Effect of high throughput RHD typing of fetal DNA in maternal plasma on use of anti-RhD immunoglobulin in RhD negative pregnant women: prospective feasibility study
- PMID: 18390496
- PMCID: PMC2292334
- DOI: 10.1136/bmj.39518.463206.25
Effect of high throughput RHD typing of fetal DNA in maternal plasma on use of anti-RhD immunoglobulin in RhD negative pregnant women: prospective feasibility study
Abstract
Objectives: To assess the feasibility of applying a high throughput method, with an automated robotic technique, for predicting fetal RhD phenotype from fetal DNA in the plasma of RhD negative pregnant women to avoid unnecessary treatment with anti-RhD immunoglobulin. VSports手机版.
Design: Prospective comparison of fetal RHD genotype determined from fetal DNA in maternal plasma with the serologically determined fetal RhD phenotype from cord blood V体育安卓版. .
Setting: Antenatal clinics and antenatal testing laboratories in the Midlands and north of England and an international blood group reference laboratory V体育ios版. .
Participants: Pregnant women of known gestation identified as RhD negative by an antenatal testing laboratory VSports最新版本. Samples from 1997 women were taken at or before the 28 week antenatal visit. .
Main outcome measures: Detection rate of fetal RhD from maternal plasma, error rate, false positive rate, and the odds of being affected given a positive result V体育平台登录. .
Results: Serologically determined RhD phenotypes were obtained from 1869 cord blood samples. In 95 VSports注册入口. 7% (n=1788) the correct fetal RhD phenotype was predicted by the genotyping tests. In 3. 4% (n=64) results were either unobtainable or inconclusive. A false positive result was obtained in 0. 8% (14 samples), probably because of unexpressed or weakly expressed fetal RHD genes. In only three samples (0. 2%) were false negative results obtained. If these results had been applied as a guide to treatment, only 2% of the women would have received anti-RhD unnecessarily, compared with 38% without the genotyping. .
Conclusions: High throughput RHD genotyping of fetuses in all RhD negative women is feasible and would substantially reduce unnecessary administration of anti-RhD immunoglobulin to RhD negative pregnant women with an RhD negative fetus V体育官网入口. .
Conflict of interest statement
Competing interests: None declared.
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Comment in
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Universal RHD genotyping in fetuses.BMJ. 2008 Apr 12;336(7648):783-4. doi: 10.1136/bmj.39533.358252.BE. Epub 2008 Apr 3. BMJ. 2008. PMID: 18390495 Free PMC article.
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Fetal RHD typing: Is fetal RHD typing in all RhD negative women cost effective?BMJ. 2008 Apr 26;336(7650):906. doi: 10.1136/bmj.39556.499549.80. BMJ. 2008. PMID: 18436926 Free PMC article. No abstract available.
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- National Institute for Clinical Excellence. Technology appraisal guidance 41. Guidance on the use of routine antenatal anti-D prophylaxis for RhD-negative women London: NICE, 2002
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