Report of the first nationally implemented clinical routine screening for fetal RHD in D− pregnant women to ascertain the requirement for antenatal RhD prophylaxis

Frederik Banch Clausen*, Mette Christiansen, Rudi Steffensen, Steffen Jørgensen, Christian Nielsen, Marianne Antonius Jakobsen, Rikke Dyhrberg Madsen, Karina Jensen, Grethe Risum Krog, Klaus Rieneck, Ulrik Sprogøe, Keld Mikkelsen Homburg, Niels Grunnet, Morten Hanefeld Dziegiel

*Corresponding author

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Abstract

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.
OriginalsprogEngelsk
TidsskriftTransfusion
Vol/bind52
Udgave nummer4
Sider (fra-til)752-758
ISSN0041-1132
DOI
StatusUdgivet - 2012
Udgivet eksterntJa

Citer dette

Clausen, F. B., Christiansen, M., Steffensen, R., Jørgensen, S., Nielsen, C., Jakobsen, M. A., Madsen, R. D., Jensen, K., Krog, G. R., Rieneck, K., Sprogøe, U., Mikkelsen Homburg, K., Grunnet, N., & Dziegiel, M. H. (2012). Report of the first nationally implemented clinical routine screening for fetal RHD in D− pregnant women to ascertain the requirement for antenatal RhD prophylaxis. Transfusion, 52(4), 752-758. https://doi.org/10.1111/j.1537-2995.2011.03362.x