The predictive value of maternal serum testing for detection of fetal anemia in red blood cell alloimmunization

OBJECTIVE: Current management protocols for pregnancies complicated by red blood cell alloimmunization use the maternal antibody titer to predict the need for invasive testing for detection fetal anemia. We investigated the use of three maternal serum tests to assess their usefulness in predicting f...

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Veröffentlicht in:American journal of obstetrics and gynecology 1995-03, Vol.172 (3), p.1003-1009
Hauptverfasser: Moise Jr, Kenneth J., Perkins, James T., Sosler, Steven D., Brown, Susan J., Saade, George, Carpenter, Robert J., Thorp, James A., Ludomirski, Avi, Wilkins, Isabelle A., Grannum, Peter A., Copel, Joshua
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container_end_page 1009
container_issue 3
container_start_page 1003
container_title American journal of obstetrics and gynecology
container_volume 172
creator Moise Jr, Kenneth J.
Perkins, James T.
Sosler, Steven D.
Brown, Susan J.
Saade, George
Carpenter, Robert J.
Thorp, James A.
Ludomirski, Avi
Wilkins, Isabelle A.
Grannum, Peter A.
Copel, Joshua
description OBJECTIVE: Current management protocols for pregnancies complicated by red blood cell alloimmunization use the maternal antibody titer to predict the need for invasive testing for detection fetal anemia. We investigated the use of three maternal serum tests to assess their usefulness in predicting fetal disease: indirect Coombs' titer, Marsh score, and monocyte monolayer assay. STUDY DESIGN: Foryt-seven serum samples from pregnant women with red blood cell antibodies associated with fetal anemia were analyzed at cordocentesis. Fetal blood was analyzed for hematocrit (correlated for gestational age) and antigen status. Fetal anemia was defined as a hematocrit value of
doi_str_mv 10.1016/0002-9378(95)90034-9
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We investigated the use of three maternal serum tests to assess their usefulness in predicting fetal disease: indirect Coombs' titer, Marsh score, and monocyte monolayer assay. STUDY DESIGN: Foryt-seven serum samples from pregnant women with red blood cell antibodies associated with fetal anemia were analyzed at cordocentesis. Fetal blood was analyzed for hematocrit (correlated for gestational age) and antigen status. Fetal anemia was defined as a hematocrit value of &lt;2 SD from the mean value for gestational age. Fetuses were classified into three groups: Antigen positive with anemia ( n = 19), antigen positive without anemia ( n = 17), antigen negative ( n = 11). Statistical methods included Kruskal-Wallis test, Newman-Keuls test, Spearman's rank correlation, and receiver-operator characteristic curves; p &lt; 0.05 was considered significant. RESULTS: The median monocyte monolayer assay (phagocytosis, adherence, and association) did not differ among the three groups. Both maternal titers and Marsh scores were significantly higher in fetuses with anemia compared with the other two groups of fetuses (256 vs 64 vs 64, p &lt; 0.001, and 86 vs 69 vs 64, p = 0.02, respectively). Both titer and Marsh score exhibited significant correlations with corrected fetal hematocrit ( r = −0.70, p &lt; 0.001; r = −0.63, p &lt; 0.001, respectively). Comparison of the overall receiver-operator characteristic curves for titer and Marsh score revealed no statistical difference; however, a Marsh score of 57 was noted to have a superior specificity than a titer of 16 ( p = 0.02). CONCLUSION: The maternal Marsh score can be performed in conjunction with standard indirect Coombs' titers to enhance the predictability of fetal anemia.</description><identifier>ISSN: 0002-9378</identifier><identifier>EISSN: 1097-6868</identifier><identifier>DOI: 10.1016/0002-9378(95)90034-9</identifier><identifier>PMID: 7892839</identifier><identifier>CODEN: AJOGAH</identifier><language>eng</language><publisher>Philadelphia, PA: Mosby, Inc</publisher><subject>Biological and medical sciences ; Coombs Test ; cordocentesis ; Erythroblastosis, Fetal - diagnosis ; Erythroblastosis, Fetal - etiology ; Evaluation Studies as Topic ; Female ; Gynecology. Andrology. Obstetrics ; Hemagglutination Tests ; Hemolytic disease of the newborn ; Humans ; indirect Coombs' titers ; Infant, Newborn ; Management. Prenatal diagnosis ; Marsh titration score ; Medical sciences ; monocyte monolayer assay ; Pregnancy ; Pregnancy Complications - blood ; Pregnancy. Fetus. Placenta ; Prenatal Diagnosis - methods ; Rh Isoimmunization - blood ; Rh Isoimmunization - complications ; ROC Curve ; Sensitivity and Specificity ; Serologic Tests - methods</subject><ispartof>American journal of obstetrics and gynecology, 1995-03, Vol.172 (3), p.1003-1009</ispartof><rights>1995</rights><rights>1995 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c386t-8c804a5052dd420ece325532fe41e361aa695690ba24d3a19a4aec5356eb466e3</citedby><cites>FETCH-LOGICAL-c386t-8c804a5052dd420ece325532fe41e361aa695690ba24d3a19a4aec5356eb466e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/0002937895900349$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=3458891$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/7892839$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Moise Jr, Kenneth J.</creatorcontrib><creatorcontrib>Perkins, James T.</creatorcontrib><creatorcontrib>Sosler, Steven D.</creatorcontrib><creatorcontrib>Brown, Susan J.</creatorcontrib><creatorcontrib>Saade, George</creatorcontrib><creatorcontrib>Carpenter, Robert J.</creatorcontrib><creatorcontrib>Thorp, James A.</creatorcontrib><creatorcontrib>Ludomirski, Avi</creatorcontrib><creatorcontrib>Wilkins, Isabelle A.</creatorcontrib><creatorcontrib>Grannum, Peter A.</creatorcontrib><creatorcontrib>Copel, Joshua</creatorcontrib><title>The predictive value of maternal serum testing for detection of fetal anemia in red blood cell alloimmunization</title><title>American journal of obstetrics and gynecology</title><addtitle>Am J Obstet Gynecol</addtitle><description>OBJECTIVE: Current management protocols for pregnancies complicated by red blood cell alloimmunization use the maternal antibody titer to predict the need for invasive testing for detection fetal anemia. We investigated the use of three maternal serum tests to assess their usefulness in predicting fetal disease: indirect Coombs' titer, Marsh score, and monocyte monolayer assay. STUDY DESIGN: Foryt-seven serum samples from pregnant women with red blood cell antibodies associated with fetal anemia were analyzed at cordocentesis. Fetal blood was analyzed for hematocrit (correlated for gestational age) and antigen status. Fetal anemia was defined as a hematocrit value of &lt;2 SD from the mean value for gestational age. Fetuses were classified into three groups: Antigen positive with anemia ( n = 19), antigen positive without anemia ( n = 17), antigen negative ( n = 11). Statistical methods included Kruskal-Wallis test, Newman-Keuls test, Spearman's rank correlation, and receiver-operator characteristic curves; p &lt; 0.05 was considered significant. RESULTS: The median monocyte monolayer assay (phagocytosis, adherence, and association) did not differ among the three groups. Both maternal titers and Marsh scores were significantly higher in fetuses with anemia compared with the other two groups of fetuses (256 vs 64 vs 64, p &lt; 0.001, and 86 vs 69 vs 64, p = 0.02, respectively). Both titer and Marsh score exhibited significant correlations with corrected fetal hematocrit ( r = −0.70, p &lt; 0.001; r = −0.63, p &lt; 0.001, respectively). Comparison of the overall receiver-operator characteristic curves for titer and Marsh score revealed no statistical difference; however, a Marsh score of 57 was noted to have a superior specificity than a titer of 16 ( p = 0.02). CONCLUSION: The maternal Marsh score can be performed in conjunction with standard indirect Coombs' titers to enhance the predictability of fetal anemia.</description><subject>Biological and medical sciences</subject><subject>Coombs Test</subject><subject>cordocentesis</subject><subject>Erythroblastosis, Fetal - diagnosis</subject><subject>Erythroblastosis, Fetal - etiology</subject><subject>Evaluation Studies as Topic</subject><subject>Female</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Hemagglutination Tests</subject><subject>Hemolytic disease of the newborn</subject><subject>Humans</subject><subject>indirect Coombs' titers</subject><subject>Infant, Newborn</subject><subject>Management. Prenatal diagnosis</subject><subject>Marsh titration score</subject><subject>Medical sciences</subject><subject>monocyte monolayer assay</subject><subject>Pregnancy</subject><subject>Pregnancy Complications - blood</subject><subject>Pregnancy. Fetus. Placenta</subject><subject>Prenatal Diagnosis - methods</subject><subject>Rh Isoimmunization - blood</subject><subject>Rh Isoimmunization - complications</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Serologic Tests - methods</subject><issn>0002-9378</issn><issn>1097-6868</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1995</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU2LFDEQhoO4rLOj_0AhB5H10Gu-O7ksyOLHwoKX9Rxq0tUa6e6MSfeA--tNO8McPYWinnp5eULIa85uOOPmA2NMNE629trp944xqRr3jGw4c21jrLHPyeaMvCBXpfxaR-HEJblsrRNWug1Jjz-R7jN2MczxgPQAw4I09XSEGfMEAy2Yl5HOWOY4_aB9yrTDGSudppXrca4QTDhGoHGiNYruhpQ6GnCoi2FIcRyXKT7BevKSXPQwFHx1erfk--dPj3dfm4dvX-7vPj40QVozNzZYpkAzLbpOCYYBpdBaih4VR2k4gHHaOLYDoToJ3IECDFpqgztlDMoteXfM3ef0e6nl_RjL2qg2TUvxbcurA2srqI5gyKmUjL3f5zhC_uM586tnv1rzq0TvtP_nuU5b8uaUv-xG7M5HJ7F1__a0hxJg6DNMIZYzJpW21vGK3R4xrC4OEbMvIeIU6n_k6th3Kf6_x1-QcJpj</recordid><startdate>19950301</startdate><enddate>19950301</enddate><creator>Moise Jr, Kenneth J.</creator><creator>Perkins, James T.</creator><creator>Sosler, Steven D.</creator><creator>Brown, Susan J.</creator><creator>Saade, George</creator><creator>Carpenter, Robert J.</creator><creator>Thorp, James A.</creator><creator>Ludomirski, Avi</creator><creator>Wilkins, Isabelle A.</creator><creator>Grannum, Peter A.</creator><creator>Copel, Joshua</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19950301</creationdate><title>The predictive value of maternal serum testing for detection of fetal anemia in red blood cell alloimmunization</title><author>Moise Jr, Kenneth J. ; Perkins, James T. ; Sosler, Steven D. ; Brown, Susan J. ; Saade, George ; Carpenter, Robert J. ; Thorp, James A. ; Ludomirski, Avi ; Wilkins, Isabelle A. ; Grannum, Peter A. ; Copel, Joshua</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c386t-8c804a5052dd420ece325532fe41e361aa695690ba24d3a19a4aec5356eb466e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1995</creationdate><topic>Biological and medical sciences</topic><topic>Coombs Test</topic><topic>cordocentesis</topic><topic>Erythroblastosis, Fetal - diagnosis</topic><topic>Erythroblastosis, Fetal - etiology</topic><topic>Evaluation Studies as Topic</topic><topic>Female</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Hemagglutination Tests</topic><topic>Hemolytic disease of the newborn</topic><topic>Humans</topic><topic>indirect Coombs' titers</topic><topic>Infant, Newborn</topic><topic>Management. Prenatal diagnosis</topic><topic>Marsh titration score</topic><topic>Medical sciences</topic><topic>monocyte monolayer assay</topic><topic>Pregnancy</topic><topic>Pregnancy Complications - blood</topic><topic>Pregnancy. Fetus. Placenta</topic><topic>Prenatal Diagnosis - methods</topic><topic>Rh Isoimmunization - blood</topic><topic>Rh Isoimmunization - complications</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Serologic Tests - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Moise Jr, Kenneth J.</creatorcontrib><creatorcontrib>Perkins, James T.</creatorcontrib><creatorcontrib>Sosler, Steven D.</creatorcontrib><creatorcontrib>Brown, Susan J.</creatorcontrib><creatorcontrib>Saade, George</creatorcontrib><creatorcontrib>Carpenter, Robert J.</creatorcontrib><creatorcontrib>Thorp, James A.</creatorcontrib><creatorcontrib>Ludomirski, Avi</creatorcontrib><creatorcontrib>Wilkins, Isabelle A.</creatorcontrib><creatorcontrib>Grannum, Peter A.</creatorcontrib><creatorcontrib>Copel, Joshua</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of obstetrics and gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moise Jr, Kenneth J.</au><au>Perkins, James T.</au><au>Sosler, Steven D.</au><au>Brown, Susan J.</au><au>Saade, George</au><au>Carpenter, Robert J.</au><au>Thorp, James A.</au><au>Ludomirski, Avi</au><au>Wilkins, Isabelle A.</au><au>Grannum, Peter A.</au><au>Copel, Joshua</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The predictive value of maternal serum testing for detection of fetal anemia in red blood cell alloimmunization</atitle><jtitle>American journal of obstetrics and gynecology</jtitle><addtitle>Am J Obstet Gynecol</addtitle><date>1995-03-01</date><risdate>1995</risdate><volume>172</volume><issue>3</issue><spage>1003</spage><epage>1009</epage><pages>1003-1009</pages><issn>0002-9378</issn><eissn>1097-6868</eissn><coden>AJOGAH</coden><abstract>OBJECTIVE: Current management protocols for pregnancies complicated by red blood cell alloimmunization use the maternal antibody titer to predict the need for invasive testing for detection fetal anemia. We investigated the use of three maternal serum tests to assess their usefulness in predicting fetal disease: indirect Coombs' titer, Marsh score, and monocyte monolayer assay. STUDY DESIGN: Foryt-seven serum samples from pregnant women with red blood cell antibodies associated with fetal anemia were analyzed at cordocentesis. Fetal blood was analyzed for hematocrit (correlated for gestational age) and antigen status. Fetal anemia was defined as a hematocrit value of &lt;2 SD from the mean value for gestational age. Fetuses were classified into three groups: Antigen positive with anemia ( n = 19), antigen positive without anemia ( n = 17), antigen negative ( n = 11). Statistical methods included Kruskal-Wallis test, Newman-Keuls test, Spearman's rank correlation, and receiver-operator characteristic curves; p &lt; 0.05 was considered significant. RESULTS: The median monocyte monolayer assay (phagocytosis, adherence, and association) did not differ among the three groups. Both maternal titers and Marsh scores were significantly higher in fetuses with anemia compared with the other two groups of fetuses (256 vs 64 vs 64, p &lt; 0.001, and 86 vs 69 vs 64, p = 0.02, respectively). Both titer and Marsh score exhibited significant correlations with corrected fetal hematocrit ( r = −0.70, p &lt; 0.001; r = −0.63, p &lt; 0.001, respectively). Comparison of the overall receiver-operator characteristic curves for titer and Marsh score revealed no statistical difference; however, a Marsh score of 57 was noted to have a superior specificity than a titer of 16 ( p = 0.02). CONCLUSION: The maternal Marsh score can be performed in conjunction with standard indirect Coombs' titers to enhance the predictability of fetal anemia.</abstract><cop>Philadelphia, PA</cop><pub>Mosby, Inc</pub><pmid>7892839</pmid><doi>10.1016/0002-9378(95)90034-9</doi><tpages>7</tpages></addata></record>
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subjects Biological and medical sciences
Coombs Test
cordocentesis
Erythroblastosis, Fetal - diagnosis
Erythroblastosis, Fetal - etiology
Evaluation Studies as Topic
Female
Gynecology. Andrology. Obstetrics
Hemagglutination Tests
Hemolytic disease of the newborn
Humans
indirect Coombs' titers
Infant, Newborn
Management. Prenatal diagnosis
Marsh titration score
Medical sciences
monocyte monolayer assay
Pregnancy
Pregnancy Complications - blood
Pregnancy. Fetus. Placenta
Prenatal Diagnosis - methods
Rh Isoimmunization - blood
Rh Isoimmunization - complications
ROC Curve
Sensitivity and Specificity
Serologic Tests - methods
title The predictive value of maternal serum testing for detection of fetal anemia in red blood cell alloimmunization
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