In this episode of the Allo Podcast we listen to Molly’s Story: how she found out she was alloimmunized, the steps that she took to maintain appropriate care, the pregnancies and births of her two subsequent sons, and its effect on her life and that of her family. 

Episode themes: 

• Low titer alloimmunized pregnancy
• Anti-S; Anti E antibodies 
• Partial D/Weak D antigen
• Rhogam
• Induced vaginal birth after cesarean (VBAC) 
• Miscarriage
• Hemorrhage
• Pain medication-free birth 
• Delayed onset fetal anemia

Allo Hope Terminology Library https://allohopefoundation.org/library/terminology/

Explanation of Weak D and Partial D and its implications for pregnancy: https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.12275

Research for this episode provided by Bethany Weathersby and Molly Sherwood of the Allo Hope Foundation. Find more information at https://allohopefoundation.org

The Allo Podcast is produced and edited by 

https://www.mediaclub.co

Welcome to the Allo Podcast! This episode introduces our hosts, Bethany and Molly, our recurring guests from our Medical Advisory Board, the Allo Hope Foundation, and most importantly the diseases known as Maternal Alloimmunization and Hemolytic Disease of the Fetus and Newborn. Get the quick facts on how to monitor and treat this disease and how Bethany, Molly, and so many moms have used these treatments to deliver healthy babies. 

Episode themes: 

• Alloimmunization overview
• What to expect in an allo pregnancy
• How HDFN affects the baby
• How allo moms can protect themselves and their baby

Terminology used in this episode: 

• Alloimmunization: a disease in which a mother’s antibodies are primed to attack an incompatible blood antigen that may be present in the blood of their fetus.
• Hemolytic disease of the fetus and newborn (HDFN): a blood disorder in a fetus or newborn that develops when the pregnant mother’s antibodies pass through the placenta during pregnancy and attack the baby's red blood cells, breaking down the baby’s red blood cells (hemolysis) at a rapid rate and causing the baby to become anemic. 

Allo Hope Terminology Library https://allohopefoundation.org/library/terminology/

Guests: Dr. Ken Moise https://partnersincare.health/directory/kenneth-moise

Dr. Thomas Travett http://www.georgiaperinatal.com/dr-trevett/

Links mentioned in this episode: 

Partners in Care HDFN Definition: https://partnersincare.health/conditions/hemolytic-disease-of-the-fetus-and-newborn

Research for this episode provided by Bethany Weathersby and Molly Sherwood of the Allo Hope Foundation. Find more information at https://allohopefoundation.org

The Allo Podcast is produced and edited by 

https://www.mediaclub.co

Testing is the first step toward having a safe and healthy HDFN baby. This episode covers the importance of early tests that can determine how severely your baby will be affected by your antibodies. We include information about new tests, Rhogam, and how you can donate plasma to help other expectant mothers determine the antigen status of their babies. 

Episode themes: 

• Standard pregnancy screening for antibodies
• Antibody ID and titer blood test 
• Blood tests for baby’s father
• Cell free fetal DNA (cffDNA) for baby’s antigen status
• Rh Immune Globulin (Rhogam)

Plasma Donation: Southern Blood Services https://southernbloodservices.com/

For information on donating to create test kits email msertell@southernbloodservices.com

Terminology used in this episode:

• Antibody Screen: Part of mother’s blood work that can be used to determine the presence of antibodies 
• Antibody ID: followup screen on the mother that identifies what type of antibody the mother has
• Titer: test (and term often used to describe measurement) of the amount of antibodies present in the mother’s blood 
• Critical Titer: Kell 4, All others 16 
• Antigen Phenotype test: Test for the father to determine antigen that baby may inherit 
• Amniocentesis: drawing amniotic fluid by piercing the amniotic sack with a needle through the mother’s belly, can cause antibody titer to go up 
• MCA Doppler Scan: advanced non-invasive scanning technique used to determine fetal anemia 
• Cell Free Fetal DNA Testing: a test using the mom’s blood to determine baby’s blood type, not readily available in the United States. Can be used to detect D, Kell, E, c, and C antigen status. 

Cell Free Fetal DNA (cffDNA) information https://allohopefoundation.org/library/cffdna/ 

cffDNA direct from Sanquin Laboratories https://www.sanquin.org/products-and-services/diagnostics/non-invasive-fetal-blood-group-genotyping

Allo Hope Terminology Library https://allohopefoundation.org/library/terminology/

For more on tests during pregnancy, see our prenatal testing guide at https://allohopefoundation.org/library/prenatal-testing/

Guests: Dr. Thomas Trevett http://www.georgiaperinatal.com/dr-trevett/

Research for this episode provided by Bethany Weathersby and Molly Sherwood of the Allo Hope Foundation. Find more information at https://allohopefoundation.org.

The Allo Podcast is produced and edited by https://www.mediaclub.co.

Bethany and Molly discuss how to monitor an Alloimmunized pregnancy. This is the first step to treating a sensitized pregnancy. Monitoring the antibody titer can indicate when you need MCA Scans, and intrauterine blood transfusions to keep your baby healthy. 

Episode themes: 

• How babies at risk for HDFN are monitored
• Titers (purpose and frequency) 
• MCA Scans and MoM values (purpose and frequency)
• Specific MCA Scan tips
• What’s next after a high MCA scan
• Fetal outcomes and survival rates 

Terminology used in this episode: 

• Antibody Titer: A measure of antibodies in the mom’s blood, indicates threat to a baby who is affected. Antigen negative babies do not need titer monitoring. 
• Critical Titer: A titer level of 16 (or 4 for Kell) that indicates a need for in utero medical treatments. Remember, once you hit critical levels in a pregnancy you are considered always critical for each subsequent pregnancy and should start MCA scans at 15 weeks in that and each subsequent pregnancy. 
• MCA Scan:  (Middle Cerebral Artery Doppler Scan)  Special ultrasound often only used after a critical titer is detected. Scans the blood flow in the middle cerebral artery of the fetus. 
• MoM: (Multiple of the Median score) the final measurement of an MCA scan divided by gestational age of fetus. Scores of 1 are ideal, scores of 1.5 or higher indicate moderate to severe anemia and a need for intervention.
• Hematocrit: a score detected during a cordocentesis (blood drawn from the cord) to determine the red blood cell volume in the blood.  The normal hematocrit range for infants 0-6 months is 37.4 - 55.9% for females, and 43.4 - 56.1% for males. A fetal hematocrit of less than 30% is considered anemia. Cordocentesis tests can start at 15 weeks. 

Anti-E Pregnancy Study: Moran P, Robson SC, Reid MM. Anti‐E in pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology. 2000 Nov;107(11):1436-8. LINK

Survival rates for fetuses receiving IUTs: Lee L, Nasser J. Doppler ultrasound assessment of fetal anaemia in an alloimmunised pregnancy. Australasian Journal of Ultrasound in Medicine. 2010 Nov;13(4):24. LINK

Allo Hope Terminology Library https://allohopefoundation.org/library/terminology/

For more on tests during pregnancy, see our prenatal testing guide at https://allohopefoundation.org/library/prenatal-testing/

Research for this episode provided by Bethany Weathersby and Molly Sherwood of the Allo Hope Foundation. Find more information at https://allohopefoundation.org.

The Allo Podcast is produced and edited by https://www.mediaclub.co.

Severe alloimmunization is surrounded by vague information and confusion, but this episode will prepare patients and providers for available treatment. Patients with previous fetal death, previous IUT before 24 weeks, or with a titer of 256 or higher may be diagnosed with severe disease. Remember, options do exist for severe situations, and prevention and monitoring are the key elements to having a healthy baby. This episode discusses IVIG and plasmapheresis, early MCA Scans and early IUTs, and phenobarbital. 

Episode themes: 

• Common misconceptions about severe disease
• Defining severe disease
• Delaying IUTs with IVIG and plasmapheresis treatment
• What to expect during IVIG and plasmapheresis
• Oral phenobarbital for mom to reduce need for newborn transfusion after birth
• Tips for patients entering a pregnancy complicated by severe disease

IVIG: Intravenous Immunoglobulin:  An infusion of mostly IgG immunoglobulins that is made by extracting the immunoglobulins from the plasma of ~1,000 donors. It is thought to lessen the mother’s antibody response and delay fetal anemia. It can also be given after birth to newborns to treat hyperbilirubinemia. 

Phenobarbital: An oral medication given to an alloimmunized mother before baby’s birth to improve baby’s liver function, allowing the baby to more efficiently break down bilirubin and reducing the need for exchange transfusion after birth.

Plasmapheresis: The process of removing the plasma from the body whereby the blood is removed and run through a machine that separates the plasma from the red blood cells. The plasma is discarded and the red blood cells are returned to the body with fewer antibodies (which live in plasma).

Allo Hope Terminology Library https://allohopefoundation.org/library/terminology/

Guests: Dr. Ken Moise https://partnersincare.health/directory/kenneth-moise

Dr. Thomas Travett http://www.georgiaperinatal.com/dr-trevett/

Links mentioned in this episode: 

PETIT study on IVIG:l https://pubmed.ncbi.nlm.nih.gov/29902448/

Ruma et al. on plasmapheresis & IVIG:  https://www.sciencedirect.com/science/article/abs/pii/S0002937806022058

Trevett et al. on phenobarbital: https://www.ajog.org/article/S0002-9378(04)00938-X/fulltext

Jansen nipocalimab clinical trials for severe disease patients: 

https://clinicaltrials.gov/ct2/show/NCT03755128

https://clinicaltrials.gov/ct2/show/NCT03842189

Research for this episode provided by Bethany Weathersby and Molly Sherwood of the Allo Hope Foundation. Find more information at https://allohopefoundation.org.

The Allo Podcast is produced and edited by https://www.mediaclub.co.

Host and Allo Hope Foundation founder Bethany Weathersby tells the story of Lucy, her daughter, who passed from HDFN. Her loss sparked the blog Losing Lucy and Finding Hope, which grew into a resource for alloimmunized mothers seeking help and support. Lucy’s loss gave Bethany the drive to advocate for alloimmunized moms and HDFN babies around the world, and to advocate for the lives of her future children (more on that in Part 2). Lucy’s life has continued to impact the lives of countless babies with HDFN.

Note that since the time of this recording, Allo Hope Foundation has changed its recommendation such that a critical titer for Kell is any titer (previously 4), consistent with the ACOG Practice Bulletin, available here: https://pubmed.ncbi.nlm.nih.gov/29470342/

Episode themes: 

• Diagnosis of alloimmunization
• Family life during an alloimmunized pregnancy
• The life saving power of advocacy
• Severe, early HDFN
• Fetal death, stillbirth  and grief

Terminology used in this episode: 

• PSV: the measurement gained from the MCA Doppler ultrasound. It is the maximum velocity (sometimes called Pmax) that blood is moving through the middle cerebral artery. Anemic blood flows faster than nonanemic blood. The PSV is used to calculate the Multiples of the Median (MoM) value to check for anemia.
• MoM: The result of the calculation to see if the baby is anemic. The peak systolic velocity (PSV) and gestational age are used to calculate the MoM. A result of 1.3 indicates mild anemia. Numbers of 1.5 or higher indicate moderate to severe anemia and signals the need for an intrauterine transfusion or delivery. Lucy’s was 2.5

Allo Hope Terminology Library https://allohopefoundation.org/library/terminology/

Links in this episode: 

https://losinglucyandfindinghope.com/

Research for this episode provided by Bethany Weathersby and Molly Sherwood of the Allo Hope Foundation. Find more information at https://allohopefoundation.org

The Allo Podcast is produced and edited by https://www.mediaclub.co