Desetogodišnja studija jednog centra o aloimunizaciji eritrocitnim antigenima u trudnoći
Sažetak
Uvod/Cilj. Aloimunizacija eritrocitnim antigenima izazvana trudnoćom nije važna samo zbog mogućih negativnih efekata na ishode sledećih trudnoća, ukoliko fetus nosi određeni antigen, već i zbog optimalnog upravljanja transfuzijom u slučajevima akušerskog krvarenja. Pravovremeno otkrivanje antieritrocitnih antitela deo je strategije ispitivanja, prevencije i lečenja, kako bi se postigao bolji ishod za aloimunizovane majke sa ugroženim fetusom. Cilj rada bio je da se utvrdi učestalost i specifičnost aloantitela među trudnicama južnobačkog okruga, Srbija, sa posebnom pažnjom na učestalost anti-D aloantitela. Metode. Retrospektivnom studijom, sprovedenom u Zavodu za transfuziju krvi Vojvodine, obuhvaćen je period od 1. januara 2010. do 31. decembra 2019. godine Skrining i identifikacija antitela kod trudnica vršeni su indirektnim antiglobulinskim testom u gel-mikrokarticama (ID-Card Liss/Coombs), dvoćelijskim test eritrocitima (ID-DiaCell I-II screening cells, Bio-Rad, Cressier, Switzerland), automatizovanim sistemom (IH-500, Bio-Rad). Rezultati. Među 25 694 testiranih trudnica ustanovljeno je da je 1,38% aktivno imunizovanih, dok su kod njih 1,12% ova antitela nastala u tekućoj trudnoći. Među 3 622 (14,09%) RhD-negativnih žena, njih 1,77% je produkovalo anti-D antitelima tokom tekuće trudnoće. Raspodela antitela prema specifičnosti bila je: anti-D 23,34%, anti-M 11,85%, anti-E 9,41%, anti-K 9,41%, anti-C 5,92%, anti-Fyb 5,92%, anti-c 3,13%, anti-S 3,13%, anti-Lea 3,13%, anti-Leb 3,13%, anti-Cw 1,75%, anti-Jka 1,40%, anti-P 1,05%, anti-Lub 0,70%, anti-Fya 0,35%, autoantitela čija specifičnost se nije mogla odrediti 0,70%, i iregularna antitela čija specifičnost se nije mogla utvrditi 15,68%. Zaključak. Profilaksa imunoglobulinom značajno je smanjila učestalost D-aloimunizacije među trudnicama južnobačkog okruga tokom poslednjih deset godina, ali je učestalost anti-D antitela i dalje znatno viša od objavljenih podataka za razvijene zemlje. Takođe, identifikovali smo prisustvo i drugih, ređe prisutnih, ali klinički značajnih antitela. Potrebno je uvesti jedinstvene preporuke za imunohematološka ispitivanja u trudnoći na teritoriji Republike Srbije, u skladu sa savremenim zahtevima.
Reference
Storry JR, Clausen FB, Castilho L, Chen Q, Daniels G, Denomme G, et al. International Society of Blood Transfusion Working Party on Red Cell Immunogenetics and Blood Group Termi-nology: Report of the Dubai, Copenhagen and Toronto meet-ings. Vox Sang 2019; 114(1): 95‒102.
Hendrickson JE, Tormey CA. Understanding red blood cell allo-immunization triggers. Hematology Am Soc Hematol Educ Program 2016; 2016(1): 446‒51.
Tormey CA, Hendrickson JE. Transfusion-related red blood cell alloantibodies: induction and consequences. Blood 2019; 133(17): 1821–30.
White J, Qureshi H, Massey E, Needs M, Byrne G, Daniels G, et al. British Committee for Standards in Haematology. Guide-line for blood grouping and red cell antibody testing in preg-nancy. Transfus Med 2016; 26(4): 246‒63.
Belic B. Rh blood-group system and the importance of its re-search in the population of Vojvodina. Glas Antropol Druš Srb 2012; 47: 97‒102. (Serbian)
de Haas M, Thurik FF, Koelewijn JM, van der Schoot CE. Haemo-lytic disease of the fetus and newborn. Vox Sang 2015; 109(2): 99‒113.
Ghesquière L, Garabedian C, Coulon C, Verpillat P, Rakza T, Wibaut B, et al. Management of red blood cell alloimmuniza-tion in pregnancy. J Gynecol Obstet Hum Reprod 2018; 47(5): 197‒204.
Markham KB, Rossi KQ, Nagaraja HN, O'Shaughnessy RW. He-molytic disease of the fetus and newborn due to multiple ma-ternal antibodies. Am J Obstet Gynecol 2015; 213(1): 68.e1‒68.e5.
Sørensen K, Kjeldsen-Kragh J, Husby H, Akkök ÇA. Determina-tion of fetal RHD type in plasma of RhD negative pregnant women. Scand J Clin Lab Invest 2018; 78(5): 411‒6.
Mayer B, Hinkson L, Hillebrand W, Henrich W, Salama A. Effi-cacy of Antenatal Intravenous Immunoglobulin Treatment in Pregnancies at High Risk due to Alloimmunization to Red Blood Cells. Transfus Med Hemother 2018; 45(6): 429‒36.
Bujandric N, Grujic J. Exchange Transfusion for Severe Neona-tal Hyperbilirubinemia: 17 Years' Experience from Vojvodina, Serbia. Indian J Hematol Blood Transfus 2016; 32(2): 208‒14.
Webb J, Delaney M. Red Blood Cell Alloimmunization in the Pregnant Patient. Transfus Med Rev 2018; 32(4): 213‒9.
Slootweg YM, Koelewijn JM, van Kamp IL, van der Bom JG, Oepkes D, de Haas M. Third trimester screening for alloimmunisation in Rhc-negative pregnant women: evaluation of the Dutch na-tional screening programme. BJOG 2016; 123(6): 955‒63.
Das S, Shastry S, Murugesan M, B PB, Shastry S. What is it real-ly? Anti-G or Anti-D plus Anti-C: Clinical Significance in An-tenatal Mothers. Indian J Hematol Blood Transfus 2017; 33(2): 259‒63.
Roman L, Armstrong B, Smart E. Principles of laboratory tech-niques. ISBT Sci Ser 2020; 15(S1): 81‒111.
Jovanovic-Srzentic S, Djokic M, Tijanic N, Djordjevic R, Rizvan N, Plecas D, et al. Antibodies detected in samples from 21730 pregnant women. Immunohematology 2003; 19(3): 89‒92.
Jerkovic Raguz M, Prce Z, Bjelanovic V, Bjelanovic I, Dzida S, Mabic M. 20 Years of Follow-up Alloimmunization and Hemolytic Disease in Newborn: Has Anything Changed in the Field Over the Years? Klin Padiatr 2020; 232(6): 314‒20.
Sánchez-Durán MÁ, Higueras MT, Halajdian-Madrid C, Avilés García M, Bernabeu-García A, Maiz N, et al. Management and outcome of pregnancies in women with red cell isoimmuniza-tion: a 15-year observational study from a tertiary care univer-sity hospital. BMC Pregnancy Childbirth 2019; 19: 356.
Awowole I, Cohen K, Rock J, Sparey C. Prevalence and obstetric outcome of women with red cell antibodies in pregnancy at the Leeds Teaching Hospitals NHS Trust, West Yorkshire, England. Eur J Obstet Gynecol Reprod Biol 2019; 237: 89‒92.
Pal M, Williams B. Prevalence of maternal red cell alloimmun-isation: a population study from Queensland, Australia. Pa-thology 2015; 47(2): 151‒5.
Moinuddin I, Fletcher C, Millward P. Prevalence and specificity of clinically significant red cell alloantibodies in pregnant women - a study from a tertiary care hospital in Southeast Michigan. J Blood Med 2019; 10: 283–9.
Das S, Shastry S, Baliga PB. Impact of awareness on routine an-tenatal antibody screening: A prospective study. Glob J Trans-fus Med 2019; 4(1): 84‒6.
Bollason G, Hjartardottir H, Jonsson T, Gudmundsson S, Kjartans-son S, Halldorsdottir AM. Red blood cell alloimmunization in pregnancy during the years 1996-2015 in Iceland: a nation-wide population study. Transfusion 2017; 57(11): 2578‒85.
Chatziantoniou V, Heeney N, Maggs T, Rozette C, Fountain C, Watts T, et al. A descriptive single-centre experience of the management and outcome of maternal alloantibodies in preg-nancy. Transfus Med 2017; 27(4): 275‒85.
Gavrančić T, Milanović M, Gavrančić B. Ucestalost razlicitih vrsta antitela kod trudnica sa pozitivnimin direktnim anti-globulinskim testom. Timočki Med Glas 2012; 37(1): 10‒3.
Karim F, Moiz B, Kamran N. Risk of maternal alloimmuniza-tion in Southern Pakistan - a study in a cohort of 1000 preg-nant women. Transfus Apher Sci. 2015; 52(1): 99‒102.
Sidhu M, Bala R, Akhtar N, Sawhney V. Prevalence, specificity and titration of red cell alloantibodies in multiparous antena-tal females at a tertiary care centre from North India. Indian J Hematol Blood Transfus 2016; 32(3): 307‒11.
Ngoma AM, Mutombo PB, Ikeda K, Nollet KE, Natukunda B, Ohto H. A systematic review of red blood cell alloimmunization in pregnant women in Africa: time to do better. Vox Sang 2016; 11: 62‒9.
Al-Dughaishi T, Al Harrasi Y, Al-Duhli M, Al-Rubkhi I, Al-Riyami N, Al Riyami A, et al. Red Cell Alloimmunization to Rhesus Antigen Among Pregnant Women Attending a Tertiary Care Hospital in Oman. Oman Med J 2016; 31(1): 77–80.
Al-Dughaishi T, Al-Rubkhi IS, Al-Duhli M, Al-Harrasi Y, Gowri V. Alloimmunization due to red cell antibodies in Rhesus pos-itive Omani Pregnant Women: Maternal and Perinatal out-come. Asian J Transfus Sci 2015; 9(2): 150–4.
Xu P, Li Y, Yu H. Prevalence, specificity and risk of red blood cell alloantibodies among hospitalised Hubei Han Chinese pa-tients. Blood Transfus 2014; 12(1): 56–60.