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Background: Cesarean sections (C-section) often require blood transfusions in cases of severe bleeding, particularly challenging in Rh-negative pregnancies due to the scarcity of Rh-negative donors, with only approximately 0.3% of the population in Thailand. Autologous blood donation, where individuals donate their own blood before surgery, offers a promising solution. Our study focused on preparing preoperative autologous blood donations (PAD) for Rh-negative pregnancies. Methods: We conducted blood screening on 7,182 pregnancies at Takuapa Hospital from October 2013 to September 2018, identifying 21 Rh-negative pregnant women. We established criteria based on hemoglobin (Hb) levels, which are crucial for autologous blood preparation (Hb at 11.0 g/dL, and hematocrit (Hct) above 33%). Blood samples were collected twice during pregnancy, at 36 and 37 weeks, with the second collection 1 week before the C-section. Pregnancies testing positive for infectious markers were excluded following standard blood donation guidelines. Twelve pregnant women testing negative for infectious markers were enrolled. Results: The demographic data showed 12 subjects aged 17 to 41 years, with an average of 27.83. Initial blood tests indicated Hb and Hct levels of 12.5 g/dL, and 36.4%, slightly decreasing to 12.2 g/dL and 35.8% in the second collection. On the day of the cesarean, levels further declined to 11.6 g/dL and 34.4%, respectively, within normal ranges. At discharge, the Hct measured 34.8%. Maternal and infant health post-C-section were good, with baby weights ranging from 2,640 to 4,080 g. None of the 12 cases required autologous blood transfusion, validating the safety of standard autologous blood preparation practices. Conclusions: This study highlights the safety of autologous blood donation for pregnant women with rare blood types, which was achieved through effective planning and collaboration among hospital departments. These findings can serve as a model for other hospitals and significantly reduce the burden of searching for Rh-negative donors.

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BACKGROUND: Transplacental-derived anti-D IgG in RhD-negative pregnant women can trigger an immune response to Rh D-positive red cells in fetuses and newborns. We assessed the effect of anti-D titers in RhD-negative pregnant women on fetuses and newborns. METHODS: The clinical data of 142 singleton RhD-sensitized pregnancies were retrospectively collected. The pregnant women received routine prenatal care and the newborns had standard care. Based on the tertile categories of the pregnancies, the maximum titers of anti-D IgG in the pregnant women were divided into three groups ranging from low to high as follows: low-titer group (anti-D titer: 1:4-1:128, n = 57); medium-titer group (anti-D titer: 1:256-1:512, n = 50); and high-titer group (anti-D titer: 1:1024-1:4096, n = 35). RESULTS: The frequencies of major neonatal complications did not significantly differ among the three groups. The high-titer group had the highest frequency of pregnancies requiring intrauterine transfusion (IUT) and number of IUTs among the three groups. The high-titer group had a significantly higher frequency of newborns treated with top-up transfusion, number of top-up transfusions, frequency of newborns treated with exchange transfusion (ET), and number of ETs when compared to the low-titer group. CONCLUSION: Higher anti-D titers in RhD-negative pregnant women predict more severe fetal and neonatal hemolytic anemia. Increasing maternal anti-D titers results in an increased need for IUTs, and neonatal top-up transfusions and ETs. Methods for reducing titers of anti-D IgG in RhD-sensitized pregnant women warrants further investigation.

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The Bombay Rh D negative is the rarest of the rare in blood groups. A 65-year-old male patient with coronary artery disease was admitted for CABG. During grouping, forward showed no agglutination in A, B, D, and H, and reverse showed agglutination in A, B, and O cell. The blood group was confirmed as Bombay Rh D negative. Four units of PRBC was requested for the surgery as it was cardiothoracic surgery. We checked our inventory and rare donor list for Bombay-negative blood. Acute normovolemic hemodilution was done for 2 units preoperatively with saline replacement. Autologous platelet apheresis was done for this patient. During routine cross-match, one unit was incompatible. The patient had naturally occurring anti-S, which was reactive at 37°C and clinically significant. A total of 4 PRBC (Packed Red Blood Cell), 1 Single Donor Platelet (SDP), 12 Fresh Frozen Plasma (FFP), and 9 cryoprecipitate were transfused throughout the hospital stay. The patient was Bombay Rh negative with anti-S with major surgery, which was re-explored twice; the patient was managed successfully in spite of all these difficulties with cooperation from different blood banks from all over India.

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BACKGROUND: Placenta accreta is known to be associated with significant maternal morbidity and mortality-primarily due to intractable bleeding during abortion or delivery at any level of gestation. The complications could be reduced if placenta accreta is suspected in a patient with a history of previous cesarean delivery and the gestational sac/placenta is located at the lower part of the uterus. Then, a proper management plan can be instituted, and complications can be reduced. The diagnosis of placenta accreta in the first trimester of pregnancy is considered uncommon. CASE PRESENTATION: A 34-year-old Malay, gravida 4, para 3, rhesus-negative woman was referred from a private hospital at 13 weeks owing to accreta suspicion for further management. She has a history of three previous lower-segment cesarean sections. She also had per vaginal bleeding in the early first trimester, which is considered to indicate threatened miscarriage. Transabdominal ultrasound revealed features consistent with placenta accreta spectrum. She was counseled for open laparotomy and hysterectomy because of potential major complication if she continued with the pregnancy. Histopathological examination revealed placenta increta. CONCLUSION: A high index of suspicion of placenta previa accreta must be in practice in a patient with a history of previous cesarean deliveries and low-lying placenta upon ultrasound examination during early gestation.

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We report the case of a 33-year-old pregnant Chinese woman who typed as Rh-negative in routine serology. Two injections of RhIG were given and two Rh-negative red cell units were sourced and put aside then returned with a reduced shelf life. RHD*DEL1 allele was determined in this woman by RHD genotyping two month later after delivery occasionally. In this representative case, a pregnant woman with RHD*DEL1 allele can safely be managed as Rh-positive, avoiding the unnecessary procurement of Rh-negative red cells and payment for RhIG injections. We analyzed the cost benefit of using RHD genotyping to guide transfusion management on the Chinese pregnant woman in Beijing where the average salary level is top-ranked in China. Considering the healthcare condition in China, we recommend molecular analysis of serologic Rh-negative early in pregnancy before the Rh-negative transfusion and administration of RhIG become unnecessarily required.

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BACKGROUND: The Rhesus (Rh) blood group system is the next most clinically significant blood group system following the ABO blood group. Rh D-negative women are at risk of alloimmunization following exposure to Rh D-positive blood. The exposure of Rh D-negative women to Rh D-positive fetal blood may cause hemolytic disease of the fetus or new-born due to Rh incompatibility. Knowing Rh blood phenotype has paramount importance to prevent the risk of sensitization and bad obstetric outcome in Rh D-negative women. Despite the aforementioned fact, the distribution of Rh D-negative phenotype of women was not explored in Arba Minch Zuria district, southern Ethiopia. This study was aimed to assess the prevalence of Rh D-negative blood phenotype among reproductive-age women in Arba Minch Zuria district, southern Ethiopia. METHODS AND MATERIALS: A community-based cross-sectional study was conducted among reproductive-age women in Arba Minch Zuria district, Southern Ethiopia from March to April 2019. Socio-demographic data were collected using an interviewer-administered semi-structured questionnaire and blood phenotype determination was done by laboratory technicians using the slide method principle aseptically and Statistical Package for Social Science (SPSS) version 21 was used for analysis. RESULT: The data were collected from 417 study participants with a 98.8% response rate. This study revealed that 2.1%, 1.9%, 1.2%, and 1% of study participants with blood group O, A, B, and AB were Rh D negative, respectively. In this study, the overall prevalence of Rh D negative phenotype was found 6.2% among reproductive-age women in Arba Minch Zuria district, Southern Ethiopia. CONCLUSIONS: This study showed a high prevalence of Rh D negative factor among reproductive-age women in Arba Minch Zuria district. Therefore, counseling of reproductive age women on the importance of Rh D factor status determination would be worthy to avoid the potential risk of sensitization among Rh D negative women in order to prevent hemolytic disease of the fetus and new-born.

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BACKGROUND: Transplacental or fetomaternal hemorrhage (FMH) may occur during pregnancy or at delivery and lead to immunization to the D antigen if the mother is Rh-negative and the baby is Rh-positive. This can result in hemolytic disease of the fetus and newborn (HDFN) in subsequent D-positive pregnancies. Therefore, the aim of this systematic review and meta-analysis was to estimate distribution of ABO and Rh (D) blood groups among pregnant women in Ethiopia. METHOD: We searched PubMed, Google Scholar, EMBASE, Cochrane Library, HINARI, AFRO Library Databases, and African Online Journal databases for all available studies using the following keywords: "High rhesus (Rh(D)) negative frequency", "ABO blood group distribution", "haemolytic disease of the newborn (HDN)", "rh isoimmunization", "anti-RhD immunoglobulin", "D-negative pregnancies", "Frequency", "ABO and Rh blood group distribution", "feto-maternal hemorrhage", "rhesus D negative pregnant mothers", "kleihauer-betke test (KBT)", "Neonatal Hyperbilirubinemia", "non-sensitized RhD-negative pregnant women", "antenatal anti-D immunoglobulin prophylaxis", "Hemolytic disease of the newborn (alloimmunization), Ethiopia. The search string was developed using "AND" and "OR" Boolean operators. All published and unpublished observational studies reporting the distribution of ABO and Rh (D) blood groups among pregnant women in Ethiopia were included. The study participants were all pregnant women in Ethiopia, and the main outcome measure of this systematic review and meta-analysis was Rhesus D-negative blood type and ABO blood group distribution among pregnant women in Ethiopia. The data was extracted by the author (AAA) by using a standardized JBI data extraction format. Microsoft Excel (2016), and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) software were used for data entry and analysis, respectively. The random effect model was used for estimating the pooled effects, and the publication bias was assessed by visual inspection of the funnel plots and objectively by using the Egger's test (i.e. p < 0.05). RESULTS: One hundred thirty-two articles were identified through electronic database searching. Of which, 34 were excluded due to duplication, 65 through review of titles and abstracts, and 22 full-text articles were excluded for not reporting the outcome variable and other reasons. Finally, 7 were included to estimate the distribution of ABO and Rh (D) blood groups among pregnant women in Ethiopia. The pooled distribution of Rh-negative blood group among pregnant women in Ethiopia was 10.8% (95%CI: 7.53-14.07, I2 = 85%, p < 0.001). In the ABO system, type O was the most prevalent 39.9% (37.51-42.38), followed by A (30.59% (26.00-35.18)), B (23.04% (20.03-26.05)), and AB the least (4.82%(3.17-6.47)), in the pattern O > A > B > AB. CONCLUSION: The pooled distribution of Rh-negative blood group among pregnant women in Ethiopia was high. Rh alloimmunization remains a major factor responsible for perinatal morbidity in Ethiopia and may result in the compromise of the woman's obstetric care due to the unaffordability of anti-D immunoglobulin. There is the urgent need for the implementation of universal access to anti-D immunoglobulin for the Rh-negative pregnant population in Ethiopia.

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BACKGROUND AND AIM: Rh isoimmunization still contributes to the neonatal morbidity and mortality due to non-immunization, under-immunization, and in rare cases, false Rh typing. The main objective of this study was to determine the prevalence of Rh incompatibility, mothers' knowledge about Rh incompatibility, mothers' knowledge about anti-D immunoglobulin and to show the pregnancy outcome of Rh negative mothers. METHODS: A cross-sectional study was carried out at the Maternity and Children Hospital in Arar city from November 2016 to May 2017. All pregnant mothers attending the Maternity and Children Hospital for pregnancy follow up or delivery, during the study period were studied. Data were collected by means of personal interview with the sampled population using a researcher-made questionnaire covering the needed data. Data were analyzed by SPSS version 16, using descriptive statistics and Chi-Square test. RESULTS: Of the studied mothers, 23% were Rh negative. Only 38% of the studied mothers had knowledge about Rh incompatibility, 68.5% had knowledge about anti-D and 51% had knowledge about time of administration of anti D. Considering pregnancy outcome; 55% of the delivered babies needed incubation after delivery, 23.3% of those babies were born to Rh negative mothers. However, 6.7% of the incubated children died after incubation (47.8% of them belong to Rh negative mothers). CONCLUSION: About a quarter of the mothers in the studied population were Rh negative. Mothers had a low level of knowledge about Rh incompatibility and anti-D immunoglobulin and its administration. Health education sittings are needed to increase public awareness about this important issue.

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Objective:To study antenatal immunity test and outcomes of Rh-negative pregnant women.Methods:287cases(1.25％ in 22880 cases)of Rh-negative pregnant women delivered in Shanghai Sixth People hospital from January 1 st,2010 to December 31,2016 were retrospectively analyzed.Rh(D) blood group was identified by a micro column gel method,and the same as serum anti-D antibody.The Rh phenotype detection was done Serology method and the hemolytic disease of the newborn was used indirect antiglobulin test,serum free antibody test,absorption and elution test.Some Rh negative pregnant women were implemented autologous blood at 37 weeks of gestation.Results:Among 287 cases of Rh-negative,12 cases had anti-D antibody and the positive rate was 4.18％.Among the 12 cases of anti-D positive,their Rh phenotype were all ccdee and they all had history of childbearing.In 90 cases which had one history of birth,there were ten cases had anti-D antibody (11.11％),in 15 cases which had two history of birth,there were two cases had anti-D antibody(13.33％).287 Rh negative pregnant women had 290 child births,among which 8 newborn had neonatal hemolytic disease,the incidence rate was 2.75％ (8/290).In the 12 cases of anti-D positive,there were 1 case died because of fetal neonatal hemolytic disease and 7 cases were cured and 4 cases were normal with free of jaundice symptoms.There were 146 pregnant women implementation of autologous donation safely.According to the delivery way of childbirth,287 cases were divided by cesarean section and vaginal delivery,comparing postpartum haemorrhage amount with autologous donantion and unautologous donation,respectively,the result showed that they had no significant difference(P ＞0.05).Conclusions:It should be pay attention to the pregnant women who had childbearing history and whose Rh phenotype is ccee,which tend to produce anti-D immune antibody.However,this does not necessarily lead to hemolytic disease.Based on maternal and fetus conditions,autologous donation is safe and valuable in Rh-negative pregnant.

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INTRODUCTION: Hemolytic disease of the newborn was first described in the medical literature 1609, when it was diagnosed in one French housewife. In 1932 Diamond and colleagues described the mutual relationship of fetal hydrops, jaundice, anemia and erythoblastosis, which was later called fetal erytroblastosis. Hemolytic disease of the newborn (HDN) in the strict sense is considered disease whose basis is accelerated immune destruction of fetal/child erythrocytes that are bound to IgG antibodies of maternal origin. These antibodies are directed against antigens of father's origin, which are present in the fetal/children's erythrocytes and that the mother's immune system recognizes them as foreign antigens. GOAL: The goal is that in the period from January 1(st) 2011 to October 23(st) 2013 determine the frequency of ABO and Rh D incompatibilities in our sample of pregnant women/mothers, and to underscore the importance of regular check of ABO Rh D negative pregnant women and application specific Rh D protection. MATERIAL AND METHODS: In the General Hospital "Prim. Dr. Abdulah Nakas" in Sarajevo by retrospective study are followed several relevant variables. Immune alloantibodies were detected in vivo by indirect Coombs test (ICT) with serum mother and O test erythrocytes, by direct Coombs test (DCT) with erythrocytes of a newborn. RESULTS: The total number of births ABO Rh D negative was 596 (14%) and ABO Rh D positive mothers 4261 (86%). Of the total number of Rh D negative mothers there was A Rh D: negative mothers 42%; O Rh D negative 33%; B Rh D: negative 17% and AB Rh D: negative 8%. Most of immune antibodies appear in mothers with O Rh D: negative blood type. The emergence of immune antibodies in the Rh D negative mothers was 1%, the appearance of ABO incompatibilities amounted to 2.3% of our sample. CONCLUSION: IN ORDER TO REDUCE THE OCCURRENCE OF ALLOIMMUNIZATION OF THE MOTHER TO ERYTHROCYTE ANTIGENS OF THE NEWBORN THAT CAN LEAD TO MAJOR COMPLICATIONS IN SUBSEQUENT PREGNANCIES OF RH D: negative mothers and HDN constant monitoring in order to prevent them is necessary. Prevention is essential because once immunized mother will remain immunized for life.

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Transplacental or fetomaternal hemorrhage (FMH) may occur during pregnancy or at delivery and lead to immunization to the D antigen if the mother is Rh-negative and the baby is Rh-positive. This can result in hemolytic disease of the fetus and newborn (HDFN) in subsequent D-positive pregnancies. The aim of this study is to highlight the challenges associated with the effective management and prevention of Rh alloimmunization among Rh-negative women in Sub-Saharan Africa. In most Sub-Saharan African countries, there is poor and sometimes no alloimmunization prevention following potentially sensitizing events and during medical termination of pregnancy in Rh-negative women. Information about previous pregnancies and termination are often lacking in patients' medical notes due to poor data management. These issues have made the management of Rh-negative pregnancy a huge challenge. Despite the fact that the prevalence of Rh-negative phenotype is significantly lower among Africans than Caucasians, Rh alloimmunization remains a major factor responsible for perinatal morbidity in Sub-Saharan Africa and may result in the compromise of the woman's obstetric care due to the unaffordability of anti-D immunoglobulin. There is the urgent need for the implementation of universal access to anti-D immunoglobulin for the Rh-negative pregnant population in Africa. Anti-D immunoglobulin should be available in cases of potentially sensitizing events such as amniocentesis, cordocentesis, antepartum hemorrhage, vaginal bleeding during pregnancy, external cephalic version, abdominal trauma, intrauterine death and stillbirth, in utero therapeutic interventions, miscarriage, and therapeutic termination of pregnancy. There is also the need for the availability of FMH measurements following potentially sensitizing events. The low-cost acid elution method, a modification of the Kleihauer-Betke (KB) test, can become a readily available, affordable, and minimum alternative to flow cytometric measurement of FMH. Knowledge of anti-D prophylaxis among obstetricians, biomedical scientist, midwives, traditional birth attendants, pharmacists, and nurses in Africa needs to be improved. This will facilitate quality antenatal and postnatal care offered to Rh-negative pregnant population and improve perinatal outcomes.

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BACKGROUND: The use of uncrossmatched group O, Rh-negative RBCs has enabled immediate transfusion of patients who need critical care in life-threatening situations. We examined our 1-year experience with uncrossmatched group O, Rh-negative RBC transfusion in a tertiary care university hospital. METHODS: Uncrossmatched group O, Rh-negative RBCs were available for immediate transfusion upon request without performing any of the following pretransfusion tests: ABO and RhD typing, irregular antibody screening, crossmatching test. The characteristics of the transfused patients were studied retrospectively. RESULTS: Twenty-five patients received 56 units of uncrossmatched group O, Rh-negative RBCs from November 2005 to October 2006. An average of 2.24 units was issued to each patient, with no more than 4 units per patient being given; subsequent transfusion was done with type-specific, crossmatched blood. The average turnaround time for the release of uncrossmatched group O, Rh-negative RBCs was 1.8 minutes (mean+/-standard deviation: 1.8+/-1.96, range: 0~7 minutes). Seventeen patients died (68%), which included 16 patients who had received cardiopulmonary resuscitation. CONCLUSION: Patients admitted for traffic accident, falling down injury, gastrointestinal bleeding and aortic dissection received 72% of the emergency group O, Rh-negative RBCs, with a 72.2% mortality rate, which indicates the dire condition of these patients. The majority of RBCs for transfusion were available within 5 minutes upon request. Though group O, Rh-negative RBCs are recommended in emergency situations in which the blood group of the patient is unknown, the use of group O, Rh-positive RBCs may be an alternative blood supply, when considering the short supply of Rh-negative RBCs.

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The authors have experienced a case of Rh negative brother and sister, both of whose parents were Rh positive. On the testing by five major Rh antisera (anti D, anti C, anti E, anti c, and anti e), the phenotypes of his father and mother were each DccEe and DCCee, those of the brother and sister were ddCcee. Considering the possible genotypes, their genotype was only one Cde/cde in twenty-four combinations. The possibility of that Rh negative (Cde/cde) child could successively born by those parents was 0.00017, with reference to Rh haplotype frequency in Korea. So, this case is rare and showed that Rh negative child could be born by Rh positive parents.

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No abstract available.

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