Characterization of blood bank and transfusion medicine practices for pregnant individuals with fetuses at risk of hemolytic disease in the United States.

Autor: Jacobs JW; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.; Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Booth GS; Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Moise KJ; Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, Texas, USA.; Comprehensive Fetal Care Center, Dell Children's Medical Center, Austin, Texas, USA., Adkins BD; Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA., Bakhtary S; Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA., Fasano RM; Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA., Goel R; Corporate Medical Affairs, Vitalant National Office, Scottsdale, Arizona, USA.; Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.; Division of Hematology/Oncology, Department of Internal Medicine and Pediatrics, Simmons Cancer Institute at SIU School of Medicine, Springfield, Illinois, USA., Hinton HD; Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Laghari SA; Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Stephens LD; Department of Pathology, University of California San Diego, La Jolla, California, USA., Tormey CA; Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA., Crowe EP; Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Bloch EM; Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Abels EA; Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA.; Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA.
Jazyk: angličtina
Zdroj: Transfusion [Transfusion] 2024 Oct; Vol. 64 (10), pp. 1870-1880. Date of Electronic Publication: 2024 Sep 09.
DOI: 10.1111/trf.18011
Abstrakt: Background: Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal alloantibody-mediated destruction of fetal/neonatal red blood cells (RBCs). While the pathophysiology has been well-characterized, the clinical and laboratory monitoring practices are inconsistent.
Methods: We surveyed 103 US institutions to characterize laboratory testing practices for individuals with fetuses at risk of HDFN. Questions included antibody testing and titration methodologies, the use of critical titers, paternal and cell-free fetal DNA testing, and result reporting and documentation practices.
Results: The response rate was 44% (45/103). Most respondents (96%, 43/45) assess maternal antibody titers, primarily using conventional tube-based methods only (79%, 34/43). Among respondents, 51% (23/45) rescreen all individuals for antibodies in the third trimester, and 60% (27/45) perform paternal RBC antigen testing. A minority (27%, 12/45) utilize cell-free fetal DNA (cffDNA) testing to predict fetal antigen status. Maternal antibody titers are performed even when the fetus is not considered to be at risk of HDFN based on cffDNA or paternal RBC antigen testing at 23% (10/43) of sites that assess titers.
Discussion: There is heterogeneity across US institutions regarding the testing, monitoring, and reporting practices for pregnant individuals with fetuses at risk of HDFN, including the use of antibody titers in screening and monitoring programs, the use of paternal RBC antigen testing and cffDNA, and documentation of fetal antigen results. Standardization of laboratory testing protocols and closer collaboration between the blood bank and transfusion medicine service and the obstetric/maternal-fetal medicine service are needed.
(© 2024 The Author(s). Transfusion published by Wiley Periodicals LLC on behalf of AABB.)
Databáze: MEDLINE
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