Immunohaematological Testing, Monitoring, and Treatment of Haemolytic Disease of the Newborn: Where are we in this Field after 25 Years?

Context

Prevention of pregnancy-related alloimmunisation and the management of haemolytic disease of the foetus and newborn (HDFN) has significantly improved over the past decades.

Aim

Considering the improved HDFN care in recent years, the goal of this 25-year analysis is to determine the epidemiological aspects of alloimmunisation during pregnancy and the presentation, diagnosis, and treatment of different types of haemolytic disease of newborns (HDN).

Materials and methods

The retrospective study encompasses all pregnant women whose immunohaematological screening detected antibodies against any of the antigens in ABO, Rhesus, Kell, Duffy, Kidd, and/or other blood group systems or had newborns who developed HDN.

Results

Over the 25-year study period, 830/38,898 (2.1%) of immunohaematologically tested pregnant women developed alloimmunisation, while 556 (1.42%) of their newborns developed HDN. The most common form of HDN in our study was ABO HDN at 73.2% (407/556). RhD HDN was treated in 12.9% (72/556) of the newborns. Exchange transfusions (ET) were administered to 5.76% (32/556) of newborns with HDN. ET was performed on 24 (75%) with ABO HDN, and 8 (25%) with RhD HDN.

The conclusion of this 25-year study is that alloimmunisation is still present, as are its consequences for the newborn. Despite better screening of pregnant women, diagnosis, and treatment of the consequences of alloimmunisation, we must know that there is no universal cure for HDN; therefore, continuous research and new guidelines in this field are needed.