The Allo Podcast

Bethany and Molly kick off Season 4 with a dive into the weirdest corners of HDFN — from mind-blowing bizarre facts (like babies born with 100% donor blood and drones parachuting blood bags in Africa) to rare case studies featuring anti-Kell + anti-D, the ultra-rare anti-KU and anti-PP1P˩K antibodies, and a mystery about false-positive newborn screens that still has experts stumped.Watch this episode on YouTube Do you have any ideas about why some infants who have received IUTs test (falsely) positive for certain metabolic syndromes in their newborn screens? E-mail us at info@allohopefoundation.orgView all of our resources at www.allohopefoundation.orgIf you are an alloimmunized mother from any country, you are welcome in our Facebook support group called “Antibodies in Pregnancy: An AHF Support Group. Join here. https://www.facebook.com/groups/antibodiesinpregnancyPlease consider donating to AHF. If you are a listener, you know we do a lot with a little. Not sure how much will make a difference? An antibody screen in Kenya costs $13 USD. A dose of RhIG for a mother who cannot afford it is $80 USD. Click here to make a one-time or recurring donation.References in this episode: Read more about the “grandmother effect” here where a female fetus can become exposed to her mother’s Rh(D) positive blood in utero, priming her for Anti-D sensitization: here.Gender as a risk factor for developing neutropenia in HDFN: Alkhani A, Arefi A, AlTayeb M, Naaz S, Alghanbar J, Alhuthil R, Alrowaily F, Almidani E. Incidence and risk factors of neutropenia in neonates with hemolytic disease of the newborn. International Journal of Pediatrics and Adolescent Medicine. 2024 Sep 1;11(3):83-7. Available here.; Blanco E, Johnston DL. Neutropenia in infants with hemolytic disease of the newborn. Pediatric blood & cancer. 2012 Jun;58(6):950-2. Available here.Read about drone delivery of blood in Rwanda: here.Anti-PP1PK literature review and case presentations: Di Ciaccio P, Cutts B, Alahakoon TI, Dennington PM, Soo LA, Curnow J. Clinical consequences of the extremely rare anti‐PP1Pk isoantibodies in pregnancy: a case series and review of the literature. Vox Sanguinis. 2021 May;116(5):591-600. Available here.

Bethany and Molly close out Amanda’s incredible survival story that began in Episode 2 of this season (Low Titer Pregnancies). After a rapid increase in titers from too low to titer to 2,048, Amanda’s referral to an MFM team went unnoticed for a few weeks. By the time she was seen, her son was very sick, but he was in the right hands with Dr. Snowise and his team. Listen to this miraculous story unfold. Then, Bethany and Molly reflect on AHF’s accomplishments and goals for the year and close with a powerful reflection that will touch the hearts of every listener, ending with a special dedication. References in this episode: Nipocalimab trial results: NipocalimabUse of cffDNA to find fetal antigen status for D, E, C, c, K, Fya: Fetal Antigen StudyESAs for newborns with HDFN to reduce the number of transfusions: Transfusion ReductionDonate to AHF: Allo Hope DonateAHF Merch: Allo Hope MerchWatch this episode on YouTube: Allo Hope on YouTubeJoin the AHF patient support group: AHF Support Facebook

Bethany and Molly interview Dr. Timothy Bahr, a neonatologist with a specialty in neonatal hematology about all of your HDFN questions for newborns. Dr. Bahr patiently answers many of the common challenges and questions in neonatal HDFN care. This is an advanced discussion of neonatal HDFN. For a primer describing disease presentation, visit our neonatal episode in Season 1.Questions answered in this episode:What does it entail to prepare blood for a neonatal exchange transfusion?When and how do you use erythropoietin/darbepoetin (ESAs)?When does an HDFN baby need to be referred to hematology after discharge?Heel prick versus blood draw from a vein, does it matter?Is it ok to do transcutaneous bilirubin readings (with a small device on the skin instead of blood draw)?When is a baby cleared from HDFN?Why can’t we have the same neonatologist throughout a baby’s NICU stay?How can a mother politely insist on regular laboratory testing for their newborn with HDFN?How can a mother explain to the team at birth that it’s very important to get an immediate bilirubin check at birth (through cord or placenta if possible)?What’s the difference between neonatal and pediatric hematologist?Publications mentioned in this episode: Delayed cord clamping in alloimmunization: https://www.sciencedirect.com/science/article/abs/pii/S2589933323003075Iron overload in HDFN: https://scholarlypublications.universiteitleiden.nl/access/item%3A2881417/download#page=194Systematic review on IVIG in the neonate for HDFN: https://fn.bmj.com/content/99/4/F325.shortLeiberman et al on IVIG in the neonate for HDFN: https://onlinelibrary.wiley.com/doi/pdf/10.1111/bjh.18170Darbepoetin to reduce the need for neonatal transfusion: https://cdn.clinicaltrials.gov/large-docs/26/NCT03104426/Prot_000.pdfPublications by Dr. Tim Bahr: https://pubmed.ncbi.nlm.nih.gov/?term=Bahr_TMPublications by Tim’s mentor, Dr. Robert (Bob) Christensen: https://pubmed.ncbi.nlm.nih.gov/?term=Christensen_RDDonate to AHF: Allo Hope DonateAHF Merch: Allo Hope MerchWatch this episode on YouTube: Allo Hope on YouTubeJoin the AHF patient support group: AHF Support Facebook

Bethany and Molly build on last season’s discussion of grief to expand to anxiety, stress, depression and PTSD during and after the experience of a high risk pregnancy. They talk through how these challenges present themselves, how they feel to an alloimmunized mother, and specific coping mechanisms. The close with a positive segment called “what’s in the bag”, where moms submitted lists of items that they packed for their delivery, IUT, and NICU visits.Mental health burden in alloimmunized pregnancy: https://www.ajog.org/article/S0002-9378(23)01145-6/pdfDonate to AHF: Allo Hope DonateAHF Merch: Allo Hope MerchWatch this episode on YouTube: Allo Hope YouTubeJoin the AHF patient support group: AHF Support Facebook

Bethany, Molly and Katie talk through differences in HDFN care continent by continent. They review country-specific research, practice patterns, and patient stories. Donate to AHF: Allo Hope DonateAHF Merch: Allo Hope MerchWatch this episode on YouTube: Allo Hope on YouTubeJoin the AHF patient support group: AHF Support FacebookCross-matching for Kell in Netherlands: Luken JS, Folman CC, Lukens MV, Meekers JH, Ligthart PC, Schonewille H, Zwaginga JJ, Janssen MP, van Der Schoot CE, van der Bom JG, de Haas M. Reduction of anti‐K‐mediated hemolytic disease of newborns after the introduction of a matched transfusion policy: a nation‐wide policy change evaluation study in the Netherlands. Transfusion. 2021 Mar;61(3):713-21. Iceland study: Gudlaugsson B, Hjartardottir H, Svansdottir G, Gudmundsdottir G, Kjartansson S, Jonsson T, Gudmundsson S, Halldorsdottir AM. Rhesus D alloimmunization in pregnancy from 1996 to 2015 in Iceland: A nation‐wide population study prior to routine antenatal anti‐D prophylaxis. Transfusion. 2020 Jan;60(1):175-83. South Korea study: Yang EJ, Shin KH, Song D, Lee SM, Kim IS, Kim HH, Lee HJ. Prevalence of unexpected antibodies in pregnant Korean women and neonatal outcomes. The Korean Journal of Blood Transfusion. 2019 Apr 30;30(1):23-32. Saudi Arabia study: Alkhaibary A, Ali M, Tulbah M, Al-Nemer M, Khan RM, Al Mugbel M, Al Sahan N, Hassounah MM, Alshammari W, Kurdi WI. Complications of intravascular intrauterine transfusion for Rh alloimmunization. Annals of Saudi Medicine. 2021 Nov;41(6):313-7.Iran study: Niroomanesh S, Dadgar S, Shirazi M, Sharbaf FR, Golshahi F. Neonatal outcomes of Rh alloimmunization pregnancy treated with intrauterine transfusion. Med. Sci.. 2020;24(101):57-65.Japan study: Mizuuchi M, Murotsuki J, Ishii K, Yamamoto R, Sasahara J, Wada S, Takahashi Y, Nakata M, Murakoshi T, Sago H. Nationwide survey of intrauterine blood transfusion for fetal anemia in Japan. Journal of Obstetrics and Gynaecology Research. 2021 Jun;47(6):2076-81.Canada study: Jackson ME, Baker JM. Hemolytic disease of the fetus and newborn: historical and current state. Clinics in Laboratory Medicine. 2021 Mar 1;41(1):133-51.Brazil study: Pares DB, Pacheco GH, Lobo GA, Araujo Júnior E. Intrauterine Transfusion for Rhesus Alloimmunization: A Historical Retrospective Cohort from A Single Reference Center in Brazil. Journal of Clinical Medicine. 2024 Feb 28;13(5):1362.

In true Bethany and Molly fashion, the hosts open with laughing at inappropriate stories and end in happy tears sharing the most heartfelt moments of love and appreciation for each other and this special community. One Tiny Thing is a compilation of patient-provided “tiny things” that happened to them and changed everything. Bethany and Molly discuss listener answers to these special questions:What is one tiny thing that could have saved your HDFN baby’s life? What is one tiny thing that did save your HDFN baby’s life? What is one tiny thing that someone said to you that changed your perspective on this experience? Donate to AHF: https://allohopefoundation.org/get-involved/donate/AHF Merch: https://allo-hope-foundation.myspreadshop.com/Watch this episode on YouTube: allohope youtubeJoin the AHF patient support group: https://www.facebook.com/groups/antibodiesinpregnancy

S3E2: Low Titer Alloimmunized Pregnancies Over half of alloimmunized pregnancies begin with a low antibody titer, and a portion stay low throughout the pregnancy. Others begin low and later rise to critical levels. This episode is dedicated to management of the low titer pregnancy and how to anticipate a potential change in disease trajectory if titers increase. Bethany and Molly include management recommendations and stories submitted by low titer moms before transitioning to a special interview with allo mom Amanda, whose pregnancy began as a low titer pregnancy before taking a surprising turn. We meet Amanda in this episode before resuming the second half of her HDFN journey in this season’s final episode, Incredible HDFN Survival Stories. Key aspects of low titer disease management: Determine baby’s antigen status if possible. If not possible, monitor as if antigen positive. If the baby is certainly antigen negative, the pregnancy proceeds as normal and there is no need to do anything further beyond standard pregnancy careEstablish care with an MFM and determine up front if this MFM is able to do IUTs on your baby if your disease progresses. If not, have a referral plan set upCheck titers every 4 weeks in the first and second trimester, then every 2 in the third trimesterWeekly fetal assessment beginning at 32 weeks (Nonstress tests and biophysical profiles).Delivery at 37-38 weeksFollow all neonatal recommendations (establish a plan with pediatrician in advance if possible b/c they are likely to be doing the follow-up care) - bilirubin consistent with AAP guidelines which may include daily testing after discharge for a week or more, and hemoglobin/hematocrit weekly for the first six weeks and until hemoglobin/hematocrit increases or is in stable normal range for two consecutive weeksDelivery timing 37-38 weeks: ACOG Medically Indicated Late Term and Early Preterm Deliveries. ACOG Early Delivery GuidlinesAAP guidelines for hyperbilirubinemia after birth: AAP on HyperbilirubinemiaUndetectable antibodies progressing to severe disease: Dajak S, Stefanović V, Čapkun V. Severe hemolytic disease of fetus and newborn caused by red blood cell antibodies undetected at first‐trimester screening (CME). Transfusion. 2011 Jul;51(7):1380-8. Undetected Antibodies ResearchAmanda’s video blog of her alloimmunized pregnancy journey: Amanda's Video BlogDonate to AHF: https://allohopefoundation.org/get-involved/donate/AHF Merch: https://allo-hope-foundation.myspreadshop.com/Watch this episode on YouTube: https://youtu.be/AA9J1pHPNUAJoin the AHF patient support group: https://www.facebook.com/groups/antibodiesinpregnancy