Document Detail

Reassessing the critical maternal antibody threshold in Rh(D) alloimmunisation: a 16-year retrospective cohort study.
MedLine Citation:
PMID:  24706487     Owner:  NLM     Status:  Publisher    
OBJECTIVE: To determine the critical maternal antibody threshold for specialist referral in Rh(D) alloimmunisation.
METHODS: A retrospective 16-year cohort study at the national tertiary fetal medicine centre for management of alloimmunisation. Rh(D) alloimmunised pregnancies were extracted from an institutional database and the maternal Anti-D levels cross-checked with the national reference laboratory. Fetal haemoglobin (Hb) levels were determined at 1(st) intrauterine transfusion (IUT) only and compared with the pre-transfusion maternal Anti-D level (IU/mL). Sensitivity, specificity, positive and negative predictive values of maternal antibody thresholds for detecting moderate-severe (Hb ≤ 0.64MoM) fetal anaemia were calculated.
RESULTS: Between 1996 and 2011, 66 women underwent a 1(st) IUT for Rh(D) alloimmunisation at our institution. The highest serum Anti-D level was extracted for 208 other Rh(D) alloimmunised women who did not require IUT during the study period. The traditional maternal antibody threshold of >15 IU/mL failed to detect 20% cases of moderate-severe fetal anaemia. The ≥4 IU/mL threshold had 100% sensitivity but a 45% false positive rate. The optimal Anti-D threshold for specialist referral in our population was ≥6 IU/mL; at this level, no cases of moderate-severe anaemia were missed and specificity was 61%. Use of this threshold would have eliminated 10% of referrals to our fetal medicine unit without compromising fetal outcomes.
CONCLUSIONS: Setting the critical maternal Rh(D) antibody level at >15 IU/mL lacks sufficient sensitivity. The lower ≥4 IU/mL threshold, though sensitive, is associated with a 46% false positive rate. In our population, a threshold of ≥6 IU/mL minimises false positive referrals while maintaining 100% sensitivity for moderate-severe fetal anaemia.
Colin A Walsh; Barry Doyle; John Quigley; Fionnuala M McAuliffe; Joan Fitzgerald; Rhona Mahony; Shane Higgins; Stephen Carroll; Peter McParland
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-4-4
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  -     ISSN:  1469-0705     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-4-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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This article is protected by copyright. All rights reserved.
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