Anti-paternal antibodies by flow cytometry in the management of alloimmunization on recurrent miscarriages

PROBLEM: There is no reliable laboratory test available to diagnose immunol ogically mediated miscarriages. We investigated the clinical significance o f maternal anti-paternal leukocyte antibodies by flow cytometry after alloi mmunization. METHOD OF STUDY: The flow cytometry crossmatch (FCXM) was performed in 158 patients with a history of three or more unexplained first-trimester miscar riages without live birth. After negative FCXM patients were immunized, sub sequent pregnancy outcomes and FCXM results were followed. RESULTS: Of 112 subsequent pregnancies, 83 of 100 (83.0%) FCXM-positive pat ients after immunotherapy had successful pregnancy outcomes, whereas seven of 10 (70.0%) FCXM-negative patients had miscarriages (P = 0.0001). The per cent live birth ratio was 2.77 (CI, 1.07-7.16; P = 0.0001) for FCXM-positiv e patients compared to FCXM-negative patients. The calculated predictive va lue showed that 75.6% of FCXM-negative patients would have subsequent misca rriages. CONCLUSIONS: Positive FCXM is closely associated with successful pregnancy outcome following immunotherapy. We propose that FCXM might be included in the routine laboratory tests for the management of recurrent miscarriages.