Prenatal and postnatal immunohematology

Czech version

Authors: J. Masopust ¹; H. Banzetová ²; D. Dušková ³; A. Pejchalová ⁴; M. Písačka ⁵; P. Štolba ¹
Authors‘ workplace: Transfuzní oddělení, Krajská zdravotní, a. s. – Masarykova nemocnice v Ústí nad Labem, o. z., 2Transfuzní oddělení Nemocnice České Budějovice, a. s., 3Fakultní transfuzní oddělení, VFN Praha, 4Transfuzní oddělení a krevní banka Fakultní nemocnice Brno, 5Ú ¹
Published in: Transfuze Hematol. dnes,14, 2008, No. 1, p. 7-18.
Category: Comprehensive Reports, Original Papers, Case Reports

Overview

Introduction:
Hemolytic disease of the fetus and newborn (HDN) is serious perinatal illness. Clinically important antibodies, which are capable to cause severe HDN in the second trimester, are anti-D, -K, -c and -E. Routine prenatal and postnatal immunohematological diagnostic procedures are heterogeneous in CR. The aim of this article is discussion on suitable algorithm of immunohematological testing in pregnancy and after delivery.

Immunohematological laboratory testing in pregnant women:
basic tests are ABO and antigen D typing, screening of irregular antibodies, antibody identification and titrating of clinically important antibodies. Cell-mediated functional assays correlate with clinical seriousness of HDN and we discuss their introduction in CR. We discuss suitable timing, procedures and methods.

Immunohematological laboratory testing in the fetus:
the most important testing is fetal genotyping in alloimmunized pregnant women preferably by means of non-invasive fetal DNA isolation from maternal plasma. We discuss performance and difficulties of this technique. Immunohematological laboratory testing after delivery: mother - it rather serves as a control examination or pretransfusion testing. Anti-A, anti-B immune antibodies’ testing is controversial. The newborn - the most important testing are ABO typing (especially in O mothers) and antigen D typing (in D-negative mothers) and direct antiglobulin test. In suspicion of ABO HDN also anti-A, anti-B immune antibodies testing in the newborn is performed. Feto-maternal haemorrhage quantification is suitable for precise dose of prophylactic anti-D immunoglobulin.

Conclusion:
information presented in this article could be a basis for guideline on immunohematological perinatal testing in the Czech Republic.

Key words:
immunohematology, hemolytic disease of the newborn, red blood cells antibodies, blood group, direct antiglobulin test, genotyping, feto-maternal haemorrhage, functional tests

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