Background Red blood cell alloimmunisation during the pregnancy is a significant cause for neonatal mortality and morbidity. This study was planned to determine the prevalence and specificity of irregular erythrocyte antibodies in antenatal mothers and their neonatal outcome.
Methods In this observational study, blood grouping and red cell antibody screening of mothers were performed at first visit and after 28 weeks of gestation and positive cases were identified and followed up monthly till delivery by repeating antibody titre and middle cerebral artery—peak systolic velocity. After delivery of alloimmunised mothers, cord blood haemoglobin, bilirubin and direct antiglobulin tests (DAT) were analysed and further outcome of neonate was recorded.
Results Among 652 registered antenatal cases, 18 multigravida women were found to be alloimmunised, accounting to prevalence of 2.8%. Most common alloantibody identified was anti D (>70%) followed by anti-Lea, anti-C, anti-Leb, anti-E and anti-Jka. Only 47.7% Rh D negative women received anti-D prophylaxis during previous pregnancies or whenever indicated. DAT was positive in 56.2% of neonates. Among nine DAT positive neonates, two early neonatal deaths due to severe anaemia were observed following birth resuscitation. Four antenatal mothers required intrauterine transfusion in view of fetal anaemia while three neonates received double volume exchange transfusion and top up transfusions after birth.
Conclusions This study emphasises importance of red cell antibody screening for all multigravida antenatal women at registration of pregnancy and additionally at 28 weeks or later in high-risk cases irrespective of RhD status.
- blood bank & transfusion medicine
- fetal medicine
- prenatal diagnosis
Data availability statement
Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information. All data are available. It will shared if necessary.
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Contributors SaM, ShM, GN and DK planned the study. JC collected antenatal mother samples, consent and follow up. MM and SB assessed neonatal outcome. The laboratory testing was performed by Sam and ShM. Manuscript written by SaM and DK. All shared their opinion and made corrections. SaM is responsible for the overall content as the guarantor.
Funding This study was funded by Indian Council of Medical Research (No. 2/3/July-2019/PG-Thesis-HRD(27)).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.