Dose Of anti-D Immunoglobulin Research Articles

Assessment of Fetomaternal Hemorrhage in Rhesus D-negative Postpartum Women by Kleihauer—Betke Test

ABSTRACT Objectives The aim of this article is to assess fetomaternal hemorrhage (FMH) and determine its volume and also to study the relation of the amount of FMH to various factors. Materials and methods This was a prospective study carried out at Ahmedabad Civil Hospital from October 2012 to March 2013. A total of 75 blood samples were collected from RhDnegative mothers during the postnatal period. Sixteen samples were excluded because the fetus blood group was either Rh negative or unknown. The acid elution or Kleihauer—Betke quantitative test was used to measure the amount of FMH. The data were analyzed using Epi Info version 7. Results With Kleihauer—Betke/acid elution test (KBT), 45.76% of women had fetal whole blood in their blood circulation during a postnatal period varying from 1.2 to 9.6 mL. The test was negative (i.e., no fetal cells were identified) in 54.24% of women. The majority of women had hemorrhage less than 4 mL. None of them had a large FMH. Conclusion Most of the FMH calculated was <10 mL, which could have been neutralized by lower doses of anti-D immunoglobulin, which have incurred lower costs than the 300-μg dosage. Thus, developing optimized testing and accessing dosing protocols is needed in health care facilities. In the present study, we found no significant relation between the amount of FMH and parity or type of delivery. How to cite this article Kapadia SN, Bansal KR, Parmar K, Panot H, Bandi F. Assessment of Fetomaternal Hemorrhage in Rhesus D-negative Postpartum Women by Kleihauer—Betke Test. J South Asian Feder Obst Gynae 2016;8(3):181-184.

A comparison of intravenous immunoglobulin (2 g/kg totally) and single doses of anti-D immunoglobulin at 50 μg/kg, 75 μg/kg in newly diagnosed children with idiopathic thrombocytopenic purpura

We conducted this prospective randomized trial of intravenous immunoglobulin (IVIG) treatment in children with newly diagnosed immune thrombocytopenic purpura (ITP) to compare the efficacy of IVIG to standard and higher doses of anti-D IVIG. Seventy-eight patients who were previously untreated and between the age of 1 and 18 years with newly diagnosed acute ITP and a platelet concentration less than 20×10/l were eligible for enrollment. In this study IVIG treatment was compared with two different doses of anti-D. Study patients were randomized to receive treatment according to one of the two single anti-D IVIG doses [50 μg/kg (n=19) or 75 μg/kg (n=20)] or 2 g/kg (400 mg/kg per day, 5 day) total dose of IVIG (n=39). There is a significant increase of 24th hour, 48th hour, 72nd hour, 7th day and 30th day platelet counts in IVIG (2 g/kg, total dose) group compared to anti-D IVIG 50 μg/kg and anti-D IVIG 75 μg/kg groups. However, there were no difference between 24th hour, 48th hour, 72nd hour, 7th day and 30th day platelet counts across anti-D IVIG 50 μg/kg and anti-D IVIG 75 μg/kg groups. In conclusion, this study suggests that IVIG is well tolerated and significantly more effective than standard and high-dose anti-D IVIG for the treatment of newly diagnosed ITP in children. Apart from this, we believe that IVIG might be the first-line treatment of these patients. Regarding this issue further prospective studies comparing different IVIG treatment regimens with anti-D IVIG treatment regimens are needed.

Cytometry and Rhesus: not only for haemolytic disease of the newborn.

Since the 1960s, when passive immunoprophylaxis with intramuscular administration of adequate doses of anti-D immunoglobulin was introduced to prevent maternal-foetal Rhesus (Rh) immunisation, the number of cases of haemolytic disease of the newborn (HDN) has decreased dramatically1–2. The most widely used test to detect the presence of foetal erythrocytes in maternal blood is the acid elution method described by Kleihauer-Braun-Betke3. Since the 1990s, other methods have been adopted for routine laboratory assessment of the degree of foetal-maternal haemorrhage (FMH), such as flow cytometric search for Rh-positive erythrocytes with monoclonal antibodies4 and the agglutination test on a card (gel agglutination technique, GAT). In our laboratory, we use the flow cytometric method, which selectively quantifies the circulating Rh-positive erythrocytes, by using a monoclonal antibody directed to the erythrocyte D antigens (Quanti-D Pe, Millipore). This method has the obvious advantages of sensitivity, specificity, objectivity and is faster than the traditional one5–6. The extreme specificity of the test has led us to adopt it not only to quantify the extent of FMH in order to prevent HDN, but also for other purpose. Here we illustrate two cases in which the use of flow cytometry helped us to explain clinical problems and to detect transfusion errors.

PREVENTION OF RhD ALLOIMMUNIZATION IN RhD NEGATIVE WOMEN

Despite the introduction of anti-D prophylaxis into clinical practice, RhD alloimmunization still presents a problem to date. The actual incidence of RhD alloimmunization in pregnant women remains unknown in most countries. Anti-D immunoglobulin is administered to RhD negative women at a fixed dose and in much greater amounts than is actually necessary. On the other hand, it is not possible to diagnose cases where greater doses are needed. To optimize the prevention of RhD alloimmunization in RhD negative women, it is important to diagnose conditions that lead to fetomaternal hemorrhage (FMH), precisely determine the volume and subsequently administer the appropriate dose of anti-D immunoglobulin. The possibility to accurately detect FMH and precisely determine its volume would enable more effective and less costly prevention of RhD alloimmunization. Anti-D immunoglobulin could be administered only in indicated cases and only in doses essentially necessary for prevention of RhD alloimmunization. The Cochrane and UpToDate databases of systematic reviews, as well as national guidelines, were reviewed. Due to the medical significance and indispensable economic costs associated with prevention of RhD alloimmunization, it would be appropriate to establish exact methodical guidelines. The text itself should be limited to a list of potentially sensitising events during which anti-D immunoglobulin should be administered to RhD negative women if anti-D antibodies are not already present. Following each potentially sensitising event, the minimal dose of anti-D immunoglobulin necessary for prevention of RhD alloimmunization should be determined. After 20 weeks of gestation, the volume of FMH should also be determined to specify the necessary dose of anti-D immunoglobulin.

Therapeutic Efficacy of a Single Dose of Anti-D Immunoglobulin 50µg/kg in Childhood Acute Immune Thrombocytopenic Purpura

Methods: We serially evaluated the platelet count in 21 acute ITP patients that were treated with anti-D immunoglobulin (50μg/kg) to determine how many patients achieved platelet counts over the levels of 20×10 3 /mm 3 , 50×10 3 /mm 3 and 100×10 3 /mm 3 after the infusion of anti-D immunoglobulin. In addition, constitutional symptoms were monitored and changes in the hemoglobin levels were serially evaluated. Results: By three days after treatment, 90.5% of the patients had achieved a platelet count over 20× 10 3 /mm 3 . At seven days after treatment, 66.7% of patients achieved a platelet count of 50×10 3 /mm 3 . In addition, at seven days after treatment 61.9% of patients achieved a platelet count of 100×10 3 /mm 3 . Constitutional adverse symptoms were observed 61.9% of patients, and the symptoms diminished spon- taneously without any severe sequelaes. The decline of hemoglobin concentration after treatment recovered to the initial level after two weeks. Conclusion: A single dose of anti-D immunoglobulin (50 μg/kg)was effective in Korean children with acute ITP to raise the platelet count rapidly. The adverse effects of anti-D immunoglobulin, including hemolytic anemia, were not severe to prevent the use of the anti-D. (Korean J Hematol 2007;42:258-263.)

Porque usamos imunoglobulina anti-D em excesso no abortamento precoce?

OBJECTIVE: evaluation of fetomaternal hemorrhage (FMH) in patients who would need Rh alloimmunization with anti-D immunoglobulin (300 mg) prophylaxis after early miscarriage. METHOD: we included in the study Rh (D) negative blood group patients with positive or unknown Rh (D) partners, who had had a miscarriage up to 12 weeks of gestation, and had been admitted to hospital for uterine curettage. After this procedure 5 ml of venous blood was collected from the patients and the rosette test was applied to screen which patients would need quantitative determination of fetal blood transferred to the maternal circulation, by the Kleihauer-Betke test (K-B). RESULTS: out of 26 patients evaluated the rosette test was positive in one , who showed an FMH of 1.5 ml in the K-B test. CONCLUSIONS: the dose of anti-D immunoglobulin used in cases of miscarriage up to 12 weeks of gestation should be substantially reduced. The availability of preparations of 50 mg is recommended, for a more inexpensive and rational treatment.

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

OBJECTIVETo evaluate signs of haemolysis in babies of Rh-D negative mothers who underwent prophylaxis with anti-D immunoglobulin during pregnancy.DESIGNThe following were evaluated in all babies of Rh-D negative mothers born...

Management of women who are Rhesus D negative in Northern Ireland

In 1998, all 15 maternity hospitals in Northern Ireland participated in a retrospective survey of the management of pregnant women who were Rhesus D (RhD) negative. This area of clinical practice was chosen for study in the knowledge that a policy of routine antenatal prophylaxis had been proposed at the RCP/RCOG Consensus Conference, and that a change in current clinical practice was likely to follow. It was therefore felt prudent to survey critically current practice in order to collect baseline data before the introduction of new guidelines. Data were analysed on 3274 RhD negative women. The findings from this study show that current management of women who are RhD negative is suboptimal. In particular, there is poor adherence to the guidelines relating to the management of potentially sensitising events in pregnancy. Testing to assess the size of a feto-maternal bleed was often omitted, and it was therefore impossible to ascertain whether an appropriate dose of anti-D immunoglobulin had been administered. Recent publications have also identified this as an area of concern. Trauma during pregnancy was often not managed appropriately, as a potentially sensitising event. Better compliance with the current guidelines was noted when management after delivery was considered. The reasons for this apparent inconsistency should be addressed. New guidelines, recommending the use of routine antenatal prophylaxis to all women who are RhD negative, have recently been published. Providers of antenatal care will need to address this issue within the context of their own practice environment. In doing so they should be mindful of current deficits in guideline compliance which may need to be remedied, to avoid building new practices upon fragile foundations.

Kleihauer Testing and Flow Cytometry. A Comparative Study for Assessment of Feto-Maternal Haemorrhage.

The Kleihauer test has been used world-wide for many years to quantify feto-maternal haemorhage, and to ensure that an appropriate dose of anti-D Immunoglobulin (anti-D Ig) is administered both ante-natally and postnatally to RhD negative women to prevent Rh alloimmunisation. Although apparently a simple test to perform, recent reports have suggested that unless meticulous attention is paid to both technique and interpretation, the accuracy of the test cannot be guaranteed. It is suggested that it should be replaced with a flow cytometric test for the presence of fetal RhD positive cells which would give more relevant and accurate results. Flow cytometers are not, however, available to all laboratories performing estimations of feto-matemal haemorrhage (FMH). This study was undertaken to assess the comparability of results obtained using a standardised Kleihauer technique with results obtained using a variety of techniques within hospital laboratories and with flow cytometry. A total of 957 samples were analysed, referring hospitals initially performing a routine Kleihauer test and then forwarding the same sample to the Mersey Transfusion Centre where a standardised Kleihauer test and flow cytometric analysis of FMH were performed. Our results showed that there is variation in Kleihauer results, even when the same sample is used, particularly in quantifying an FMH for which additional anti-D Ig may be required. The tendency however, appears to be to over-estimate the size of FMH and administer unnecessary anti-D Ig. Our results suggest that if careful attention is paid to performing a standardised Kleihauer test, then it is of value in estimating the size of FMH, and that flow cytometry may be of additional value for cases in which the Kleihauer result is equivocal or indicates that a large FMH has occurred which requires the administration of additional anti-D Ig.

Dose of Anti-D Immunoglobulin for the Prevention of RhD Immunisation after RhD-Incompatible Platelet Transfusions

Dose of Anti-D Immunoglobulin for the Prevention of RhD Immunisation after RhD-Incompatible Platelet Transfusions

The Yorkshire Antenatal Anti-D Immunoglobulin Trial in Primigravidae

Abstract 2069 Rh(D)-negative women in their first pregnancy received 100 μg doses of anti-D immunoglobulin at 28 and 34 weeks' gestation and a further dose at delivery if the infant was Rh(D)-positive. The antibody status was determined at 28 weeks, 34 weeks, at delivery, and 6 months after delivery. The findings were compared with those in a control group of 2000 Rh(D)-negative primigravidae who gave birth to Rh(D)-positive infants and received the standard post-delivery injection of anti-D immunoglobulin. 2 women in the trial group and 18 in the control group became actively immunised during the first pregnancy. 325 women in the trial group have had a further Rh(D)-positive pregnancy and in 2 anti-D antibodies were detected for the first time. 528 control women have had a further Rh(D)-positive pregnancy and anti-D was demonstrable in 29-18 in whom antibodies developed during the first pregnancy and 11 in whom antibodies first appeared during the second. The reduction in the incidence of sensitisation was significant. It is estimated that the extra cost in anti-D immunoglobulin was approximately £1600 for each woman sensitised.