involve predominantly men...
October 31, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29031020/fetal-mri-lower-acceptance-by-women-in-research-vs-clinical-setting
#2
Bloeme J van der Knoop, Roland J Vermeulen, Jonathan I M L Verbeke, Lourens R Pistorius, Johanna I P de Vries
AIM: To determine acceptance of pregnant women to undergo fetal magnetic resonance imaging (MRI) examination in research and clinical setting. METHODS: A prospective study included a research group [part of a study comparing brain ultrasound (US) to MRI in fetuses at risk for acquired brain damage] and a clinical group [fetuses with suspected (brain) anomalies after structural US examination] from 2011 to 2014. All women were advised to use sedatives. MRI declinations, use of sedation, MRI duration and imaging quality were compared between both groups...
October 14, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/29024716/accelerated-humoral-renal-allograft-rejection-due-to-hla-c14-mediated-allosensitization-to-hla-bw6
#3
Stephen P Persaud, Brian Duffy, Donna L Phelan, Thalachallour Mohanakumar, Rowena Delos Santos, Joseph P Gaut, Chang Liu
OBJECTIVES: To investigate immunological mechanisms underlying accelerated antibody-mediated rejection (AMR) of a living-related renal allograft in a patient with no detectable antibodies to donor human leukocyte antigens (HLA) in pre-transplant sera. METHODS: Pre- and post-transplant HLA antibody specificities were determined by single-antigen bead assay, and crossmatching was performed by flow cytometry- and complement-dependent cytotoxicity-based methods. Intermediate- and high-resolution HLA typing were performed by molecular methods...
October 9, 2017: Human Immunology
https://www.readbyqxmd.com/read/28970962/ivig-associated-maternal-pancytopenia-during-treatment-for-neonatal-alloimmune-thrombocytopenia
#4
Alyssa Herrmann, Benjamin J Samelson-Jones, Sami Brake, Renee Samelson
Background  Treatment for neonatal alloimmune thrombocytopenia (NAIT) primarily involves maternal administration of intravenous immunoglobulin (IVIG) therapy and prednisone according to protocols based on risk stratification. While IVIG is generally well tolerated, hematologic side effects are a potential complication. Case  We present the successful management of a rare complication of maternal pancytopenia following standard IVIG treatment. Diagnosis was made during routine obstetric exams. Management included reducing IVIG dosage and adding daily prednisone...
July 2017: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/28937404/genotyping-to-prevent-rh-disease-has-the-time-come
#5
C Ellen van der Schoot, Masja de Haas, Frederik Banch Clausen
PURPOSE OF REVIEW: In this review, we analyzed the current literature on noninvasive fetal RHD typing to answer the question whether the administration of RhIg to prevent D-alloimmunization during pregnancy can be safely guided by fetal RHD typing. RECENT FINDINGS: Recently the first centers that implemented large-scale nationwide fetal RHD typing in the second trimester for targeted RhIg administration have published their studies evaluating the diagnostic accuracy of their screening programs...
November 2017: Current Opinion in Hematology
https://www.readbyqxmd.com/read/28840609/red-blood-cell-alloimmunization-in-pregnancy-during-the-years-1996-2015-in-iceland-a-nation-wide-population-study
#6
Gunnar Bollason, Hulda Hjartardottir, Thorbjorn Jonsson, Sveinn Gudmundsson, Sveinn Kjartansson, Anna Margret Halldorsdottir
BACKGROUND: Red blood cell (RBC) alloimmunization during pregnancy is still a major problem. Historically, anti-D antibodies are most likely to cause severe hemolysis, but other antibodies are also important. In Iceland, postnatal RhIg prophylaxis was implemented in 1969, universal RBC antibody screening was implemented in 1978, but antenatal RhIg prophylaxis is not yet routine. STUDY DESIGN AND METHODS: This nation-wide population study gathered data on alloimmunized pregnancies in Iceland between 1996 and 2015...
August 24, 2017: Transfusion
https://www.readbyqxmd.com/read/28837581/fetal-exposure-to-maternal-human-platelet-antigen-1a-does-not-induce-tolerance-an-analytical-observational-study
#7
Mette Kjær, Heidi Tiller, Gøril Heide, Jens Kjeldsen-Kragh, Bjørn Skogen, Anne Husebekk
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a disease that may cause severe bleeding complications with risk of perinatal death or lifelong disability. The main cause of FNAIT is maternal antibodies against human platelet antigen (HPA)-1a. Both fetomaternal bleeding and transplacental trafficking of fetal cells during pregnancy could be the cause of alloimmunization. Persistence of fetal cells in the mother (fetal microchimerism) and maternal cells in the child (maternal microchimerism) are well-recognized phenomena...
2017: PloS One
https://www.readbyqxmd.com/read/28794456/activated-nk-cells-cause-placental-dysfunction-and-miscarriages-in-fetal-alloimmune-thrombocytopenia
#8
Issaka Yougbaré, Wei-She Tai, Darko Zdravic, Brigitta Elaine Oswald, Sean Lang, Guangheng Zhu, Howard Leong-Poi, Dawei Qu, Lisa Yu, Caroline Dunk, Jianhong Zhang, John G Sled, Stephen J Lye, Jelena Brkić, Chun Peng, Petter Höglund, B Anne Croy, S Lee Adamson, Xiao-Yan Wen, Duncan J Stewart, John Freedman, Heyu Ni
Miscarriage and intrauterine growth restriction (IUGR) are devastating complications in fetal/neonatal alloimmune thrombocytopenia (FNAIT). We previously reported the mechanisms for bleeding diatheses, but it is unknown whether placental, decidual immune cells or other abnormalities at the maternal-fetal interface contribute to FNAIT. Here we show that maternal immune responses to fetal platelet antigens cause miscarriage and IUGR that are associated with vascular and immune pathologies in murine FNAIT models...
August 9, 2017: Nature Communications
https://www.readbyqxmd.com/read/28742673/practice-bulletin-no-181-prevention-of-rh-d-alloimmunization
#9
(no author information available yet)
Advances in the prevention and treatment of Rh D alloimmunization have been one of the great success stories of modern obstetrics. There is wide variation in prevalence rates of Rh D-negative individuals between regions, for example from 5% in India to 15% in North America (1). However, high birth rates in low prevalence areas means Rh hemolytic disease of the newborn is still an important cause of morbidity and mortality in countries without prophylaxis programs (1). In such countries, 14% of affected fetuses are stillborn and one half of live born infants suffer neonatal death or brain injury (1)...
August 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28742667/practice-bulletin-no-181-summary-prevention-of-rh-d-alloimmunization
#10
(no author information available yet)
Advances in the prevention and treatment of Rh D alloimmunization have been one of the great success stories of modern obstetrics. There is wide variation in prevalence rates of Rh D-negative individuals between regions, for example from 5% in India to 15% in North America (1). However, high birth rates in low prevalence areas means Rh hemolytic disease of the newborn is still an important cause of morbidity and mortality in countries without prophylaxis programs (1). In such countries, 14% of affected fetuses are stillborn and one half of live born infants suffer neonatal death or brain injury (1)...
August 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28729746/the-incidence-and-effects-of-alloimmunization-in-pregnancy-during-the-period-2000%C3%A2-%C3%A2-2013
#11
Marjana Jerković Raguž, Darinka Šumanovic Glamuzina, Jerko Brzica, Tonći Gruica
INTRODUCTION: The objective of the analysis was to examine the epidemiological aspects of maternal alloimmunization and to determine the most common antibody specificities resulting in hemolytic disease of the newborn (HDN). MATERIALS AND METHODS: The retrospective epidemiological study encompasses all pregnant women who underwent immunohematological screening and the newborn treated for HDN in the period from 2000 to 2013 in the Herzegovina region. RESULTS: The indirect Coombs test (ICT) detected antibodies against antigens in 384 (2...
July 2017: Geburtshilfe und Frauenheilkunde
https://www.readbyqxmd.com/read/28724194/paving-the-way-for-improved-management-of-severe-itp-in-pregnancy
#12
Andra H James
Those of us who take care of women with blood disorders have few data on which to base our management of thrombocytopenia in pregnancy, particularly immune thrombocytopenia purpura (ITP). We extrapolate from the management of ITP in nonpregnant individuals and try to raise platelet counts in an attempt to meet the bleeding challenges of childbirth. Thirty years ago we believed that ITP conferred fetal risks similar to those conferred by alloimmune thrombocytopenia. This article is protected by copyright. All rights reserved...
July 19, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/28718002/infectious-pathogens-may-trigger-specific-allo-hla-reactivity-via-multiple-mechanisms
#13
REVIEW
Lloyd D'Orsogna, Heleen van den Heuvel, Cees van Kooten, Sebastiaan Heidt, Frans H J Claas
Transplant recipients can be sensitized against allo-HLA antigens by previous transplantation, blood transfusion, or pregnancy. While there is growing awareness that multiple components of the immune system can act as effectors of the alloresponse, the role of infectious pathogen exposure in triggering sensitization and allograft rejection has remained a matter of much debate. Here, we describe that exposure to pathogens may enhance the immune response to allogeneic HLA antigens via different pathways. The potential role of allo-HLA cross-reactivity of virus-specific memory T cells, activation of innate immunity leading to a more efficient induction of the adaptive alloimmune response by antigen-presenting cells, and bystander activation of existing memory B cell activation will be discussed in this review...
August 2017: Immunogenetics
https://www.readbyqxmd.com/read/28686909/unraveling-the-role-of-maternal-anti-hla-class-i-antibodies-in-fetal-and-neonatal-thrombocytopenia-antibody-specificity-analysis-using-epitope-data
#14
Jesper Dahl, Erle Refsum, Maria Therese Ahlen, Torstein Egeland, Tore Jensen, Marte K Viken, Tor Brynjar Stuge, Ganesh Acharya, Anne Husebekk, Bjørn Skogen, Heidi Tiller
Anti-HLA class I antibodies have been suggested as a possible cause of fetal and neonatal alloimmune thrombocytopenia (FNAIT). The aim of this study was to characterize maternal anti-HLA class I alloantibodies in suspected cases of FNAIT. The study population consisted of all nationwide referrals of neonates with suspected FNAIT to the National Unit for Platelet Immunology in Tromsø, Norway, during 1998-2009 (cases), and 250 unselected pregnancies originally included in a prospective study (controls). Inclusion criterion was a positive screening for maternal anti-HLA class I antibodies...
June 27, 2017: Journal of Reproductive Immunology
https://www.readbyqxmd.com/read/28675682/imaging-and-management-of-fetuses-and-neonates-with-alloimmune-thrombocytopenia
#15
REVIEW
Arzu Kovanlikaya, Priyanka Tiwari, James B Bussel
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the most common cause of severe neonatal thrombocytopenia and intracranial bleeding in term newborns. Intracranial hemorrhage (ICH) commonly results in death or severe, lasting neurologic disability. The timing of ICH is also important for management of the next affected pregnancy in cases of FNAIT. This manuscript reviews the advantages and disadvantages of the different radiologic methodologies to identify and characterize ICH. It discusses the limits of ultrasound and the advantages of magnetic resonance imaging allowing avoidance of the radiation associated with computed tomography (CT) scans...
December 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/28661314/effect-of-single-sensitization-event-on-human-leukocyte-antigen-alloimmunization-in-kidney-transplant-candidates-a-single-center-experience
#16
Marianna Resse, Rossella Paolillo, Biagio Pellegrino Minucci, Dario Costa, Carmela Fiorito, Michele Santangelo, Paride De Rosa, Claudio Napoli
OBJECTIVES: Human leukocyte antigen alloimmunization is caused by exposure to HLA antigens through transfusion, pregnancy, or transplant. Our study objective was to present the rate of positivity of anti-HLA antibody considering the effects of a single sensitization event in kidney transplant candidates at our center. MATERIALS AND METHODS: Our study reviewed 606 kidney transplant candidates. Patient sera were analyzed using Luminex xMAP technology. Panel reactive antibody positivity rates and antibody strengths in patients were analyzed according to a single sensitization event...
June 28, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28657764/two-cases-of-the-variant-rhd-dau5-allele-associated-with-maternal-alloanti-d
#17
Jennifer A Duncan, Susan Nahirniak, Rodrigo Onell, Gwen Clarke
Rh is a complex blood group system with diverse genotypes that may encode weak and partial D variants. Standard serologic analysis may identify clinically significant D variants as D+; nevertheless, individuals with these D variants should be managed as D- patients to prevent antibody formation to absent D epitopes. Variant identification is necessary during pregnancy to allow for timely and appropriate Rh immune globulin (RhIG) prophylaxis for hemolytic disease of the fetus and newborn (HDFN) as D alloimmunization can occur with some D variants...
June 2017: Immunohematology
https://www.readbyqxmd.com/read/28648573/personalized-treatment-with-immunoadsorption-and-intravenous-immunoglobulin-in-a-case-of-severe-rh-alloimmunization-during-pregnancy-unresponsive-to-plasma-exchange
#18
Anna Colpo, Tiziana Tison, Maria Teresa Gervasi, Cinzia Vio, Maria Vicarioto, Giustina De Silvestro, Piero Marson
INTRODUCTION: Despite prophylaxis, a small proportion of RhD-negative women may develop anti-D antibodies after a sensitizing event occurring during pregnancy or delivery of a D-positive baby. Intrauterine transfusion (IUT) is the treatment of choice in case of fetal anemia, but it cannot be performed early during pregnancy. Combined treatment with therapeutic plasma-exchange (TPE) and intravenous immunoglobulin (IVIG) can avoid or delay IUT. Immunoadsorption (IA) could represent a more effective treatment in selected cases...
June 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28644735/fetal-and-neonatal-alloimmune-thrombocytopenia-evidence-based-antenatal-and-postnatal-management-strategies
#19
REVIEW
Dian Winkelhorst, Dick Oepkes, Enrico Lopriore
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a relatively rare but potentially lethal disease, leading to severe bleeding complications in 1 in 11.000 newborns. It is the leading cause of thrombocytopenia in healthy term-born neonates. Areas covered: This review summarizes the antenatal as well as postnatal treatment, thus creating a complete overview of all possible management strategies for FNAIT. Expert commentary: The optimal antenatal therapy in order to prevent bleeding complications in pregnancies complicated by FNAIT is non-invasive treatment with weekly intravenous immunoglobulin (IVIG)...
August 2017: Expert Review of Hematology
https://www.readbyqxmd.com/read/28643663/delivery-outcomes-of-term-pregnancy-complicated-by-idiopathic-polyhydramnios
#20
S Zeino, L Carbillon, I Pharisien, A Tigaizin, M Benchimol, R Murtada, J Boujenah
OBJECTIVE: Polyhydramnios is associated with an increased risk of cesarean section. The aetiology of polyhydramnios and the characteristics of the labour may be confounding factors. The objective was to study the characteristics and mode of delivery in case of pregnancy complicated with idiopathic polyhydramnios. METHODS: This retrospective matched and controlled study included all pregnant women with idiopathic polyhydramnios (amniotic index>25cm or single deepest pocket>8cm) diagnosed at the 2nd or 3rd trimester and persistent at term delivery (>37weeks of pregnancy) in our institution...
April 2017: Journal of gynecology obstetrics and human reproduction
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