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Transfusion. 2018 Jul;58(7):1611-1617. doi: 10.1111/trf.14606. Epub 2018 Apr 6.

ABO incompatibility and RhIG immunoprophylaxis protect against non-D alloimmunization by pregnancy.

Author information

1
Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.
2
Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam.
3
Sanquin Diagnostic Services, Amsterdam, the Netherlands.
4
Department of Transfusion Technology Assessment, Sanquin Research, Amsterdam.
5
Centre for Healthcare Operations Improvement & Research, University of Twente, Enschede, the Netherlands.
6
Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands.
7
Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.

Abstract

BACKGROUND:

Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal antibodies against fetal red blood cell antigens, most often anti-D, -K, or -c. ABO incompatibility between mother and child and anti-D immunoprophylaxis (RhIG) are known to reduce the risk of D immunization and subsequent HDFN. However, no immunoprophylaxis has been developed to prevent non-D immunizations.

STUDY DESIGN AND METHODS:

We evaluated whether ABO incompatibility has a preventive effect on formation of non-D alloantibodies, by performing a case-control study including pregnant women with newly detected non-D antibodies, identified within a nationwide data set, immunized during their first pregnancy and/or delivery. Subsequently, we assessed a possible protective effect of RhIG in a subgroup with non-Rh antibodies only. The proportions of previous ABO incompatibility and of RhIG administrations of these women were compared to the known rate of 19.4% ABO incompatibility and 9.9% RhIG administrations (D- women carrying a D+ child) in the general population of pregnant women.

RESULTS:

A total of 11.9% of the 232 included immunized women had a possible ABO incompatibility in their first pregnancy (vs. expected 19.4%; 95% confidence interval [CI], 7.3-18.8; p = 0.036). Furthermore, 1.0% women with non-Rh antibodies were D-, delivered a D+ child, and had therefore received RhIG, whereas 9.9% was expected (95% CI, 0.18-5.50; p = 0.003).

CONCLUSION:

We found that ABO incompatibility and RhIG reduce the risks not only for D, but also for non-Rh immunizations, suggesting that antibody-mediated immune suppression in this condition is not antigen specific.

PMID:
29624682
DOI:
10.1111/trf.14606
[Indexed for MEDLINE]

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