Thesis Yolentha Slootweg

Summary

Yolentha Slootweg present in her thesis a series of studies on this topic of a rare disease. Red blood cell alloimmunization may lead already during pregnancy to severe disease in the baby called “hemolytic disease of the fetus and newborn (HDFN)”, which is also known as “rhesus disease”. The disease is caused by destruction of the red blood cells of the (unborn) child by red blood cell alloantibodies of the mother. This may lead to life-threatening anemia and dangerous neurotoxic levels of bilirubin in the child. Therefore, in the Netherlands, there are a set of preventive measures. As primary prevention, anti-D immunoglobulin prophylaxis is administered to RhD-negative pregnant women. Another measure for all women below 45 years of age is preventive matching of red blood cell transfusions for the most implicated antigens: RhD, Rhc, RhE and K (Kell). Furthermore, all women are screened early in pregnancy for red blood cell alloantibodies and in RhD-negative women this screen is repeated at week 27. In 2011, a repeat screening at week 27 of pregnancy in Rhc-negative women was added. Finally, to enable timely start of treatment, laboratory testing to determine antibody pathogenicity and clinical management is currently part of the routine follow up.

The focus of the thesis was on three aspects: to evaluate the performance of new measures in the screening programme, the laboratory monitoring to identify high-risk pregnancies and the counseling of pregnant women and their partners. Yolentha Slootweg has a lot of professional experience as a midwife working with alloimmunized women at the Leiden University Medical Center. She showed with her research that the rare occurrence of red blood cell alloimmunization and HDFN makes it a challenge for the obstetric care providers to provide sufficient and correct information and to minimize unnecessary anxiety. In her thesis she used the wider perspective of the Can Meds framework to formulate steps to improve the care to alloimmunized women and their partners, who are faced with the message that their pregnancy may be complicated by HDFN. Furthermore, by carefully reviewing the performance of the current laboratory monitoring she showed that more focus on high risk pregnancies and less testing in others is possible. In conclusion, Yolentha Slootweg’s thesis forms a strong basis to improve the current guide lines on laboratory and clinical management of pregnancies complicated by red blood cell alloimmunization.