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Hemolytic Disease of the Fetus and Newborn
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Pedro Argoti, Ana M. Angarita, Giancarlo Mari
The most common antigens causing alloimmunization in the United States today are Rh(D) and Kell. IgG alloantibodies cross the placenta, bind to the antigens on the fetal RBCs, and can lead to hemolysis. Kell alloimmunization is mainly caused by previous blood transfusions but may also occur by maternal-fetal hemorrhage during pregnancy.
Erythroblastosis fetalis
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Avinash Patil, Brian Brocato, Rebecca A. Uhlmann, Giancarlo Mari
Maternal alloimmunization occurs when the gravid patient develops an immune response to a paternally derived antigen found on the surface of the fetal RBC. The most common antigen to cause RBC alloimmunization is Rh (D). The majority of Rh (D) alloimmunization is the result of fetomaternal hemorrhage. Fetomaternal hemorrhage has been shown to affect 75% of pregnancies during or shortly after delivery (16). Less than 0.1mL of fetal blood entering the maternal circulation causes most cases of alloimmunization (16). There are several clinical scenarios when a pregnancy is at risk for fetomaternal hemorrhage, the most significant of which is at the time of delivery. Other clinical scenarios that have demonstrated fetomaternal hemorrhage and the risk of RBC alloimmunization are found in Table 1.
Miscarriage
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Erich T. Wyckoff, Hadeer Usama Ebrahem Metwally
Although the risk of alloimmunization is low in first-trimester pregnancy loss, ACOG advises consideration of Rh(D) immune globulin. Women who undergo surgical evacuation should receive immune globulin because of the higher risk of alloimmunization resulting from the procedure [2]; the standard dose of Rh(D) immune globin is 300 µg intramuscularly, ideally administered within 72 hours of surgery.
An innovative intervention for the prevention of vaso-occlusive episodes in sickle cell disease
Published in Hematology, 2023
Won Jin Jeon, Bowon Joung, Jin Hyun Moon, Christopher Hino, Daniel Park, Bryan Pham, Dan Ran Castillo, Esther Chong, Simmer Kaur, Chanell Grismore, Huynh Cao
While prophylactic blood transfusions are commonly implemented in the clinical setting, there remains limited evidence to support their role in preventing VOEs [5]. The complications of chronic transfusions include alloimmunization, iron overload, and infection. Moreover, a worldwide shortage of blood products, especially during the COVID-19 pandemic, has further precluded this strategy from becoming standard-of-care [6,7]. Increased mortality from hyper-hemolytic reactions further limit the use of chronic blood transfusions [2,8]. In addition, patients may refuse blood transfusions due to personal or religious beliefs, and others may decline exchange transfusions due to not being amenable to central line or port placement. Consistently, the American Society of Hematology (ASH) has recommended against the use of chronic monthly blood transfusion therapy as standard, first-line therapy for prevention of acute pain in patients with SCD [5].
Platelets for advanced drug delivery in cancer
Published in Expert Opinion on Drug Delivery, 2023
Daniel Cacic, Tor Hervig, Håkon Reikvam
In a scenario where the necessary cell therapy facilities are readily available, apheresis-derived autologous platelets will be the likely source for platelet-based drug delivery systems. Subsequently, harvesting, manufacturing, and treatment can be performed in local hospitals without draining blood donor resources. This treatment strategy may be feasible for most cancer patients because medical cancer treatment is generally not commenced with concomitant thrombocytopenia, which impedes platelet harvesting. However, some patients with hematological malignancies may require treatment despite of being thrombocytopenic, and thus there is need for allogenic platelets for manufacturing of the drug delivery systems. Alloimmunization is not uncommon in multi-line treated hematological patients, who generally have received numerous platelet transfusions, and accordingly will require the use of human leukocyte antigen-matched single-donor apheresis-derived platelets. Otherwise, the more available pooled buffy coat-derived platelet concentrates may be supplied from blood banks.
Drug safety in thalassemia: lessons from the present and directions for the future
Published in Expert Opinion on Drug Safety, 2021
Laura Grech, Janet Sultana, Karen Borg, Joseph Borg
Current treatment for transfusion-dependent thalassemia (TDT) consists of regular blood transfusions to maintain hemoglobin levels between 9 and 10 g/dL [7] while non-transfusion dependent thalassemia (NTDT) patients require transfusions only when suffering from infections, during pregnancy or for surgical procedures [8]. Transfusions can give rise to a number of complications such as alloimmunization and iron overload in vital organs. In β-thalassemia major, if left untreated, iron overload is fatal in early life as a result of cardiac failure [9]. The introduction of regular transfusions followed by iron-chelating therapy has led to improved survival in β-thalassemia major. Studies have shown that optimal outcomes are achieved when chelation therapy is tailored according to patient requirements [7]. In the EPIC study, it was shown that initial iron chelating doses and subsequent titration are best guided by trends in serum ferritin and other safety markers including serum creatinine, liver function tests, cytopenia and hypersensitivity reactions [10]. It is therefore important that clinicians keep a record of patients’ transfusion history and the iron load as these parameters are used to guide treatment decisions including the type of iron-chelating drug used and the dose escalation [11].