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Fetomaternal alloimmunization

Charline Bertholdt, Olivier Morel, Matthieu Dap, Marion Choserot, Hélène Minebois
INTRODUCTION: The primary objective of the study was to evaluate the success of labor induction for indicated moderate and late preterm birth. As secondary objectives, the mode of delivery was assessed. MATERIAL AND METHODS: This is an observational study conducted in a tertiary care unit between 2013 and 2015. All patients who underwent labor induction for indicated preterm birth between 32 + 0 and 36 + 6 weeks of gestation (as premature rupture of membranes, preeclampsia, intrauterine growth restriction, fetomaternal alloimmunization, or intrahepatic cholestasis) were included...
June 10, 2018: Journal of Maternal-fetal & Neonatal Medicine
Gerald Bertrand, Anne Leguen, Laurence Delugin, Virginie Renac
No abstract text is available yet for this article.
November 15, 2017: Pediatrics and Neonatology
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
Amy Yu, Erin Morris, Richard Adams, Mark K Fung
BACKGROUND: Previous studies have shown that more than 20% of laboratories would have recommended inaccurate doses of Rh immune globulin (RhIG) in hypothetical cases. Efforts have been made in educating laboratories in correct dosing calculations; however, obstetricians are most often responsible for ordering RhIG. The objective of this study was to assess knowledge of RhIG indications and dosing among obstetrics and gynecology (OB/GYN) physicians in the United States. STUDY DESIGN AND METHODS: An anonymous 17- question online survey was distributed to all OB/GYN resident and attending physicians affiliated with US residency training programs...
June 2017: Transfusion
Gemma L Crighton, Ri Scarborough, Zoe K McQuilten, Louise E Phillips, Helen F Savoia, Bronwyn Williams, Rhonda Holdsworth, Amanda Henry, Erica M Wood, Stephen A Cole
OBJECTIVE: To describe the natural history, antenatal and postnatal therapy, and clinical outcomes of Australian patients with fetomaternal/neonatal alloimmune thrombocytopenia (NAIT) recorded in the Australian NAIT registry. METHODS: Analysis of registry data of Australian mothers treated antenatally for NAIT and any fetus/newborn with thrombocytopenia (TCP) and maternal human platelet antigen (HPA) antibodies. RESULTS: Ninety four potential cases (91 pregnancies; three twin pregnancies) were registered between December 2004 and September 2015 with 76 confirmed or treated as NAIT...
October 2017: Journal of Maternal-fetal & Neonatal Medicine
Mariela Granero Farias, Suzane Dal Bó, Simone Martins de Castro, Aline Reis da Silva, Joyce Bonazzoni, Luciana Scotti, Sergio H Almeida Martins Costa
Accurate detection and quantitation of fetomaternal hemorrhage (FMH) is critical to the obstetric management of rhesus D alloimmunization in Rh-negative pregnant women. The flow cytometry is based on the detection of fetal red blood cells using a monoclonal anti-HbF antibody, and is the method most indicated for this estimation. The objective of this study was to quantify fetal red blood cell levels of pregnant women using flow cytometry. We analyzed 101 peripheral blood samples from Rh-negative and Rh-positive women, whose mean age was 24 years (20-32 years), after vaginal delivery or cesarean section...
2016: Fetal and Pediatric Pathology
Geoffrey Lucas, Anthony Poles, Marcin J Woźniak, Ruth Gilmore
BACKGROUND: Most recently described human platelet antigens (HPAs) have been low-frequency polymorphisms identified in cases of fetomaternal alloimmune thrombocytopenia (FMAIT). There is limited opportunity to study the clinical significance or different antenatal management strategies in cases involving low-frequency HPA antibodies because many are single pregnancies. We have previously described a low-frequency platelet (PLT) antigen, HPA-28bw, implicated in FMAIT in two of the three infants in the same family...
April 2016: Transfusion
Inês Salva, Sara Batalha, Raquel Maia, Paula Kjollerstrom
Fetomaternal alloimmune thrombocytopenia (FMAIT) caused by maternal antibodies is the leading cause of severe neonatal thrombocytopenia. A 1-month-old Caucasian girl was referred to our Hematology Clinic for persistent thrombocytopenia diagnosed after a bleeding episode. Diagnostic tests suggested FMAIT. Mild thrombocytopenia persisted for 18 months, and subsequent findings of dysmorphic facies, short stature and mild pulmonary stenosis led to the hypothesis of Noonan syndrome (NS), which was confirmed by genetic test...
June 2016: Platelets
Winnie Chong, Ernest Turro, Paul Metcalfe, Rizwan Yusuf, Yves Mérieux, Dominique Rigal, Leendert Porcelijn, Elly Huiskes, Geoff Lucas, Nina Bendukidze, Ann Green, Rita Fontão-Wendel, Anne Husebekk, Jonathan Dixey, Alan Guest, Rosey Mushens, Willem H Ouwehand, Cristina V Navarrete
BACKGROUND: Fetomaternal alloimmune thrombocytopenia (FMAIT) is caused by human platelet (PLT) antigen (HPA) incompatibility. Beads coupled with recombinant β3 integrins, displaying the biallelic HPA-1 epitopes (rHPA-1), have been shown to detect HPA-1a alloantibodies implicated in FMAIT. This report describes a multicenter validation of the beads using the results of well-characterized samples to define the optimum parameters for analysis of a large cohort of 498 clinical samples. STUDY DESIGN AND METHODS: Fifty-one blinded quality assurance (QA) samples were tested by six laboratories to standardize the rHPA-1 bead assay and to develop an algorithm for sample classification...
November 2015: Transfusion
Alexis R Peedin, Marshall A Mazepa, Yara A Park, Eric T Weimer, John L Schmitz, Jay S Raval
Evaluation of fetomaternal hemorrhage (FMH) in the immediate postpartum period is critical for the timely administration of Rh immunoglobulin (RhIG) prophylaxis to minimize the risk of alloimmunization in D-negative mothers of D-positive newborns. We report a series of two clinically-unsuspected cases of massive FMHs identified at our university medical center. Retrospective records of two cases of massive FMH were investigated using the electronic medical record. After positive fetal bleed screens, flow cytometric analysis for hemoglobin F was performed to quantify the volume of the hemorrhages in both cases...
April 2015: Transfusion and Apheresis Science
Laurence H Beck
Fetomaternal alloimmunization against neutral endopeptidase (NEP) is a rare cause of antenatal membranous nephropathy, yet lessons from such cases continue to elucidate important pathophysiologic points. Vivarelli and colleagues describe two recent cases of this disease and demonstrate that despite a common genetic cause, differences in maternal anti-NEP IgG subclass modulate disease severity through such mechanisms as complement activation and enzyme inhibition.
March 2015: Kidney International
Esther P Verduin, Anneke Brand, Leo M G van de Watering, Frans H J Claas, Dick Oepkes, Enrico Lopriore, Ilias I N Doxiadis, Henk Schonewille
Red blood cell (RBC) antibodies can persist for decades or decrease quickly to undetectable levels. Antibody persistence has not been systematically studied. Women whose children are treated with intrauterine transfusions (IUT) for haemolytic disease of the fetus (HDFN) often produce additional antibodies, which can be evoked by the intrauterine transfusion or by fetomaternal haemorrhage during the procedure. Factors associated with persistence of both the antibodies responsible for HDFN and additional antibodies were studied in 260 women whose children were treated with IUT between 1988 and 2008...
February 2015: British Journal of Haematology
R Kulinska
Haemolytic disease of the fetus and newborn/HDFN/is a condition in which the lifespan of the fetal or newborn infants red cells is shortened by the action of maternal antibodies against antigens present on the infants red cells. The most common routes of maternal sensitization are via blood transfusion or fetomaternal hemorrhage. With the institution of antenatal Rhesus (Rh) D immunoglobulin prophylaxis, the frequency of maternal alloimmunization in Rh D-negative women has decreased significantly. The prevention and treatment of Rh D alloimmunization is a true success story in obstetrics...
2014: Akusherstvo i Ginekologii︠a︡
Irene T M Lindenburg, Inge L van Kamp, Dick Oepkes
Fetal anemia is a serious complication in pregnancy and associated with perinatal mortality and morbidity. During 25 years of worldwide experience with intravascular intrauterine blood transfusion, a variety of indications have been described. Intrauterine transfusion (IUT) treatment is considered most successful for fetal anemia due to red cell alloimmunization. Moreover, the use of this procedure has also been reported in pregnancies with parvovirus B19 infection, fetomaternal hemorrhage and placental chorioangiomas, for example...
2014: Fetal Diagnosis and Therapy
Monica Jerónimo, Cátia Azenha, Joana Mesquita, Dolores Faria Pereira
Neonatal alloimmune thrombocytopaenia (NAIT) results from a fetomaternal incompatibility with maternal sensitisation against a fetal human platelet antigen (HPA) and antibodies transfer to the fetal circulation, leading to platelet destruction. The clinical presentation is variable and isolated intraocular haemorrhage is rare. We present the case of a male newborn, with intrauterine growth restriction, born at 29 weeks due to pre-eclampsia. He presented proptosis of the left eye, hyphaema and elevated intraocular pressure, with no other signs of haemorrhage...
2014: BMJ Case Reports
Monika Hermann, Marie-Hélène Poissonnier, Gilles Grangé
BACKGROUND: We aimed to assess usefulness of the middle cerebral artery peak systolic velocity (MCA-PSV) in the prediction of fetal anemia after more than three intravenous fetal-exchange transfusions (IFET). STUDY DESIGN AND METHODS: A retrospective study was conducted over 6 years of 15 consecutive pregnancies with severe red blood cell fetomaternal alloimmunization requiring more than three IFETs. We evaluated correlation between MCA-PSV (expressed as multiples of the mean [MoM]) and pretransfusion hemoglobin (Hb) in the fetus (MoM)...
November 2014: Transfusion
Tuba Günel, Ibrahim Kalelioğlu, Hayri Ermiş, Kılıç Aydınlı
OBJECTIVE: Hemolytic disease of the newborn (HDN) is a clinic phenomenon which occurs during pregnancy due to the Rhesus (Rh) D alloimmunization between a Rh (-) pregnant woman, who has become sensitive to RhD antigens, and her Rh (+) fetus. As a result of the attack of maternal RhD antibodies on fetal RhD antigens, fetal anemia, HDN and fetal death may occur. % 40 of Rh (-) pregnant women carry Rh (-) fetus. However, all Rh (-) pregnant women are offered anti-D Immunoglobulin (Anti-D Ig) at 28 weeks' gestation in case of fetomaternal haemorrhage, so the pregnant women carrying Rh (-) fetus are exposed to blood products unnecessarily...
2010: Journal of the Turkish German Gynecological Association
Tamam Bakchoul, Dirk Bassler, Matthias Heckmann, Thomas Thiele, Volker Kiefel, Isabel Gross, Donald M Arnold, Julie DiTomasso, James W Smith, Bosco Paes, Andreas Greinacher
BACKGROUND: Neonatal alloimmune thrombocytopenia (NAIT) is a fetomaternal incompatibility most commonly induced by maternal anti-HPA-1a alloantibodies. Transfusion of immunologically compatible platelets (PLTs) to prevent cerebral hemorrhage, the most severe complication in affected newborns, is usually recommended. Such PLT concentrates, however, are often not readily available. STUDY DESIGN AND METHODS: The efficacy of random-donor PLT transfusions and intravenous immunoglobulin (IVIG) for the management of 17 neonates across four centers with unexpected, severe NAIT was evaluated...
March 2014: Transfusion
Fabiana Conti, Gerald Bertrand, Marcia Dezan, Thiago Costa, Maria Aravechia, Mariza Mota, Lilian Castilho, Cécile Kaplan, José Kutner
BACKGROUND: Human platelet antigens (HPA) polymorphisms may cause HPA alloimmunization, platelet (PLT) refractoriness, fetomaternal alloimmune thrombocytopenia, and posttransfusion purpura. Characterized by significant racial admixture, the Brazilian population might benefit from the knowledge about HPA frequency to guide decision-making concerning PLT transfusion. STUDY DESIGN AND METHODS: HPA frequencies were determined in 158 DNA samples from Brazilian blood donors by microarray for HPA-1 to -9, -11, and -15...
February 2014: Transfusion
M Lubušký, M Procházka, O Simetka, I Holusková
Events following which immunoglobulin (Ig) G anti-D should be given to all RhD negative women with no anti-D alloantibodies: First trimester indications (IgG anti-D sufficient dose of 50 μg*) - termination of pregnancy, spontaneous abortion followed by instrumentation, ectopic pregnancy, chorionic villus sampling, partial molar pregnancy; Second and third trimester indications (IgG anti-D sufficient dose of 100 μg*) - amniocentesis, cordocentesis, other invasive prenatal diagnostic or therapeutic procedures, spontaneous or induced abortion, intrauterine fetal death, attempt at external cephalic version of a breech presentation, abdominal trauma, obstetric hemorrhage; Antenatal prophylaxis at 28th weeks of gestation (IgG anti-D sufficient dose of 250 μg*); Delivery of an RhD positive infant** (IgG anti-D sufficient dose of 100 μg*); Minimal dose*: before 20 weeks gestation - 50 μg (250 IU), after 20 weeks gestation*** - 100 μg (500 IU); Timing: as soon as possible, but no later than 72 hours after the event...
April 2013: Ceská Gynekologie
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