CONSEQUENCES FOR FETUS AND NEONATE OF MATERNAL RED-CELL ALLOIMMUNIZATION

Aims-To study the distribution of clinically important red cell antibo dies in pregnancy, and the associated fetal and neonatal morbidity and mortality. Methods The case notes of women with clinically important red cell antibodies identified in their serum during pregnancy were re viewed. Results-During a 12 month period 22 264 women were referred fo r antenatal screening. Clinically important red cell antibodies were d etected in 244 (1%). Of these, 100 were anti-D and 144 were non-RhD an tibodies. There were three intrauterine deaths, three fetuses required intrauterine transfusion, 10 neonates were transfused, 27 others had phototherapy, and 27 with a positive direct antiglobulin test received no treatment. Early fetal losses occurred in the presence of both hig h and low levels of anti-D. Conclusions-Anti-D remains the most common clinically important antibody in pregnancy, and accounts for the grea test fetal and neonatal morbidity and mortality. Of the other antibodi es detected, anti-c was associated with most neonatal morbidity. The p roduction of many of the non-D antibodies detected could be avoided by the use of selected red cells when transfusing pre-menopausal women.