Oral Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2015

Atypical Red cell antibodies and contemporary management of isoimmunisation (#6)

Ryan Hodges 1
  1. Jessie McPherson Private Hospital, ., VIC, Australia

Maternal Rhesus-D antibodies have traditionally been the leading aetiology of haemolytic disease of the fetus and newborn and therefore the leading indication for fetal intrauterine transfusion. However, the landscape has changed considerably owing to firstly the widespread adoption of antenatal and postnatal Rhesus immune globulin that resulted in a significant decline in alloimmunisation to Rhesus-D antigen and secondly, extended red cell antibody screening in early pregnancy. Accordingly, we now can identify a diverse range of maternal red cell antibodies that in some cases can cause serious fetal disease, and unlike Rhesus-D exposure, we have no prophylactic immunoglobulin to prevent maternal sensitisation. Furthermore, the mechanisms that result in anaemia for some antibodies may differ and multiple antibodies may have a synergistic effect resulting in more severe disease. Nevertheless, our treatment guidelines borrow heavily from our Rhesus-D experience. In this presentation, I will review this literature to date and then discuss recent advances in non-invasive cell free DNA for fetal genotyping of extended red cell antigens and how this might be incorporated into current clinical practice. Finally, contemporary management algorithms will be presented.