Antenatal antibody screening irrespective of RH status at a tertiary care hospital: A prospective study

Abstract

 Maternal alloimmunization is still the leading cause of fetal anemia and is responsible for neonatal mortality and morbidity in developing countries. Evidence-based guidelines are essential for implementing antenatal alloantibodies screening in developing countries like India which will help to formulate recommendations and reduce adverse outcomes of Hemolytic disease of fetus and new born. To determine the frequency of alloimmunization among in Antenatal women during routine antenatal visits irrespective of Rh status. The prospective study carried out in a tertiary care hospital has enrolled 1000 antenatal women (500 each of Rh-positive and Rh-negative women) attending antenatal clinics and admitted for institutional deliveries, were screened for red cell alloimmunization and association between alloimmunization rate in antenatal women with variables was carried out to determine the clinical significance.  Among 1000 antenatal women enrolled and screened 33 (3.3%) antenatal women were found to be alloimmunized. The prevalence of alloimmunization among Rh-negative women is 5.4% (27/500). While the prevalence of alloimmunization among Rh-positive women is 1.2% (6/500). Majority of the alloimmunized cases were multigravida. 75.7% (25/33) antibodies identified in our study were anti-D antibodies and 24.24% (8/33) were non anti-D antibodies.  Successful implementation of Antenatal antibody screening program requires a coordinated Team approach between the Transfusion medicine, Obstetrics, Radiology and Pediatrics departments. Early screening irrespective of Rh status and effective utilization of RhIg prophylaxis in Rh negative antenatal women is the only solution to reduce fetal, neonatal morbidity and mortality due to alloimmunization.