A study recently published in Transfusion Medicine detailed the updated British Society for Hematology guidelines for monitoring red blood cell antibodies during pregnancy to improve the diagnosis and management of hemolytic disease of the fetus and newborn (HDFN).
The study outlines a wide scope of recommendations, ranging from laboratory testing to maternal counseling. “The testing protocols recommended here are designed to provide clarity for practice in order to protect pregnant women and their babies,” the authors wrote.
The investigators emphasized the importance of detailed record keeping, including a standardized system for collecting and labeling samples. A clinical history should be recorded when possible to improve diagnosis, they explained.
Laboratory testing should be performed early in pregnancy to asses maternal blood type (ABO) or evaluate for the presence of clinically significant antibodies. Regardless of antibody presence, the investigators suggested that all pregnant women with a history of HDFN should be evaluated by fetal medicine specialists for further guidance.
Read more about HDFN testing and diagnosis
If antibodies are not detected by 28 weeks’ gestation, the authors do not recommend further evaluation. If maternal antibodies are detected, though, they recommend that paternal testing should be conducted to assess the risk of the current or any future pregnancies resulting in HDFN. Mothers with antibodies should also be referred to pre-pregnancy counseling.
Additionally, non-invasive genotyping may be performed on the fetus by extracting fetal DNA found in the mother’s bloodstream. The fetus can then be evaluated for genotypes that may suggest an increased risk of developing HDFN.
While anti-D, anti-c and anti-K antibodies are most commonly associated with HDFN, the study emphasizes that several antibodies could cause the disease and should be considered. If an intrauterine transfusion is necessary, clinicians must ensure that the blood used is compatible with both the mother and fetus.
Sign up here to get the latest news, perspectives, and information about HDFN sent directly to your inbox. Registration is free and only takes a minute.
