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[Follow-up of the feto-maternal allo-immunization]
1Etablissement français du sang, Nord de France, site de Lille, 21, rue C.-Guérin, BP 2018, 59012 Cedex, Lille, France. lucienne.mannessier@efs.sante.fr <lucienne.mannessier@efs.sante.fr>
Summary
Antenatal immunohaematological testing has advanced, but accurately assessing fetal hemolytic disease (HD) requires direct fetal blood analysis. Newer methods analyze fetal RHD genotype from maternal plasma, improving safety and accuracy for expectant mothers.
Area of Science:
- Immunohaematology
- Maternal-Fetal Medicine
- Genetics
Context:
- Antenatal screening for hemolytic disease (HD) has evolved significantly.
- Current immunohaematological tests provide indirect fetal assessments.
- Direct fetal blood analysis for hemoglobin offers definitive severity assessment but carries risks.
Purpose:
- To review advancements in antenatal immunohaematological testing for fetal health assessment.
- To highlight the evolution from indirect measurements to direct fetal RHD genotype determination.
- To emphasize the importance of ABO-RH-KEL1 blood grouping and irregular antibody screening in pregnant individuals.
Summary:
- While indirect tests aid obstetricians, direct fetal blood group hemoglobin determination is the gold standard for assessing hemolytic disease severity, despite procedural risks.
- Non-invasive methods now allow RHD genotype determination from fetal cells in amniotic fluid and, more recently, maternal plasma.
- Routine screening of pregnant women for ABO-RH-KEL1 and irregular antibodies, particularly anti-RH, is crucial, with trend analysis of antibody levels being more informative than absolute values.
Impact:
- Improved non-invasive prenatal testing for fetal RHD genotype determination enhances safety and accuracy in managing hemolytic disease.
- Quantitative haemagglutination methods offer sensitive, rapid, and reproducible anti-RH antibody measurements, advancing clinical decision-making.
- Standardized antenatal screening protocols, including blood grouping and antibody testing, are vital for optimizing fetal and neonatal outcomes.