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Report of the first nationally implemented clinical routine screening for fetal RHD in D− pregnant women to ascertain the requirement for antenatal RhD prophylaxis
Author(s) -
Clausen Frederik Banch,
Christiansen Mette,
Steffensen Rudi,
Jørgensen Steffen,
Nielsen Christian,
Jakobsen Marianne Antonius,
Madsen Rikke Dyhrberg,
Jensen Karina,
Krog Grethe Risum,
Rieneck Klaus,
Sprogøe Ulrik,
Homburg Keld Mikkelsen,
Grunnet Niels,
Dziegiel Morten Hanefeld
Publication year - 2012
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2011.03362.x
Subject(s) - medicine , obstetrics , fetus , pregnancy , antenatal screening , gestational age , prenatal diagnosis , pediatrics , genetics , biology
BACKGROUND: A combination of antenatal and postnatal RhD prophylaxis is more effective in reducing D immunization in pregnancy than postnatal RhD prophylaxis alone. Based on the result from antenatal screening for the fetal RHD gene, antenatal RhD prophylaxis in Denmark is given only to those D− women who carry a D+ fetus. We present an evaluation of the first national clinical application of antenatal RHD screening. STUDY DESIGN AND METHODS: In each of the five Danish health care regions, blood samples were drawn from D− women in Gestational Week 25. DNA was extracted from the maternal plasma and analyzed for the presence of the RHD gene by real‐time polymerase chain reaction targeting two RHD exons. Prediction of the fetal RhD type was compared with serologic typing of the newborn in 2312 pregnancies, which represented the first 6 months of routine analysis. RESULTS: For the detection of fetal RHD , the sensitivity was 99.9%. The accuracy was 96.5%. The recommendation for unnecessary antenatal RhD prophylaxis for women carrying a D− fetus was correctly avoided in 862 cases (37.3%), while 39 women (1.7%) were recommended for antenatal RhD prophylaxis unnecessarily. Two RHD + fetuses (0.087%) were not detected, and antenatal RhIG was not given. CONCLUSION: These data represent the first demonstration of the reliability of routine antenatal fetal RHD screening in D−, pregnant women to ascertain the requirement for antenatal RhD prophylaxis. Our findings should encourage the implementation of such screening programs worldwide, to reduce the unnecessary use of RhIG.