Point-of-care determination of the frequency of Rhesus(D)-negative blood types and the uptake of anti(D) immunoglobulin among Rh(D)-negative women in Dadu district, Sindh, Pakistan

doi:10.1371/journal.pgph.0004395

. 2025 Apr 9;5(4):e0004395.

doi: 10.1371/journal.pgph.0004395. eCollection 2025.

Point-of-care determination of the frequency of Rhesus(D)-negative blood types and the uptake of anti(D) immunoglobulin among Rh(D)-negative women in Dadu district, Sindh, Pakistan

Lisa G Pell¹, Shabina Ariff², Gul Nawaz Khan², Hana Dampf¹, Shah Muhammad Jokhio², Alvin Zipursky^{1

3}, Jillian M Baker^{3

4

5}, Sidrah Nausheen⁶, Sajid Soofi², Shaun K Morris^{1

3

7

8}

Affiliations

¹ Centre of Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
² Department of Paediatrics and Child Health, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
³ Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
⁴ Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada.
⁵ Division of Haematology-Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁶ Department of Obstetrics and Gynaeocology, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
⁷ Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁸ Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.

PMID: 40203017
PMCID: PMC11981162
DOI: 10.1371/journal.pgph.0004395

Point-of-care determination of the frequency of Rhesus(D)-negative blood types and the uptake of anti(D) immunoglobulin among Rh(D)-negative women in Dadu district, Sindh, Pakistan

Lisa G Pell et al. PLOS Glob Public Health. 2025.

. 2025 Apr 9;5(4):e0004395.

doi: 10.1371/journal.pgph.0004395. eCollection 2025.

Authors

Affiliations

¹ Centre of Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
² Department of Paediatrics and Child Health, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
³ Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
⁴ Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada.
⁵ Division of Haematology-Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁶ Department of Obstetrics and Gynaeocology, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
⁷ Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁸ Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.

PMID: 40203017
PMCID: PMC11981162
DOI: 10.1371/journal.pgph.0004395

Abstract

Rhesus (Rh) disease remains a serious problem in low- and middle-income countries. Rh disease prevention requires early identification and prophylactic treatment of Rh(D)-negative women. We evaluated the feasibility of point-of-care identification of Rh(D)-negative women and timely administration of two doses of anti(D) immunoglobulin by lady health visitors in Dadu district, Sindh, Pakistan. Pregnant women were enrolled at two hospitals and followed until 29 days postpartum. Rh(D)-antigen status was determined using the EldonCard2521 test and all Rh(D)-negative point-of-care test results were attempted to be verified using the conventional test tube agglutination method. Rh(D)-negative women were offered two injections of anti(D) immunoglobulin, one at 28 weeks' gestation and one within 72 hours of delivery. Knowledge pertaining to Rh disease was assessed among participants at study entry and exit, and in a sample of 30 health care providers. All participants (n=1619) had their blood tested with the EldonCard2521, and 279 (17%) women were found to be Rh(D)-negative; however, the conventional test tube method identified one discordant Rh(D)-antigen result. Among 278 Rh(D)-negative women, 254 (91%) and 268 (96%) received their first and second dose of anti(D) immunoglobulin, respectively. The rates of miscarriage (22.1 per 1,000 pregnancies vs. 4.5 per 1,000 pregnancies), stillbirth (33.8 per 1,000 pregnancies vs. 6.7 per 1,000 pregnancies), and neonatal death (35.0 vs. 16.6 per 1,000 live births) were higher among Rh(D)-negative vs. Rh(D)-positive participants. At study enrolment, there was little knowledge pertaining to Rh disease and its consequences among participants and knowledge also varied greatly among health care providers. The high frequency of maternal Rh(D)-negative blood types, high rates of stillbirth, miscarriage, and neonatal death among Rh(D)-negative women and their newborns, and limited and varied knowledge of Rh disease among pregnant women and health care providers, bolsters the need for a wide-scale Rh disease prevention program in Pakistan.

Copyright: © 2025 Pell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Disclaimer

Conflict of interest statement

Shaun Morris' research program received financial support from Eldon Biologicals A/S to support personnel costs associated with this work. None of the other co-authors have competing interests to declare.

Figures

See this image and copyright information in PMC

References

1. Kumpel BM. On the immunologic basis of Rh immune globulin (anti-D) prophylaxis. Transfusion. 2006;46(9):1652–6. doi: 10.1111/j.1537-2995.2006.00924_1.x - DOI - PubMed
1. De Winter DP, Hulzebos C, Van ’t Oever RM, De Haas M, Verweij EJ, Lopriore E. History and current standard of postnatal management in hemolytic disease of the fetus and newborn. Eur J Pediatr. 2023;182(2):489–500. doi: 10.1007/s00431-022-04724-0 - DOI - PubMed
1. Jackson ME, Baker JM. Hemolytic Disease of the Fetus and Newborn: Historical and Current State. Clin Lab Med. 2021;41(1):133–51. doi: 10.1016/j.cll.2020.10.009 - DOI - PubMed
1. Pegoraro V, Urbinati D, Visser GHA, Di Renzo GC, Zipursky A, Stotler BA, et al.. Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children. PLoS One. 2020;15(7):e0235807. doi: 10.1371/journal.pone.0235807 - DOI - PMC - PubMed
1. Freda VJ, Gorman JG, Pollack W, Bowe E. Prevention of Rh hemolytic disease--ten years’ clinical experience with Rh immune globulin. N Engl J Med. 1975;292(19):1014–6. doi: 10.1056/NEJM197505082921906 - DOI - PubMed

LinkOut - more resources

Full Text Sources
- PubMed Central

[1] Kumpel BM. On the immunologic basis of Rh immune globulin (anti-D) prophylaxis. Transfusion. 2006;46(9):1652–6. doi: 10.1111/j.1537-2995.2006.00924_1.x - DOI - PubMed

[2] Kumpel BM. On the immunologic basis of Rh immune globulin (anti-D) prophylaxis. Transfusion. 2006;46(9):1652–6. doi: 10.1111/j.1537-2995.2006.00924_1.x - DOI - PubMed

[3] De Winter DP, Hulzebos C, Van ’t Oever RM, De Haas M, Verweij EJ, Lopriore E. History and current standard of postnatal management in hemolytic disease of the fetus and newborn. Eur J Pediatr. 2023;182(2):489–500. doi: 10.1007/s00431-022-04724-0 - DOI - PubMed

[4] De Winter DP, Hulzebos C, Van ’t Oever RM, De Haas M, Verweij EJ, Lopriore E. History and current standard of postnatal management in hemolytic disease of the fetus and newborn. Eur J Pediatr. 2023;182(2):489–500. doi: 10.1007/s00431-022-04724-0 - DOI - PubMed

[5] Jackson ME, Baker JM. Hemolytic Disease of the Fetus and Newborn: Historical and Current State. Clin Lab Med. 2021;41(1):133–51. doi: 10.1016/j.cll.2020.10.009 - DOI - PubMed

[6] Jackson ME, Baker JM. Hemolytic Disease of the Fetus and Newborn: Historical and Current State. Clin Lab Med. 2021;41(1):133–51. doi: 10.1016/j.cll.2020.10.009 - DOI - PubMed

[7] Pegoraro V, Urbinati D, Visser GHA, Di Renzo GC, Zipursky A, Stotler BA, et al.. Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children. PLoS One. 2020;15(7):e0235807. doi: 10.1371/journal.pone.0235807 - DOI - PMC - PubMed

[8] Pegoraro V, Urbinati D, Visser GHA, Di Renzo GC, Zipursky A, Stotler BA, et al.. Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children. PLoS One. 2020;15(7):e0235807. doi: 10.1371/journal.pone.0235807 - DOI - PMC - PubMed

[9] Freda VJ, Gorman JG, Pollack W, Bowe E. Prevention of Rh hemolytic disease--ten years’ clinical experience with Rh immune globulin. N Engl J Med. 1975;292(19):1014–6. doi: 10.1056/NEJM197505082921906 - DOI - PubMed

[10] Freda VJ, Gorman JG, Pollack W, Bowe E. Prevention of Rh hemolytic disease--ten years’ clinical experience with Rh immune globulin. N Engl J Med. 1975;292(19):1014–6. doi: 10.1056/NEJM197505082921906 - DOI - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Point-of-care determination of the frequency of Rhesus(D)-negative blood types and the uptake of anti(D) immunoglobulin among Rh(D)-negative women in Dadu district, Sindh, Pakistan

Affiliations

Point-of-care determination of the frequency of Rhesus(D)-negative blood types and the uptake of anti(D) immunoglobulin among Rh(D)-negative women in Dadu district, Sindh, Pakistan

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

References

LinkOut - more resources

Full Text Sources

Abstract

Conflict of interest statement

Figures

Similar articles

References

Related information

LinkOut - more resources

Full Text Sources