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Clinical evaluation of a solid-phase test for red cell antibody screening of pregnant women
A Shanwell1, S Sallander, K Bremme
1Stockholm Blood Transfusion Center, South Hospital, Sweden.
Insights
A new solid-phase screening test effectively detected atypical red blood cell (RBC) antibodies in pregnant women, with no failures noted. This method aids in predicting newborn outcomes and managing transfusions.
Area of Science:
- Immunology
- Neonatal Medicine
- Transfusion Medicine
Background:
- Evaluating a novel solid-phase screening test for atypical red blood cell (RBC) antibodies.
- Assessing the test's performance in a large cohort of pregnant women.
- Correlating screening results with neonatal clinical outcomes.
Purpose of the Study:
- To assess the efficacy of a new solid-phase screening test for detecting atypical RBC antibodies in pregnant individuals.
- To compare the test results with the clinical outcomes of newborns.
Main Methods:
- Retrospective study of 38,700 infants born in Stockholm.
- 18,500 infants' mothers were screened using the solid-phase test.
- Data on direct antiglobulin test (DAT)-positive newborns and transfusion requirements were correlated with maternal screening.
Main Results:
- A serologic explanation was found for 349 of 409 DAT-positive newborns.
- ABO incompatibility accounted for most DAT-positive cases requiring exchange transfusion (19/304).
- Unexpected maternal RBC antibodies were identified in 42 cases, with 11 infants needing exchange transfusion, all detected antenatally.
Conclusions:
- ABO incompatibility is a primary cause of exchange transfusion in DAT-positive newborns.
- The solid-phase screening test demonstrated no failures in detecting clinically significant RBC antibodies.
- Routine screening of D+ women once per pregnancy appears sufficient, without need for more frequent testing.
Background:
The aims of this study were to evaluate the results of a new solid-phase screening test for detecting atypical red cell (RBC) antibodies in a large number of pregnant women and to compare these results to the clinical outcome of the newborn.
Study Design And Methods:
A total of 38,700 infants born in Stockholm were studied retrospectively. Of these infants, 18,500 were born to pregnant women screened with the solid-phase test. Data were collected on all newborns with a positive direct antiglobulin test (DAT) and on infants requiring an exchange transfusion or a blood transfusion. These data were correlated to the screening results for the mothers.
Results:
Of 409 DAT-positive newborns, a serologic explanation for the positive DAT was found in 349. Three hundred four cases were due to ABO incompatibility between mother and child; 19 of these infants needed an exchange transfusion. Forty-two cases were due to unexpected maternal RBC antibodies; 11 of these infants were given an exchange transfusion. All 11 were identified before birth. Three other infants had DAT-positive tests due to ABO incompatibility and to unexpected maternal RBC antibodies.
Conclusion:
ABO incompatibility is a major indication for exchange transfusion in DAT-positive newborns. There was no evidence that the solid-phase screening test had failed to detect any clinically significant RBC antibodies. Finally, the results of this study do not indicate a need for routine screening of D+ women more than once during each pregnancy.