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Discordance between fetal RhD typing using molecular methods and neonatal typing with serology
I B Van Den Veyver1, J Yankowitz, S B Subramanian
1Department of Obstetrics and Gynecology, Divisions of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX, USA.
Gynecologic and Obstetric Investigation
|December 11, 1999
Summary
Polymerase chain reaction (PCR) testing on amniotic fluid initially misidentified fetal RhD type, leading to hemolytic disease. Using multiple PCR primer sets and parental testing improved RhD blood type prediction accuracy.
Area of Science:
- Obstetrics and Gynecology
- Genetics
- Neonatology
Background:
- RhD alloimmunization poses risks during pregnancy, necessitating accurate fetal RhD blood typing.
- Polymerase chain reaction (PCR) is a common method for genetic analysis, including fetal blood typing.
Observation:
- A discrepancy was noted between PCR-based RhD genotyping of amniotic fluid and the neonate's actual RhD-positive blood type.
- The initial PCR results incorrectly predicted an RhD-negative fetus, despite the mother being RhD-negative alloimmunized.
- Similar discrepancies were observed during paternal blood type testing.
Findings:
- The initial PCR genotyping failed to accurately determine the fetal RhD blood type.
- Re-analysis using a different set of PCR primers correctly identified both the fetus and the father as RhD-positive.
- This highlights potential limitations in specific PCR primer sets for RhD genotyping.
Implications:
- Inaccurate RhD genotyping can lead to delayed or incorrect management of RhD alloimmunization.
- Employing multiple PCR primer sets enhances the reliability of fetal RhD blood type determination.
- Incorporating parental testing alongside fetal testing can serve as a crucial validation step to prevent diagnostic errors.