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Monitoring the clearance of fetal RhD‐positive red cells in FMH following RhD immunoglobulin administration
Author(s) -
A. Lubenko,
M Williams,
Anthony Johnson,
J Pluck,
Deborah L. Armstrong,
Sheila MacLennan
Publication year - 1999
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1046/j.1365-3148.1999.00217.x
Subject(s) - medicine , antibody , fetus , administration (probate law) , immunology , pregnancy , biology , political science , genetics , law
Anti‐RhD immunoglobulin was administered to RhD‐negative women based on estimates of fetal bleed size obtained using a direct immunofluorescence flow cytometric technique employing a FITC‐conjugated monoclonal human anti‐D (BRAD 3). The effectiveness of the dose administered was assessed by (i) measuring the fraction of RhD‐positive fetal cells in the maternal circulation at d0, and between d2 and d10 post RhD Ig administration, (ii) quantifying the amount of anti‐D detectable in maternal plasma following RhD Ig injection in the perinatal period and (iii) assessing maternal serum for the presence of immune anti‐D in follow‐up samples taken 3 months to 3 years after delivery. Fifty‐four women were assessed, 29 having fetal bleeds in excess of 4 mL. Follow‐up samples were received from 20/29 mothers after RhD Ig administration; 43–99% and 69–99% of fetal cells had been cleared by d2/3 and d5/6, respectively, in 14/20 mothers, whereas less than 50% had been cleared in the remaining mothers. Long‐term follow‐up samples were obtained from eight of the 29 mothers (four with bleeds ≥20 mL, two with bleeds >95 mL): none had detectable anti‐D in the serum 4 months to 3 years after delivery despite the persistence of up to 36% fetal RhD‐positive cells in the maternal circulation six days after delivery.