Serologic Reactivity of Unidentified Specificity in Antenatal Testing and Hemolytic Disease of the Fetus and Newborn: The BEST Collaborative Study

Authors

Wen Lu, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Alyssa Ziman, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Matthew T S Yan, Canadian Blood Services, Vancouver, British Columbia, Canada.
Allison Waters, Irish Blood Transfusion Service, Dublin, Ireland.
Mrigender Singh Virk, Transfusion Medicine Service, Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
Ann Tran, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Hongying Tang, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Andrew W. Shih, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Edel Scally, Irish Blood Transfusion Service, Dublin, Ireland.
Jay S. Raval, Transfusion Medicine and Therapeutic Pathology, Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA.
Suchi Pandey, Stanford Blood Center, Palo Alto, California, USA.
Monica B Pagano, Department of Laboratory Medicine and Pathology, Transfusion Medicine Division, University of Washington, Seattle, Washington, USA.
Hua Shan, Transfusion Medicine Service, Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
Carmel Moore, National Maternity Hospital, Dublin, Ireland.
Douglas Morrison, Department of Pathology and Laboratory Medicine, BC Women's and Children's Hospital, Vancouver, British Columbia, Canada.
Orla Cormack, National Maternity Hospital, Dublin, Ireland.
Joan Fitzgerald, National Maternity Hospital, Dublin, Ireland.
Jennifer Duncan, Vancouver Island Health Authority, Courtenay, British Columbia, Canada.
Jessica Corean, Transfusion Medicine Service, Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
Gwen Clarke, Canadian Blood Services, Vancouver, British Columbia, Canada.
Mark Yazer, Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Document Type

Article

Publication Date

4-1-2023

Abstract

BACKGROUND: The clinical significance of serologic reactivity of unidentified specificity (SRUS) in pregnancy is not clear based on available literature. The aim of this study is to determine if SRUS is associated with hemolytic disease of the fetus and newborn (HDFN).

STUDY DESIGN AND METHODS: Retrospective data were collected from eight institutions over an 11-year study period (2010-2020), when available (5/8 sites). The outcome of the pregnancies with SRUS-no, mild, moderate, or severe HDFN-was determined.

RESULTS: SRUS was demonstrated in 589 pregnancies. After excluding those with incomplete data, a total of 284 pregnancies were included in the primary HDFN outcome analysis. SRUS was detected in 124 (44%) pregnancies in isolation, and none were affected by HDFN. Of 41 pregnancies with SRUS and ABO incompatibility, 37 (90%) were unaffected, and 4 (10%) were associated with mild HDFN. Of 98 pregnancies with SRUS and concurrent identifiable antibody reactivity(s), 80 (81%) were unaffected, and 19 (19%) were associated with mild to severe HDFN. There was 1 case of mild HDFN and 1 case of severe HDFN in the 21 pregnancies with SRUS, ABO incompatibility, and concurrent identifiable antibody reactivity(s), and 19 (90%) were unaffected by HDFN. Among all patients with repeat testing, newly identified alloantibodies or other antibodies were identified in 63 of 212 (30%) patients. Although most were not clinically significant, on occasion SRUS preceded clinically significant antibody(s) associated with HDFN (3%, 5/188).

CONCLUSION: The antenatal serologic finding of SRUS in isolation is not associated with HDFN but may precede clinically significant antibodies.

Recommended Citation

Lu W, Ziman A, Yan MTS, Waters A, Virk MS, Tran A, Tang H, Shih AW, Scally E, Raval JS, Pandey S, Pagano MB, Shan H, Moore C, Morrison D, Cormack O, Fitzgerald J, Duncan J, Corean J, Clarke G, Yazer M. Serologic reactivity of unidentified specificity in antenatal testing and hemolytic disease of the fetus and newborn: The BEST collaborative study. Transfusion. 2023 Apr;63(4):817-825. doi: 10.1111/trf.17276. Epub 2023 Feb 23. PMID: 36815517.