Advancements in the diagnosis, treatment and prevention of hemolytic disease of the fetus and newborn (HDFN) have been linked to enhanced knowledge regarding Rhesus D (RhD) alloimmunization and its related complications, according to findings from a review conducted in Poland and published in the journal Quality in Sport—often referred to as Akademicka Platforma Czasopism.
In pregnancy, RhD alloimmunization is reported when a mother with RhD-negative red blood cells (RBCs) is exposed to RhD-positive RBCs via the placenta. This event, in turn, causes the mother’s body to generate antibodies that attack the RhD-positive RBCs, which the body recognizes as being foreign. Immunization, which is also known as sensitization, of the mother to these fetal antigens generally occurs when the fetal blood containing foreign antigens interacts with the mother’s immune system.
When the condition referred to as maternal-fetal serological conflict is reported, antigenic incompatibility exists between the RBCs of the mother and those of the fetus. In such a scenario, the immune antibodies that are produced by the pregnant patient’s body are directed against the fetal antigens.
Success in the prevention and treatment of RhD alloimmunization is considered a major accomplishment in the field of modern-day obstetrics. In fact, the well-known use of RhD immune globulin (RhIg) has been associated with a reduction in rates of RBC alloimmunization. In spite of the effectiveness linked to the utilization of RhIg, however, many cases of RhD alloimmunization continue to be reported. This is likely due to a lack of compliance with conventional protocols.
Read more about the prognosis of HDFN
The researchers of the current review sought to summarize the available knowledge regarding alloimmunization in pregnancy and the types of prophylaxis, both specific and nonspecific, initiated either during or after pregnancy. They conducted a literature search of relevant publications.
The use of rapid, noninvasive diagnostics has enabled more efficient treatment of patients with HDFN. Diagnostic techniques include cell-free DNA testing in maternal plasma, which is used to establish RhD status, and ultrasound for assessing the presence of fetal anemia.
Although the application of routine anti-D prophylaxis in the third trimester has been well established, more careful, well-assessed local implementation is still needed to achieve maximum public health benefits.
Nonspecific prophylaxis entails adherence to principles of transfusion, avoidance of unnecessary blood contact, and the utilization of single-use injection equipment only. The most essential role is played by the use of specific prophylaxis, however, in which anti-D immunoprophylaxis is needed in some situations.
Traditional postpartum immunoprophylaxis involves the administration of anti-D immunoglobulin after the end of a pregnancy—in other words, following birth, miscarriage, or surgery for an ectopic pregnancy. These are all situations in which an elevated risk for fetomaternal hemorrhage exists.
Antenatal prophylaxis can also be used alongside traditional postpartum prophylaxis. This occurs when anti-D immunoglobulin is administered to all RhD-negative pregnant women with a negative result on an indirect antiglobulin test between 28 and 30 weeks of pregnancy.
“There are many guidelines, studies, and recommendations regarding indications, methods and possibilities of using immunoglobulin during pregnancy,” the authors stated. “However, attention should be paid to the education of medical personnel regarding diligence in managing diagnosed cases of [HDFN] during pregnancy,” they concluded.
