Background - Although great advances have been made in the prevention of hemolytic disease of the fetus and newborn, especially for anti-D, irregular antibodies still appear. In order to ascertain the situation in Spain, we conducted a survey among hospitals treating pregnant women.
Materials and methods - We sent a survey to Spanish public hospitals comprising demographical data (ethnicity, number of pregnancies, type of fertilization), characteristics of antibodies (specificity, number, antigenic compatibility), cause of alloimmunization and the clinical consequences (fetal death, icterus, anemia) between 2016 and 2021. We characterized the risk posed by antibodies and their clinical impact according to previously described criteria.
Results - During the study period, 574,140 children were born in the responding hospitals. Antibodies were detected in 1,055 women with 1,112 pregnancies, resulting in a 0.19% alloimmunization prevalence. The most common antibodies were anti-D (No.=393, 28.7%), anti-c (No.=204, 14.9%), anti-E (No.=199, 14.6%), anti-M (No.=129, 9.4%), and anti-Kell (No.=114, 8.3%). Incorrect prophylaxis administration in the current or past pregnancy accounted for 88.6% of anti-D, and 12 (6.5%) arose from an RhD-positive transfusion. When analyzing incompatible pregnancies (No.=424; 38%), 103 (24.3%) presented severe or very severe hemolytic disease, most of which (No.=92, 89%) were produced by high-risk antibodies, while only 11 cases were caused by medium-risk antibodies.
Discussion - The prevalence of irregular antibodies during pregnancy in Spain is lower than previously described for other Western countries. The most important antibodies are anti-D, anti-c and anti-K. More efforts to characterize antibodies should be made in order to reduce their prevalence and clinical impact.
Iñigo Romón
- Department of Hematology and Hemotherapy, University Hospital Marqués de Valdecilla - IDIVAL, Santander, Spain
https://orcid.org/0000-0003-2428-4469
Enric García-Rey
- Department of Transfusion, Catalonia Blood and Tissue Bank, Hospital Sant Joan de Deu, Esplugues Llobregat, Spain
María-Eva Mingot-Castellano
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
https://orcid.org/0000-0001-9083-855X
José María García Gala
- Department of Transfusion, Hematology. H.U.C Asturias (HUCA), Instituto Sanitario Principado Asturias (ISPA) Oviedo, Spain
https://orcid.org/0000-0001-5992-1961
José Luís Bueno Cabrera
- Department of Transfusion, Hospital Puerta de Hierro, Madrid, Spain
Veronica Pons Escoll
- Department of Transfusion, Catalonia Blood and Tissue Bank, H.U. Vall d'Hebron, Barcelona, Spain
https://orcid.org/0009-0006-3084-0627
Roberto Céspedes López
- Department of Transfusion, Catalonia Blood and Tissue Bank, U.H. Josep Trueta, Girona, Spain
Maria Falcón Rodríguez
- Department of Transfusion, Complejo Universitario Insular Materno-Infantil de Gran Canaria, Spain
https://orcid.org/0009-0002-2726-5845
Montse Gómez Calafat
- Hematology and Hemotherapy Service, Clinic University Hospital of Valencia, INCLIVA Biomedical Research Institute, Valencia, Spain
https://orcid.org/0000-0003-3365-9680
Pablo Rodríguez Whilhemi
- Department of Transfusion, Hospital Navarra, Pamplona, Spain
Christian Palafox Camps
- Department of Transfusion, Catalonia Blood and Tissue Bank, U.H. Mutua de Terrassa, Terrassa, Spain
Miguel Angel Álvarez
- Instituto Maimónides de Investigación Biomédica de Córdoba, UGC Department of Hematology and Hemotherapy, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
https://orcid.org/0000-0002-8025-5112
Jordi Fornells Albanell
- Department of Transfusion, Catalonia Blood and Tissue Bank, Hospital Clinic, Barcelona, Spain
https://orcid.org/0009-0005-7359-254X
María Belén Moreno Risco
- Department of Transfusion, Hospital Materno-Infantil de Badajoz, Badajoz, Spain
Gemma Moreno Jiménez
- Department of Transfusion, Hospital Ramon y Cajal, Madrid, Spain
Josefina Galende del Canto
- Department of Transfusion, Hospital El Bierzo, Ponferrada, Leon, Spain
Laia Ramiro Infante
- Department of Transfusion, Catalonia Blood and Tissue Bank U.H. Joan XXIII, Tarragona, Spain
María del Carmen Hernández García
- Department of Transfusion, Hospital Don Benito Villanueva VVA, Caceres, Spain
Asunción Pinacho Oyarzabal
- Department of Transfusion, Catalonia Blood and Tissue Bank, U.H. Arnau Vilanova, Lleida, Spain
María-Ángeles Fernández Galán
- Department of Transfusion, Hospital Virgen Del Puerto, Plasencia, Spain
Elena Delgado Casado
- Hematology and Hemotherapy, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
Virginia Callao Molina
- Regional Transfusion Centre of the Comunidad Valenciana, Valencia, Spain
Eduardo Muñiz-Diaz
- Transfusion Medicine and Immunohematology Institute, Barcelona, Spain
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