Hemolytic disease of the fetus and newborn and Rhesus alloimmunization in Latin American countries: a scoping review.

IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Mário Dias Corrêa Júnior, Salvador Espino Y Sosa, Milene Fernandes, Lais do Carmo, Renato Watanabe de Oliveira, Gabriela Kanevsky
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引用次数: 0

Abstract

Background: Hemolytic disease of the fetus and newborn (HDFN) is a condition due to maternal blood group antibodies targeting antigens in fetal red blood cells, with significant prenatal/perinatal morbidity and mortality. Severe HDFN cases are often associated with alloimmunization against Rhesus D (RhD) or Kell antigens. Information about HDFN epidemiology and treatment in Latin American countries is limited. This review aims to identify and synthesize the available evidence on the epidemiology and management of HDFN in this region.

Methods: In July 2023, EMBASE, PubMed, LILACS, and other databases were searched for articles reporting epidemiology, treatment, prenatal and perinatal outcomes, and patient journey of HDFN cases in Latin American countries. A snowball search of cross-references and gray literature complemented the initial search. Publications in English, Spanish, and Portuguese were reviewed. Data were extracted using a defined template and charted in tables.

Results: We reviewed five guidelines and 19 observational studies from Brazil, Chile, Mexico, Argentina, Colombia, Panamá, Paraguay, and Peru. HDFN due to Rh alloimmunization ranged from 0.5 to 5 per 1000 live births, and anti-D remains the most frequent alloantibody type for severe HDFN. The perinatal mortality rate of HDFN is approximately 1.3-1.6 per 100,000 live births, and fetal deaths can reach 30% among patients treated with intrauterine transfusions. Up to 47% of alloimmunized pregnancies were referred to reference centers only during the third trimester. About 60% of eligible pregnancies received anti-D IgG prophylaxis.

Conclusions: Although estimates in LATAM countries are scarce and lack standardized measures, we observed that the incidence, morbidity, and mortality of HDFN in this region are problematic. RhD alloimmunization was reported in approximately up to 70% of severe HDFN cases, despite anti D HDFN being largely preventable.

拉丁美洲国家胎儿和新生儿溶血性疾病及恒河猴同种异体免疫:范围综述
背景:胎儿和新生儿溶血病(hddn)是一种由母体血型抗体靶向胎儿红细胞抗原引起的疾病,具有显著的产前/围产期发病率和死亡率。严重的hdn病例通常与针对D河猴(RhD)或Kell抗原的同种免疫有关。关于HDFN流行病学和拉丁美洲国家治疗的信息有限。本综述旨在识别和综合该地区HDFN流行病学和管理方面的现有证据。方法:于2023年7月检索EMBASE、PubMed、LILACS等数据库,检索拉美国家HDFN病例的流行病学、治疗、产前和围产期结局、患者历程等相关文献。对交叉参考文献和灰色文献的滚雪球式搜索补充了最初的搜索。对英文、西班牙文和葡萄牙文出版物进行了审查。使用定义的模板提取数据,并在表格中绘制图表。结果:我们回顾了来自巴西、智利、墨西哥、阿根廷、哥伦比亚、巴拿马、巴拉圭和秘鲁的5项指南和19项观察性研究。Rh同种异体免疫引起的HDFN为每1000个活产0.5至5个,抗d抗体仍然是严重HDFN最常见的同种异体抗体类型。HDFN的围产期死亡率约为每10万活产1.3-1.6例,在接受宫内输血治疗的患者中,胎儿死亡率可达30%。高达47%的同种异体免疫孕妇仅在妊娠晚期才被转介到参考中心。约60%符合条件的孕妇接受了抗d IgG预防。结论:虽然拉丁美洲国家的估计数据很少,而且缺乏标准化的措施,但我们观察到该地区HDFN的发病率、发病率和死亡率存在问题。尽管抗D型hdf在很大程度上是可预防的,但据报道,在大约70%的严重hdf病例中,RhD同种异体免疫接种。
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来源期刊
BMC Pregnancy and Childbirth
BMC Pregnancy and Childbirth OBSTETRICS & GYNECOLOGY-
CiteScore
4.90
自引率
6.50%
发文量
845
审稿时长
3-8 weeks
期刊介绍: BMC Pregnancy & Childbirth is an open access, peer-reviewed journal that considers articles on all aspects of pregnancy and childbirth. The journal welcomes submissions on the biomedical aspects of pregnancy, breastfeeding, labor, maternal health, maternity care, trends and sociological aspects of pregnancy and childbirth.
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