Helen Ryan, Mark Lambert, Sorcha Ní Loingsigh, Richard Hagan, Diarmaid O'Donghaile
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Evaluation of 6 years of fetal RHD screening in Ireland: From implementation to practice.
Background and objectives: The discovery of circulating fetal DNA in maternal plasma enabled non-invasive prenatal testing (NIPT) for targeted anti-D prophylaxis. In 2019, Ireland implemented an in-house test to guide this care. Here, we report 6 years of service.
Materials and methods: Cell-free fetal DNA (cffDNA) was extracted from 1000-μL plasma from pregnant RhD negative women at gestation age (GA) > 11 weeks. Samples were tested in triplicate for RHD by quantitative PCR using a multiplex assay of RHD exons 7 and 10.
Results: Of the 20,099 samples tested, 58.2% were predicted RhD positive and 36.9% were predicted RhD negative. Discrepancies were seen in 52 cases: 7 (0.03%) were predicted RhD negative but cord RhD positive and 45 (0.2%) were predicted RhD positive but cord RhD negative.
Conclusion: This test has ensured that over 7400 women have avoided unnecessary anti-D prophylaxis. There were few discrepant results, with false negatives posing a greater clinical risk due to withheld anti-D, increasing immunization risk. Three were linked to pre-analytical errors prompting procedural changes. Due to the success of fetal RHD screening, cord blood testing has been discontinued in some countries; a practice which could be reviewed in Ireland.
期刊介绍：
Vox Sanguinis reports on important, novel developments in transfusion medicine. Original papers, reviews and international fora are published on all aspects of blood transfusion and tissue transplantation, comprising five main sections:
1) Transfusion - Transmitted Disease and its Prevention:
Identification and epidemiology of infectious agents transmissible by blood;
Bacterial contamination of blood components;
Donor recruitment and selection methods;
Pathogen inactivation.
2) Blood Component Collection and Production:
Blood collection methods and devices (including apheresis);
Plasma fractionation techniques and plasma derivatives;
Preparation of labile blood components;
Inventory management;
Hematopoietic progenitor cell collection and storage;
Collection and storage of tissues;
Quality management and good manufacturing practice;
Automation and information technology.
3) Transfusion Medicine and New Therapies:
Transfusion thresholds and audits;
Haemovigilance;
Clinical trials regarding appropriate haemotherapy;
Non-infectious adverse affects of transfusion;
Therapeutic apheresis;
Support of transplant patients;
Gene therapy and immunotherapy.
4) Immunohaematology and Immunogenetics:
Autoimmunity in haematology;
Alloimmunity of blood;
Pre-transfusion testing;
Immunodiagnostics;
Immunobiology;
Complement in immunohaematology;
Blood typing reagents;
Genetic markers of blood cells and serum proteins: polymorphisms and function;
Genetic markers and disease;
Parentage testing and forensic immunohaematology.
5) Cellular Therapy:
Cell-based therapies;
Stem cell sources;
Stem cell processing and storage;
Stem cell products;
Stem cell plasticity;
Regenerative medicine with cells;
Cellular immunotherapy;
Molecular therapy;
Gene therapy.
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