Occurrence of erythrocyte alloimmunization in women attending antenatal care clinic

Abstract

Background and Objectives: There is limited literature available on the alloimmunization rates among pregnant women in India. Our primary aim was to estimate the occurrence of irregular erythrocyte alloantibody (IEA) immunization amongst women attending our antenatal care (ANC) clinic and to guide our obstetricians for improved ANC as well as their fetal outcomes. Methods: A cross-sectional study was performed at the blood center in North India over 12 months. We recruited a total of 212 study participants. Antibody screening and identification were performed by using semi-automated column agglutination technology and commercially available 3-red cell antibody screen panel with reagent cards having anti-human globulin (AHG) (Ortho Clinical Diagnostics Inc., USA) and 11-red cell antibody identification panel with reagent cards having AHG (Resolve Panel A; Ortho Clinical Diagnostics Inc., USA) respectively. Once identified, the semi-quantitative doubling dilutions, i.e., serial titrations of the respective IEA were performed by the conventional tube technique to assess their potency. The association of various antibodies identified was analyzed using the Pearson's Chi-square test. Results: Of the 7248 pregnant women attending our ANC clinics, the antibody screening was requested for 212 cases. Out of these, 10.8% (n = 23/212) of women were positive and were sensitized both by active and passive immunization. Their average age (in years) was 27.6 ± 3.52 (20 to 34). The majority belonged to the Dehradun district of Uttarakhand. ABO system-wise, the most common type amongst the included subjects was A as recorded in 34.4%, followed by B (30.18%), O (24.12%) and AB (11.3%), respectively. Rh system-wise, nearly 47% (n=100/212) of subjects had Rh (D) negative blood group. Interestingly, amongst these 23 ANC cases with positive IAT, nearly 13% had a history of having received a blood transfusion. Conclusion: To sum up, the screening of majority of ANC in our hospital is restricted to Rh (D) negative pregnancies. Perhaps, more awareness among obstetricians regarding the universal screening of all ANC cases irrespective of their Rh (D) status is the need of the hour.

Keywords

• antenatal care
• maternally derived antibodies
• blood group systems
• blood transfusion center
• red cell alloimmunization
• rhd
• uttarakhand