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Up to 30ml of foetal-maternal transfusion may take place with no significant signs or symptoms seen in either mother or foetus. [3] Loss in excess of this may result in significant morbidity and mortality to the fetus. Fetal-maternal haemorrhage is one cause of intrauterine death (IUD).
Blood compatibility testing is routinely performed before a blood transfusion.The full compatibility testing process involves ABO and RhD (Rh factor) typing; screening for antibodies against other blood group systems; and crossmatching, which involves testing the recipient's blood plasma against the donor's red blood cells as a final check for incompatibility.
The red blood cells are removed by macrophages from the blood circulation into liver and spleen to be destroyed, which leads to extravascular haemolysis. This process usually mediated by anti-Rh and anti-Kidd antibodies. However, this type of transfusion reaction is less severe when compared to acute haemolytic transfusion reaction. [36]
If a person without a Kidd blood antigen (for example a Jka-Jkb+ patient) receives a Kidd antigen (Jka-antigen for example) in a red blood cell transfusion and forms an alloantibody (anti-Jka); upon subsequent transfusion with Jka-antigen positive red blood cells, the patient may have a delayed hemolytic transfusion reaction as their anti-Jka antibody hemolyzes the transfused Jka-antigen ...
Transfusion hemosiderosis; Transfusion-associated circulatory overload; Transfusion-associated graft-versus-host disease; Transfusion-dependent anemia; Transfusion-related acute lung injury; Transfusion-related immunomodulation
Hemolytic disease of the fetus and newborn is similar to a transfusion reaction in that the mother's antibodies cannot tolerate the fetus's antigens, which happens when the immune tolerance of pregnancy is impaired. In many instances the maternal immune system attacks the fetal blood cells, resulting in fetal anemia.
The anti-RhE antibody can be naturally occurring, or arise following immune sensitization after a blood transfusion or pregnancy. The anti-RhE antibody is quite common especially in the Rh genotype CDe/CDe; it usually only causes a mild hemolytic disease, but can cause a severe condition in the newborn.
Kidd antibodies are dangerous as they are capable of causing severe acute hemolytic transfusion reactions. They are unique in that they are capable of dropping to low or even undetectable levels after several months following an exposure. [5] Thus, on pre-transfusion testing, an anti-Jka or -Jkb may go undetected.