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Irregular Antibodies: An Assessment of Routine Prenatal Screening

From the Divisions of Ambulatory and Community Medicine and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Department of Pathology, University of Tennessee College of Medicine, Memphis, Tennessee

Abstract

In a review of the antenatal-postnatal records of 6062 patients attending the prenatal clinic at a large university perinatal center during 1980, 8.3% of the pregnant patients seen were Rh_o(D) negative and 91.7% were Rh_o(D) positive. Through routine antibody screening of all patients, 115 were found to have irregular antibodies which would otherwise not have been detected. Fifteen of these patients were Rh_o(D) negative, but they would have been included for antibody screening due to their Rh_o(D) negative status. Of the remaining 100 Rh_o(D) positive patients, clinically significant antibodies were observed in six patients; however, no maternal morbidity or hemolytic disease of the newborn was reported. Antecedent maternal risk factors for development of irregular antibodies were not sufficiently selective for predicting outcomes of such pregnancies. Furthermore, the only four patients with irregular antibodies requiring blood transfusion were cross-matched without difficulties. Findings suggest that screening all patients for irregular antibodies cannot be justified due to the prohibitive costs involved. However, because of the racially homogenous population studied, variations in the frequency of red blood cell genotypes between racial groups, and the irregular pattern of occurrence of irregular antibodies, the authors believe that further studies on the clinical impact and costeffectiveness of screening all antenatal patients for presence of irregular antibodies are necessary.