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Use of ffDNA to determine the fetal blood group and guide anti-D

Summary of Studies:

Incompatibility between the blood group of an unborn baby and the mother can cause serious problems. Bristol was the first place in the world to use ffDNA in maternal for fetal blood resulting in paper 1 in 2002. The blood transfusion service in Filton has become the national and an international centre for these tests in the management of pregnancies with serious red cell antibodies (paper 2). Recently we took part in a multi-centre NIHR funded study led from University College London, which showed this test was reliable after 11 weeks' gestation (paper 3).

Recently we implemented (first in UK) this test for all rhesus D negative women in UHBristol, North Bristol NHS Trust and Weston Area Health Trust (paper 4). This showed we can prevent exposure to a blood product (pooled from about 800 USA donors) for about 40% of rhesus D negative women. In addition we can make a small saving to the NHS budget. The Blood Transfusion are going to offer this nationally soon (May 2015) and has already been mentioned on the RCOG website. 

Aims and Hypothesis:

That there is enough cell free fetal DNA in pregnant women's blood to determine the major fetal blood groups non-invasively. Because invasive procedures (such as amnio / CVS) have specially increased risks in these pregnancies (or boosting the antibody) this approach could greatly reduce the risks of iatrogenic worsening of red cell alloimmunisation.

Results:

The following papers have been published following this work,  please click here to find out more.


What are the next steps and how could this study impact on patient care at UH Bristol and beyond?

This series of projects have already changed clinical care both locally, nationally and internationally in several ways. Samples from around the world are sent to Filton in antibody affected pregnancies. In addition the routine service to guide anti-D and now been implemented in Bristol and Weston (the service reported in paper 4). A decision has been made to continue this service and other Trusts are planning to implement this as well. We are confident that Bristol will provide this test for at least England and expect it to become a part of routine maternity care in England and subsequently around the world.