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Alloimmunization during pregnancy with special emphasis on anti-D: Laboratory and clinical management
Linköping University, Department of Molecular and Clinical Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences.
1995 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The laboratory and clinical management of alloimmunized in pregnancy has been investigated according to a protocol currently in use in Örebro region. A 12 year epidemiological study showed the prevalence of alloimmunization to be 0.57% in this Swedish populationwith a 0.24% incidence of clinically significant antibodies that can induce haemolytic disease of the newborn (HDN). Rh antibodies, predominantly anti-D, are still the causes of most cases of severe HDN in which 45/47 babies required exchange transfusion. During the studyperiod, 14 mothers were successfully treated with plasma exchange during pregnancy owing to high anti-D antibody concentrations. Only two other blood group syswms, Kell and Duffy, besides Rh affected newborns to alloimmunized mothers to such a grade that exchange transfusion of the newborns was necessary. All generally accepted for the fetus clinically nonsignificant antibodies were also followed and shown not to cause HDN. In 3 instances, anti-D was detected in partial RhO-positive mothers who were carrying normal RhO-positive fetuses,a study to identify these partial RhD individuals and to group them into D-categories was performed. The ability of the indirect antiglobulin titre (IAT), AutoAnalyzer (AA) quantitation and chemiluminescence l£st (CLT) performed on maternal anti-D serum during pregnancy to discriminal£ babies affected or unaffected by HDN has been studied. It was found that all methods had their weaknesses, but AA-quantitation and CLT improved speeifieity when compared to the IAT-titration method. However, a great improvement was achieved when the results of IAT-titration and AA-quantitation, as determined by the cut-offlimits applied to discriminate unaffected from affected newborns, were combined; specificity was then found to increase from 60-78% to 93% and was further increased with the addition of the CLT test to 95%. Finally, the detection of HLA class II monocyte-reactive antibodies and their potential protective role in ameliorating HDN has been viewed.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 1995. , 34 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 468
Keyword [en]
Alloimmunization in pregnancy, Anti-D, Haemolytic disease of the newborn (HDN), IAT-titration, AA-quantitation, Chemiluminescence test, Category D, HLA class II antibodies
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-28562Local ID: 13715ISBN: 91-7871-320-XOAI: diva2:249373
Public defence
1995-10-27, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Papers, included in the Ph.D. thesis, are not registered and included in the posts from 1999 and backwards.Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-07-16Bibliographically approved

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