Irregular RBC antibody detection clinically important for pregnant women: Study
Irregular red blood cell (RBC) antibodies are antibodies against blood group antigens other than ABO antigens and can cause difficulties in blood typing and cross-matching, hemolytic transfusion reactions (HTRs) of varying severity, and hemolytic disease in the fetus and newborn (HDFN). It is generally accepted that the irregular RBC antibodies produced by “natural immunity” are mainly IgM antibodies, which are not clinically important; irregular RBC antibodies that are clinically important are mainly IgG antibodies, which are the less common type and are produced due to pregnancy, allogeneic blood transfusion, allogeneic tissue and organ transplantation, and other forms of allogeneic immunity. It was previously believed that fetomaternal hemorrhage occurs mainly in late pregnancy or during delivery; clinically significant alloimmune irregular RBC antibodies are rarely produced during the first pregnancy without a history of other alloimmunizations; and clinically significant irregular RBC IgG antibodies are produced after the second period of alloimmunization. However, a recent study showed that fetal RBCs can be detected in maternal blood samples at 6–22 weeks of gestation but there is a lack of research data to guide the clinical management of maternal and fetal blood and determine whether fetomaternal hemorrhage can lead to the production of alloimmune irregular RBC antibodies in pregnant women during their current pregnancy.
To understand the risk of the production of irregular RBC antibodies during the current pregnancy as a result of gestational alloimmunization, authors performed screens for irregular RBC antibodies in 4983 pregnant women during their late first pregnancy and 13,027 women patients with a history of multiple (two or more) pregnancies, and compared the differences in irregular RBC antibody positivity and specificity between the two groups; these results will be important for guiding clinical practice in maternal and fetal/neonatal blood management.
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