Results of an antibody screening programme at an antenatal clinic: relevance to haemolytic disease of the newborn and blood transfusion reaction

Abstract

Results of a routine antenatal antibody screening programme from March 1967 to March 1970 were presented. 5,354 sera from 4,724 pregnancies were screened. The indirect antiglobulin and saline techniques at 37° on separate selected commercially available screening cells were used throughout. All patients were screened at their first visit and Rh negative patients again at approximately 28 and 36 wk. gestation. Antibodies were identified with commercial cell panels. Eighty sera contained detectable antibodies (1.7%). In 44 pregnancies (41 patients) the sera contained anti-D or anti-C + D and in 36 there were other antibodies. In 12 of these (2 anti-C, 2 anti-E, 1 anti-c, 6 anti-Kell (5 patients) and 1 anti-Fya) the antibody was capable of causing haemolytic disease of the newborn but only 2 babies from this group were affected and only one (an anti-Kell) required exchange transfusion. The remaining non-rhesus antibodies could have caused transfusion reactions or cross-matching difficulties (17 anti-Lewis and 7 unidentified antibodies). Of the 44 pregnancies in which anti-D or anti-E + D were found, 12 were negative, 8 were positive at the initial antibody screen and 24 were known from previous pregnancies. Some of the 12 developing detectable antibodies during the pregnancy produced quite severe haemolytic disease. There was a decreasing rate of appearance of new examples of anti-D in each year of the programme and only one of the 20 cases developing anti-D for the first time had had anti-D gamma globulin with her last pregnancy. The yield of antibodies relevant to haemolytic disease was small but the screening of all antenatal patients for antibodies was felt to be worthwhile for the anticipation of cross-matching difficulties and for its effect in improving standards.