Immunoprophylaxis of RhD erythrocyte alloimmunization

Czech version

Authors: Zdeněk Žižka
Authors‘ workplace: Gynekologicko-porodnická klinika 1. LF UK a VFN Praha, přednosta prof. MUDr. Alois Martan, DrSc.
Published in: Prakt Gyn 2014; 18(3): 198-203
Category: Perinatology: Review Article

Overview

The erythrocyte alloimmunization (isoimmunization, hemolytic disease of the fetus and newborn – HON) occurs sporadically at present, thanks to routine immunoprophylaxis with anti-D immunoglobulin. The occurrence of atypical alloimmunizations related to non-RhD-antigens remains unchanged, as there is no prophylaxis known and even the prevention does not provide one hundred percent efficiency. When anti-D immunoglobulin immunoprophylaxis is not undertaken or fails, the threat of hemolytic disease of the fetus and newborn arises. Every case is then unique (specificity and type of antibody, blocking antibodies in maternal serum, antigenic make-up of fetal erythrocytes, gestational age at the disease onset etc). The advancements in genetic diagnostics, immunohematology and Doppler ultrasonography significantly reduce the frequency of necessary invasive interventions in the diagnostics and treatment of sensibilized pregnancy. Intraumbilical strictly intravenous transfusion under ultrasound guidance is the first-line method of therapy for cases of severe fetal anemia as well as advanced hydrops. Consultations and treatment are provided in the centres for comprehensive obstetrical and neonatal care with continuous intervention preparedness.

Key words:
anti-D immunoglobulin – erythrocyte alloimmunization – hemolytic disease of the fetus and newborn – anti-D immunoglobulin immunoprophylaxis – intraumbilical intravenous transfusion

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