Red Cell Alloimmunization and Antibody Specificity in Multigravida Attending Antenatal Clinic at Tertiary Care Centre from Rohilkhand Region

Abstract

Introduction: Red cell alloimmunization is an immuneresponse to foreign red cell antigens which can occur due totransfusion between a donor and recipient, during pregnancybetween mother and fetus and also in transplant recipients.Such disparity may result in transfusion reactions or may beassociated with hemolytic disease of the fetus and newborn.The current study was undertaken to observe the prevalenceof red cell alloimmunization and antibody specificity inmultigravida patients with respect to epidemiological (age),obstetrical, major blood group systems and transfusion-relatedparameters.Material and Methods: This prospective cross-sectional studywas conducted over a period of 1.5 years from October 2018 toApril 2020, in the patients at risk of exposure to foreign red cellantigens in multigravida patients, in the blood bank of tertiarycare medical institute of North India.Antibody screening and identification was performed on 1055multigravida females using commercially prepared O cells(IMMUCOR, USA). Statistical evaluation by Chi-square testwas performed wherever applicable. p-value of <0.05 wasconsidered statistically significant at 95% confidence interval.Results: Prevalence of red cell alloimmunization inmultigravida females was 1.99% with anti-D being the mostcommon antibody identified. Other less commonly detectedalloantibodies were anti-E, anti-Jkb (Kidds) and anti-Kpa (Kell).A statistically significant association was found between red cellalloimmunization and increase in gravida status, presence ofbad obstetric history, age (>30 years) and Rh-D status. Whencompared with other independent variables such as parityand ABO blood group of the female, no statistical significantassociation was observed.Conclusion: Maternal alloimmunization is associated withanti-D specificity and antibodies against other clinicallysignificant minor blood group antigens such as anti-E andanti-Jkb (Kidd) and anti-Kpa (Kell). Routine antibody screeningof all antenatal females, irrespective of the Rh-D status mustbe adopted by health care system for detection of clinicallysignificant antibodies that may be associated with HDFN ordelayed hemolytic transfusion reaction.