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    Optimizing hemolytic disease management with third-trimester screening


    “To our knowledge, this is the first prospective nationwide study on the effect of a second antibody screening in Rhc-negative women, and the results of the study corroborate the benefit of the second screening.”

    The investigators also sought to identify potential risk factors for late alloimmunization among Rhc-negative pregnant women by conducting a case-control study comparing 54 Rhc-negative women with late alloimunization and 104 matched controls without late alloimmunization. The analyses found that blood transfusion, parity, and chorionic villus sampling/amniocentesis in the current pregnancy were independent predictors.

    Also read: IV Drug Abuse Linked to Alloimmunization

    “These findings are consistent with the hypothesis that the primary immune response occurs in or following a previous pregnancy. Subsequently, antibody levels fall and are too low to be detected at first trimester screening, but rise again during pregnancy after the maternal immune system has renewed contact with fetal RBCs. The potential for such renewed contact to occur after invasive diagnostic procedures associated with fetomaternal hemorrhage underlines the importance of noninvasive prenatal testing,” said Ms Slootweg.

    “Our analysis also underlines a restrictive blood transfusion policy, as well as the use of Rhc- and RhE-matched donor blood, according to current Dutch guidelines.”


    1. Slootweg YM, Koelewijn JM, van Kamp IL, et al. Third trimester screening for alloimmunisation in Rhc-negative pregnant women: evaluation of the Dutch national screening programme. BJOG. 2016;123(6):955–963.


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