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

Kenneth J. Moise, James T. Perkins, Steven D. Sosler, Susan J. Brown, George Saade, Robert J. Carpenter, James A. Thorp, Avi Ludomirski, Isabelle A. Wilkins, Peter A. Grannum, Joshua Copel

Research output: Contribution to journalArticle

17 Citations (Scopus)

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 <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 < 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 < 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 < 0.001; r = -0.63, p < 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.

Original languageEnglish (US)
Pages (from-to)1003-1009
Number of pages7
JournalAmerican Journal of Obstetrics and Gynecology
Volume172
Issue number3
DOIs
StatePublished - 1995
Externally publishedYes

Fingerprint

Wetlands
Anemia
Erythrocytes
Mothers
Serum
Hematocrit
Antigens
Fetus
Gestational Age
Monocytes
Cordocentesis
Fetal Diseases
Antibodies
Fetal Blood
Phagocytosis
Pregnant Women
Pregnancy

Keywords

  • cordocentesis
  • Hemolytic disease of the newborn
  • indirect Coombs' titers
  • Marsh titration score
  • monocyte monolayer assay

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Medicine(all)

Cite this

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

In: American Journal of Obstetrics and Gynecology, Vol. 172, No. 3, 1995, p. 1003-1009.

Research output: Contribution to journalArticle

Moise, KJ, Perkins, JT, Sosler, SD, Brown, SJ, Saade, G, Carpenter, RJ, Thorp, JA, Ludomirski, A, Wilkins, IA, Grannum, PA & Copel, J 1995, 'The predictive value of maternal serum testing for detection of fetal anemia in red blood cell alloimmunization', American Journal of Obstetrics and Gynecology, vol. 172, no. 3, pp. 1003-1009. https://doi.org/10.1016/0002-9378(95)90034-9
Moise, 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. / The predictive value of maternal serum testing for detection of fetal anemia in red blood cell alloimmunization. In: American Journal of Obstetrics and Gynecology. 1995 ; Vol. 172, No. 3. pp. 1003-1009.
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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 <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 < 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 < 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 < 0.001; r = -0.63, p < 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.",
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AU - Saade, George

AU - Carpenter, Robert J.

AU - Thorp, James A.

AU - Ludomirski, Avi

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N2 - 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 <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 < 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 < 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 < 0.001; r = -0.63, p < 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.

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