Antenatal genotyping of the fetus is now in widespread use as an aid to the clinical management in cases where there is the potential of haemolytic disease of the newborn occurring. The rapid diagnosis of an antigen-negative fetus will preclude the requirement for further, potentially risky invasive procedures being performed, whilst the determination of an antigen-positive fetus allows the potential of intensifying obstetric care for this pregnancy. Molecular genotyping is a major clinical application which has led from the determination of the molecular bases of blood group antigens expressed, most of which have been defined at the level of the gene. All assays used are dependent on the Polymerase Chain Reaction amplification of fetal DNA derived from either amniotic fluid or chorionic villi. Recent work has explored the potential of utilising fetal cells found to be present in maternal peripheral blood as a source of nucleic acid for prenatal diagnosis. Using non-invasive methods will preclude exposing mother and fetus to the potential hazards of invasive methods (amniocentesis, chorionic villus sampling and cordocentesis) which include miscarriage, fetal malformations and further maternal alloimmunisation.

Antenatal genotyping of the blood groups of the fetus.

OBJECTIVE To evaluate signs of haemolysis in babies of Rh-D negative mothers who underwent prophylaxis with anti-D immunoglobulin during pregnancy. DESIGN The following were evaluated in all babies of Rh-D negative mothers born within a three month period in our department: haemoglobin level, packed cell volume, mean corpuscular volume, reticulocytes, bilirubin level, and direct Coombs9 test (direct anti-globulin test). The babies were divided into two groups according to number of doses of anti-D immunoglobulin received by the mother (one or two), and then further divided by their Rh status (negative or positive). Findings were also compared with a control group of babies of O-Rh positive mothers. RESULTS The study group consisted of 101 babies and the control group of 37 babies. No statistically significant differences were found for any of the haematological variables between the babies of mothers who received one or two doses of anti-D immunoglobulin, or between the Rh negative babies (n = 35), and the controls. Although 20% of the Rh positive babies born to mothers receiving two doses of anti-D immunoglobulin had a positive result in the direct Coombs9 test compared with only 2.4% of the babies of mothers treated with only one dose, no signs of haemolysis were documented in the babies with a positive Coombs test. CONCLUSION The prevention of Rh isoimmunisation with anti-D immunoglobulin (one or two doses) during pregnancy does not jeopardise the newborn. Blood group typing and direct Coombs9 test should be performed in every newborn of an Rh negative mother to establish whether there is a necessity to administer anti-D. In the presence of a positive direct Coombs9 test, the type of antibodies should be identified.

https://fn.bmj.com/content/fetalneonatal/84/1/F60.full.pdf

Maternal anti-D prophylaxis during pregnancy does not cause neonatal haemolysis.

The prevention of rhesus disease of the newborn is a stunning medical success story. This disease afflicted thousands of newborns each year, causing serious health problems, even death. Yet from the early 1940s to the 1970s – British and American researchers uncovered the basis of the disease and developed the medical intervention that could prevent its occurrence. Many of the key steps leading to this remarkable achievement took place at the University of Liverpool School of Medicine. Chaired by Professor Sir David Weatherall, this Witness Seminar examines the factors that triggered these studies and the challenges that confronted scientists and clinicians; the intellectual, institutional, and social factors that guided the work; the crucial insights; and the vistas that the prevention of rhesus disease has opened in fetal medicine. Participants include Professor Robin Coombs, the late Professor Ronald Finn, Dr Nevin Hughes-Jones, Professor Patrick Mollison, Dr Archie Norman, Dr Derrick Tovey, Professor Charles Whitfield, Professor John Woodrow and Professor Doris Zallen.

/pdf/the-rhesus-factor-and-disease-prevention-k9xv18049z.pdf

The rhesus factor and disease prevention

In most countries anti-D immunoglobulin G (anti-D IgG) is given to rhesus (Rh)-negative women, although evidence is lacking for the need of this intervention after abortion in early pregnancy. This is especially true for medical abortion, which has been used increasingly in recent years. Mifepristone was approved for medical abortion in France in 1988 under the brand name of Mifegyne. The UK and Sweden followed in 1991 and 1992, respectively, and most other European countries in 2000. So far more than one million women have used this method in Europe alone, and the use is still increasing. The need for the application of immunoglobulin in medical abortion has never been evaluated. The necessity seems questionable when the intervention is performed in early pregnancy and in many cases even before a fetal heart rate can be demonstrated by ultrasound. The Swedish Board of Health and Welfare gave a recommendation against the use of anti-D IgG in early spontaneous or medical abortions in 1997. However, there is still no evidence-based analysis for or against prophylaxis. This leads to regional variations in the treatment of early abortion. This paper reviews publications on this subject with the particular aim of providing a background for recommendations or further research initiatives. A review of this kind could not be found in the literature, and has probably not been done recently.

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1034/j.1600-0412.2003.00266.x

Rh-prophylaxis in early abortion.

Life-threatening hemolytic anemia due to an autoanti-Pr cold agglutinin: evidence that glycophorin A antibodies may induce lipid bilayer exposure and cation permeability independent of agglutination.

This article is also accessible online at: http://BioMedNet.com/karger Dr. S. Urbaniak Royal College of Physicians of Edinburgh 9 Queen Street Edinburgh EH2 1JQ UK At a conference convened by the Royal College of Physicians of Edinburgh and the Royal College of Obstetricians and Gynaecologists, a consensus panel considered specific issues relating to anti-D prophylaxis in the UK. This statement is based on presentations given at the meeting, published research and expert opinion. The panel reached the following conclusions:

Statement from the Consensus Conference on Anti-D Prophylaxis

Background and objectives: Pr1, 2, 3, PrM, Sa and Sia-l1, -b1, -lb1 are sialic acid (NeuNAc)-dependent antigens recognized by human cold agglutinins. Pr and Sa

α2,3-Specific Desialylation of Human Red Cells: Effect on the Autoantigens of the Pr, Sa and Sia-l1, -b1, -lb1 Series

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Statement from the Consensus Conference on Anti-D Prophylaxis

α2,3-Specific Desialylation of Human Red Cells: Effect on the Autoantigens of the Pr, Sa and Sia-l1, -b1, -lb1 Series