Rh immune globulin

  • 文章类型: Journal Article
    目的:鉴定DNT,罕见的局部D,可能是具有挑战性的,因为很难区分D+。本研究旨在通过分析DNT先证者的家庭成员来识别DNT个体,表征DNT,并提出管理策略。
    方法:招募第一个韩国DNT先证者的家庭成员。进行了RHD基因分型,使用几种抗D试剂进行弱D测试。
    结果:在6个家庭成员中确定了3个DNT个体,包括1种抗D同种抗体。由于DNT红细胞对所有抗D克隆都表现出强烈的反应性,DNT在血清学上与D+没有区别。此外,DNT个体的异常血清学发现仅在抗D同种免疫后才变得明显。
    结论:我们推荐DNT个体作为围产期Rh免疫球蛋白预防和D-血成分输血的候选者。建议对部分D家族成员进行预期的RHD基因分型,以防止潜在的部分D个体被同种免疫。
    OBJECTIVE: Identification of DNT, a rare partial D, can be challenging, as it is difficult to distinguish from D+. This study aimed to identify DNT individuals by analyzing the DNT proband\'s family members, characterize DNT, and propose management strategies.
    METHODS: Family members of the first Korean DNT proband were recruited. RHD genotyping was conducted, and weak D tests were carried out using several anti-D reagents.
    RESULTS: Three DNT individuals were identified among 6 family members, including 1 with an anti-D alloantibody. As DNT red cells exhibited strong reactivity with all anti-D clones, DNT was serologically indistinguishable from D+. Moreover, unusual serologic findings in DNT individuals only became apparent after anti-D alloimmunization.
    CONCLUSIONS: We recommend DNT individuals as candidates for Rh immune globulin prophylaxis during the perinatal period and transfusions with D- blood components. An anticipatory RHD genotyping is suggested for partial D family members to prevent potential partial D individuals from becoming alloimmunized.
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  • 文章类型: Journal Article
    To describe fetomaternal hemorrhage (FMH) during second-trimester dilation and evacuation (D&E) to evaluate if Rhesus-immune globulin (RhIG) 100 mcg (used in the United Kingdom) and 300 mcg (used in the United States) provide adequate prophylaxis.
    We conducted an exploratory prospective descriptive study of women undergoing D&E between 15 weeks 0 days and 23 weeks 6 days of gestation. Enrolled participants had Kleihauer-Betke testing on specimens obtained before and after D&E. We assessed the main outcome measures of FMH in mL suggesting need for more than 100 mcg and 300 mcg RhIG (FMH of 10 mL and 30 mL fetal whole blood, respectively) and association of postprocedure FMH with demographic characteristics and procedure-related variables.
    The 300 participants had a mean gestational age of 19 weeks 6 days±2 weeks 2 days. The median preprocedure FMH was 0 mL (range 0-50 mL) with 2 (0.67%) women exceeding 10 mL (19 mL and 50 mL). The median postprocedure FMH was 1 mL (range 0-60 mL). Almost all participants had postprocedure FMH <10 mL (n=295, 98.3%) and <30 mL (n=298, 99.3%). All participants under 18 weeks had FMH <10 mL. We found no demographic or procedure-related factors to be predictive of FMH quantity.
    FMH occurring with routine second-trimester D&E procedures is minimal. Adequate prophylaxis with RhIG 100 mcg and 300 mcg occurred in >98% of women and in all cases <18 weeks of gestation. This study is the first step to potentially reducing the dose and costs of RhIG administration with D&E.
    This study is a first step in quantifying fetomaternal hemorrhage with routine dilation and evacuation procedures; larger trials are needed, especially to understand why some women have recognizable hemorrhage preprocedure. If dosing requirements are too high with current guidelines, lower doses will result in resource and cost savings.
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  • 文章类型: Case Reports
    OBJECTIVE: To review the differential diagnosis and laboratory issues for women with a large calculated dose of Rh immune globulin (RhIG).
    METHODS: A case-based approach is used to review the differential diagnosis of patients with a large calculated dose of RhIG, RhIG dosing for women with baseline elevations in hemoglobin F, the formulations of RhIG, and issues for the transfusion medicine service with the release of large doses of RhIG.
    RESULTS: A large fetomaternal bleed after delivery requiring multiple doses of RhIG is rare. Such patients may require intravenous RhIG to avoid multiple injections. Patients with a large percentage of circulating fetal RBCs should be evaluated for a disorder of hemoglobin synthesis and, if present, should have quantification of the circulating fetal RBCs by flow cytometry.
    CONCLUSIONS: Accurate laboratory evaluation of women with large fetomaternal bleeds is essential for appropriate RhIG administration.
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