Work

Anti‐D prophylaxis should protect all newborns from haemolytic disease, regardless of their country of residence

Year: 2024

Type: article

Abstract: Anti-D prophylaxis should protect all newborns from haemolytic disease, regardless of their country of residence According to a World Health Organization (WHO) study, the observed failure rate of substandard and falsified medicines (SFM) in low-and middle-income countries is estimated to be over 10%, with an estimated spend of US$30.5 billion [1].The problem embraces drugs in many areas of healthcare.We report on monoclonal anti-Ds, used for many years in low-and middle-income countries, for prophylaxis of RhD haemolytic disease of the foetus and newborn (HDFN), which have never been shown to meet the standards of anti-D immunoglobulin (Ig).The consequences of using these drugs in postnatal women might be very serious, even fatal, for their offspring.The prevention of HDFN by administration of anti-D Ig to D-negative women has been a triumph of medicine.In Europe, North America and Australia, before prophylaxis, 16%-17% of D-negative women delivering ABO-compatible, D-positive infants developed anti-D after delivery of a second D-positive infant [2].Several clinical trials, over 6 years, on male volunteers and then on thousands of D-negative primiparae delivering ABO compatible, D-positive infants, many of them tested after delivery of a second D-positive infant, showed that postnatal anti-D Ig could suppress RhD immunization and hence be used clinically in women [2].Anti-D Ig acts, in part, by clearing foetal red blood cells from the maternal circulation.By 1971, anti-D Ig was introduced into clinical use in the United Kingdom, where mortality from HDFN fell from 46/100,000 births in 1953 [3] to 1.6/100,000 in 1989 [4].However, in several low-and middle-income countries, due to limited availability and expense of prophylaxis, this success has not occurred, where it was esti-

Source: Vox Sanguinis

DOI: 10.1111/vox.13745

Authors: Marcela Contreras, Belinda Kumpel, Natalia Olovnikova

Institutions: NHS Blood and Transplant, National Medical Research Center for Hematology

Language: English

Topic: Blood groups and transfusion

Subfield: Hematology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,950