DOCSLIB.ORG

Intrauterine Transfusion for Fetal Anemia Due to Red Blood Cell Alloimmunization: 14 Years Experience in Leuven

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Intrauterine Transfusion for Fetal Anemia Due to Red Blood Cell Alloimmunization: 14 Years Experience in Leuven FACTS VIEWS VIS OBGYN, 2015, 7 (2): 129-136 Original paper Intrauterine transfusion for fetal anemia due to red blood cell alloimmunization: 14 years experience in Leuven S.A. PasMAN1, L. ClaES1, L. LEWI1, D. VAN SCHOUBROECK1, A. DEBEER2, M. EMONds3, E. GEUTEN1, L. DE CATTE1, R. DEVLIEGER1 1Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium. 2Department of Neonatology, University Hospitals Leuven, Belgium. 3Department of Hematology, University Hospitals Leuven, Belgium and Blood transfusion center, Red Cross Flanders, Leuven, Belgium. Correspondence at: Prof. Dr. R. Devlieger, Fetal Medicine Unit, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. E-mail: [email protected] Abstract Objective: The purpose of this study is to report on the pregnancy and neonatal outcome of intrauterine transfusion (IUT) for red blood cell (RBC-)alloimmunization. Material and Methods: Retrospective cohort study of all IUT for RBC-alloimmunization in the University Hospital of Leuven, between January 2000 and January 2014. The influence of hydrops, gestational age and technique of transfusion on procedure related adverse events were examined. Results: 135 IUTs were performed in 56 fetuses. In none of the cases fetal or neonatal death occurred. Mild adverse events were noted in 10% of IUTs, whereas severe adverse events occurred in 1.5%. Hydrops and transfusion in a free loop were associated with an increased risk of adverse events whereas gestational age (GA) at transfusion after 34 weeks was not. Median GA at birth was 35.6 weeks and 9% was born before 34 weeks. Besides phototherapy 65.4% required additional neonatal treatment for alloimmune anemia. Non-hematologic complications occurred in 23.6% and were mainly related to preterm birth. Conclusion: In experienced hands, IUT for RBC-alloimmunization is a safe procedure in this era. Patients should be referred to specialist centers prior to the development of hydrops. IUT in a free loop of cord and unnecessary preterm birth are best avoided. Key words: Intrauterine blood transfusion, fetal therapy, perinatal survival, procedure related complications, fetal anemia, red blood cell alloimmunization. Introduction Indications for IUT are fetal anemia and thrombocytopenia, although the latter has become Intrauterine transfusion (IUT) was introduced in an increasingly rare indication since the introduction 1963 by Liley, who used an intraperitoneal approach of immunoglobulins for fetal and neonatal (Liley, 1963). Almost 20 years later, the procedure alloimmune thrombocytopenia (Bussel et al., 1988; was improved to a transfusion into the umbilical Van Den Akker et al., 2007). The majority of IUTs vein under constant ultrasonographic guidance used to be performed for fetal anemia caused by (Berkowitz and Hobbins, 1981; Clewell et al., Rhesus-D antibodies. Nowadays, despite a large 1981). The intravascular approach compared to the decrease because of prophylactic administration of intraperitoneal route turned out to be especially anti-D immune globulins in Rhesus negative advantageous to the hydropic fetus because the patients, maternal red blood cell (RBC)- absorption of red blood cells is less effective from a alloimmunization remains an important cause of peritoneal cavity filled with ascites. fetal anemia (Moise, 2008). However, indications 129 pasman-.indd 129 30/06/15 10:34 have shifted to a diversity of other antibodies than In this study, only IUTs for RBC-alloimmuniza- those against the Rhesus-D antigen. Timely referral tion were included. Hydrops was defined as mild is now ensured since irregular antibodies are when there was a distinct rim of ascites, with or routinely checked for in maternal blood in the first without pericardial effusion, and as severe when trimester and repeated later in gestation for Rhesus there was an abundant amount of fluid collection, negative mothers. This has led to a lower number of usually ascites, with skin edema (Van Kamp et al., hydrops in fetuses requiring IUT. 2001). Prior to 2002, only amniocentesis was used Risk factors for severe fetal anemia included: to predict fetal anemia. From 2002 onwards, anemia relevant obstetric history, presence of maternal red was predicted by assessment of the MCA PSV, blood cell antibodies, ultrasound markers as cardio-, which was converted to multiple of the median hepato- and splenomegaly and signs of hydrops and (MoM) (Mari et al., 2000). An MCA PSV above 1.5 diminished fetal movements. Timing of transfusion MoM was considered an indication for IUT. used to require amniocentesis for determining delta Sonographic features related to fetal hydrops were OD450 indicating levels of bilirubin and thus also indication for fetal blood sampling. A fetus hemolysis (Pasman et al., 2008). This has changed with a hemoglobin value of at least two standard since the introduction of MCA PSV (middle cerebral deviations (SD) below the mean for gestational age artery peak systolic velocity) Doppler measurement at fetal blood sampling was regarded as anemic to predict severe fetal anemia in 2000 (Mari et al., (Nicolaides et al., 1988). 2000). Because of the accuracy and non-invasiveness of MCA PSV measurement this new technique Intrauterine transfusion technique quickly became the standard (Oepkes et al., 2006). It can be used weekly or more frequently when During the study period, three operators performed required and is a reliable diagnostic tool between 16 the IUTs. Antenatal corticosteroids were given to and 36 weeks gestation in experienced hands. women carrying fetuses with at least 26 weeks of Furthermore, Doppler measurements can be used gestation age before IUT to anticipate the need for for timing of subsequent IUTs (Scheier et al., 2006) an emergency cesarean section. For the same reason, instead of planning the subsequent IUTs by a IUT after 28 weeks of gestation were performed standard schedule. Therefore, although the under combined spinal epidural analgesia (CSE). technique of IUT has not significantly changed, the Fetal pain relief and immobilization was achieved management of these pregnancies has evolved by either intravenous or intramuscular injection of a significantly in the last 14 years. curare derivative (pancuronium or cisatracurium) in Few studies have reported on the safety of IUT in combination with atropine and fentanyl. A 20 or large cohorts (Van Kamp et al., 2005; Somerset et 22G spinal needle was used for the IUT. The volume al., 2006; Tiblad et al., 2011). We will report on the of packed cells to be given (V) was calculated using pregnancy and neonatal outcome of all IUTs the formula (Moise et al., 1997): performed from 2000 till 2014 for fetal alloimmune anemia in the University Hospital of Leuven and FPV (Ht target – Ht first sample) identify risk factors for adverse events. V = ------------------------------------------------------------------------ Ht donor blood Materials and Methods With Study subjects FPV (fetoplacental blood volume) = 1.046 + (0.14x All reports of IUTs, performed between January ultrasound estimated fetal weight (g)) 2000 and January 2014 were collected from the electronic prenatal (Astraia software gmbh Munich, The target hematocrit (Ht) was usually 40%. The Germany) and obstetrical (Java-KWS, UZ Leuven, hematocrit of the fetal blood sample was assessed Belgium) databases. To ensure full patient inclusion, through a Sysmex pocH-100i (Sysmex NV a cross-check with the hospitals financial records Belgium). The donor blood was O Rhesus regarding the billing of IUT procedures and with the D-negative or compatible with the antibody of the distribution of blood products from the blood mother. It was leucodepleted and obtained from transfusion center was performed. Intrapartum and CMV negative donors, collected within 72 hours postpartum data of the children born in referring before the procedure. The blood was concentrated hospitals, were collected by contacting the referring to a hematocrit between 75 and 80% and underwent obstetrician or neonatologist. Prenatal, peripartal gamma irradiation less than six hours before and neonatal data were analyzed retrospectively. administration. 130 FACTS VIEWS VIS OBGYN pasman-.indd 130 30/06/15 10:34 IUT was performed into the umbilical vein either in Table I. The contribution of Rhesus-D at the placental cord root, into its intrahepatic course alloimmunization did not change over time. or into a free loop of cord, by choice of the operator. Hematological values before and after IUT are After completion of the IUT, a second blood sample shown in Table II. The hemoglobin level before was taken to confirm adequate transfusion. In some IUT was found to be between –1.1 and –10.8 SD cases blood was transfused into the peritoneal cavity below the normal mean (Nicolaides et al., 1988). as an addition to the IV transfusion. Usually, the The hemoglobin level was within 2 SD (non anemic) aim was to diminish the direct burden on the in four of 127 procedures, which were all first cardiovascular system, or to prolong the period until transfusions between 29 and 33 weeks. In 5.4%, the the next procedure. Delivery was usually planned 2 achieved Ht was below 35%, mostly because of weeks after the last IUT. Neonatal follow-up was concern for cardiovascular decompensation. In collected until discharge from the hospital in good 6.9% the achieved Ht was above 45%. condition, including ambulant controls during the There were 48 (86%) nonhydropic, five (9%) first 6 weeks of life. mildly hydropic and three (5%) severely
Load more

Recommended publications
  • Evolving Strategies in the Diagnosis and Management of Hemolytic Disease of the Fetus and Newborn
    SUPPLEMENT TO FREE CME Credit To receive CME credit, please read the articles and go to www.omniaeducation.com/HDFN to access the posttest November 2020 and evaluation. CME CREDITS: .25 CREDITS To receive CME credit, please read the articles and go to www.omniaeducation.com/HDFN to access the post-test Evolving Strategies in the and evaluation. Diagnosis and Management OVERVIEW: Hemolytic disease of the fetus and newborn (HDFN) of Hemolytic Disease of the is a rare condition with an estimated 3 to 80 cases per 100,000 persons annually in the United States. Nonetheless, Fetus and Newborn the complexity and increased risk for adverse outcomes in such cases requires more targeted approaches to HDFN that minimize or negate the risks associated with intrauterine transfusion. Kenneth J. Moise, Jr., MD Department of Obstetrics, Gynecology and This article focuses on the pathophysiology underlying Reproductive Sciences fetal/newborn allo- and autoimmune diseases, especially McGovern School of Medicine – UT Health HDFN and the current/evolving diagnostic and treatment The Fetal Center regimens for HDFN. Children’s Memorial Hermann Hospital REVIEWERS/CONTENT PLANNERS/AUTHORS: Houston, Texas • Sean T. Barrett has nothing to disclose. • Barry A. Fiedel, PhD has nothing to disclose. • Amanda Hilferty has nothing to disclose. Once a significant cause of perinatal loss, alloimmu- • Kenneth J. Moise, Jr., MD receives royalties from Up-To-Date, Inc. and has contracted research with Momenta nization to red cell antigens is infrequently encoun- Pharmaceuticals Inc. tered in obstetrical practice today. Although maternal • Robert Schneider, MSW, has nothing to disclose. alloimmunization to the rhesus blood group D (RhD) • Lee Philip Shulman, MD, FACOG, FACMG, receives antigen remains the leading cause of fetal anemia, consulting fees from Biogix, Celula, Cooper Surgical, Natera, and Vermillion/Aspira, is a speaker for Bayer, more than 50 different red cell antigens have been Lupin Pharmaceuticals, Inc., and Myriad.
    [Show full text]
  • Hemolytic Disease of the Fetus and Newborn: Modern Practice and Future Investigations
    ÔØ ÅÒÙ×Ö ÔØ Hemolytic Disease of the Fetus and Newborn: Modern Practice and Future Investigations Jeanne E. Hendrickson, Meghan Delaney PII: S0887-7963(16)30011-6 DOI: doi: 10.1016/j.tmrv.2016.05.008 Reference: YTMRV 50466 To appear in: Transfusion Medicine Reviews Received date: 20 February 2016 Accepted date: 23 May 2016 Please cite this article as: Hendrickson Jeanne E., Delaney Meghan, Hemolytic Disease of the Fetus and Newborn: Modern Practice and Future Investigations, Transfusion Medicine Reviews (2016), doi: 10.1016/j.tmrv.2016.05.008 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. ACCEPTED MANUSCRIPT Hemolytic Disease of the Fetus and Newborn: Modern Practice and Future Investigations Jeanne E. Hendrickson, MD and Meghan Delaney, DO, MPH1,2,3 1. Laboratory Medicine, Seattle Children’s Hospital, Seattle, WA, USA 2. Department of Laboratory Medicine & Pediatrics, University of Washington, Seattle, WA, USA 3. Bloodworks NW, Seattle, WA, USA Keywords: hemolytic disease of the fetus and newborn, red blood cell, alloimmunization Corresponding author: Jeanne E. Hendrickson, MD; Yale University Department of Laboratory Medicine, 330 Cedar Street, Clinic Building 405, PO Box 208035, New Haven, CT 06520-0835, USA Tel.: +1-203-737-8316ACCEPTED MANUSCRIPT E-mail: [email protected] Page 1 of 20 ACCEPTED MANUSCRIPT Abstract: Red blood cell (RBC) sensitization occurs in some women in response to exposure to paternally derived RBC antigens during pregnancy or to non-self antigens on transfused RBCs during their lifetime.
    [Show full text]
  • A Review: the Duffy Blood Group System
    A review: the Duffy blood group system K.M. BEATTIE In 1950, two reports described an antibody that had neuraminidase. On the other hand, Fy3, Fy4, and Fy5 been found during the investigation of a hemolytic are not affected. Reactionswith purified trypsin show transfusion reaction in the serum of a 43-year-old man that the Fysup(a) antigen is unaffected and Fy sup(b) is only slightly suffering from hemophilia. 1,2 After the unidentified reduced in strength; Fy3 and Fy6 are slightly enhanced. antibody had been separated from the anti-D, anti-A, The trypsin most commonly used by blood bankers and anti-Bin his serum, it was tested against the blood is a crude preparation that is contaminated with chymo- of 205 unrelated English adults; 64.9 percent were ,agglu- trypsin; therefore, results obtained with that product tinated. With the permission of the patient, the new would approximate those resulting from chymotrypsin blood group system was named Duffy The antigen was treatment. designated as Fysup(a), the gene responsible for it, Fy sup(a), and Inactivation of Fy determinants is such that they are its hypothetical allele, Fysup(b). Anti-Fysup(b) was reported the no longer capable of adsorbing their antithetical anti- following year in the serum of a German woman who bodies. This is not due to the removal of sialic acid but had been pregnant three times but not transfused.sup(3) probably represents proteolytic action on cell membrane Four years later, Fy(a-b-) was reported to be the proteins. Fy(a-b-) red cells are not sialic acid deficient most common phenotype in American blacks.sup(4) and their electrophoretic mobility is normal.
    [Show full text]
  • Fetal Intrauterine Transfusion Therapy: Neonatal Outcomes
    Blood of & al L n y r m u p o h J Badran et al., J Blood Lymph 2013, 3:1 Journal of Blood & Lymph DOI: 10.4172/2165-7831.1000112 ISSN: 2165-7831 Research Article Open Access Fetal Intrauterine Transfusion Therapy: Neonatal Outcomes Eman F Badran1*, Manar Al-lawama1, Amira Masri2, Iyad Al-Amouri3 and Fawaz Al Kazaleh4 1Neonatal Division, The University of Jordan, Amman, Jordan 2Neurology Division, The University of Jordan, Amman, Jordan 3Cardiology Division, Department of Pediatrics, The University of Jordan, Amman, Jordan 4Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, The University of Jordan, Amman, Jordan Abstract Background and objectives: Intrauterine blood transfusion (IUT) performed for fetal anemia may be associated with adverse neonatal outcomes. This study aimed to describe the clinical outcome of surviving neonates treated with IUT in an area where detailed outcome on neonatal data is limited. Patients and methods: This prospective study included all living newborns treated with IUT at our institution between March 2004 and February 2011. During this period, 30 newborns with a mean gestation age of 35 weeks (range: 25-37 weeks) were admitted with various respiratory, hematological and gastrointestinal morbidities. Results: The survival rate on discharge was 93%. Severe fetal anemia (72.2%) was significantly associated with a low reticulocyte count at birth and the need for respiratory support after birth (P<0.05). The number of IUTs was significantly correlated with the duration of admission (P=0.034) and the presence of hyporegenerative late anemia (P=0.007), but not with other neonatal outcomes or with a low reticulocyte count at birth.
    [Show full text]
  • BCW Policy and Procedures TEMPLATE WW.01.01
    INTRAUTERINE TRANSFUSION POLICY Intrauterine transfusion is used to replace fetal red cells with compatible blood in hemolytic disease of the fetus. A prescribers order is required for this procedure. The Physician Coordinator is responsible for administration of intravenous push medications, if required. Intrauterine Transfusion bookings are made through the Maternity Ambulatory Program and confirmed with the Chief Sonographer at least 24 hours in advance. C&W Transfusion Medicine Haematology Laboratory provides a specially trained Technologist to perform the testing. PROCEDURE 1.0 Criteria for Intrauterine Transfusion An intrauterine transfusion is performed in the following situations: • Fetal anemia secondary to other temporary causes • Fetal anemia secondary to parvovirus infection • Fetal thrombocytopenia secondary to anti-PLA 1 antibodies • Isoimmunization with other blood group antigens, circumstances such as: o Severe Rhesus Isoimmunization o Fetus demonstrating ultrasound evidence of hydrops fetalis o Hemoglobin of less than 10 on cordocentesis o Lower values of 450 if the rise between 2 readings is steep, indicating rapid progression of disease o OD 450 above 80% of Zone 11 (at least moderately affected) or in Zone 111(severely affected) before 30 weeks, or before fetal maturity can be demonstrated 2.0 Booking the Intrauterine Transfusion Upon the primary physician’s request the ultrasound booking clerk should schedule 1 ½ hours for the procedure. This includes 30 minutes preparation time. • The following information should be obtained: • Woman’s location (inpatient/outpatient) • Woman’s name • Blood group and Rh status • Date of birth • Gestational age at time of procedure • Indication for procedure • Laboratory tests required at time of procedure • Physicians involved • Special equipment required.
    [Show full text]
  • Hemolytic Disease of the Fetus/Newborn (Erythroblastosis Fetalis)
    Hemolytic Disease of the Fetus/Newborn (Erythroblastosis Fetalis) Introduction Hemolytic disease of the fetus or newborn is a disease that often confuses many expectant parents. By better understanding the disease, many of the treatments required may be less stressful. With proper and timely treatment, the effects of the disease can often be minimized. The purpose of this booklet is to briefly discuss the disease and its management as well as hopefully to answer any questions you may have. Below are the answers to frequently asked questions concerning Hemolytic Disease of the Fetus/Newborn. 1. What is red cell alloimmunization and how does one get it? To understand red cell alloimmunization, one must first understand about the different blood group factors. These factors appear on the surface of the red blood cell in the form of antigens. The main blood group factor system is the commonly known ABO system. These are four basic blood types in this system: A, B, AB, and O. Rh(D) is another blood group antigen that is either present or absent on human red blood cells. When a patient is called Rh negative, she does not have the Rh(D) antigen present on her red blood cells, whereas if an individual is called Rh positive, the antigen is present. There are a variety of other red blood cells antigen systems found in humans. These include Kell, Duffy, Kidd, and MNS. In general, much like the Rh system, these antigens are either present, and the individual is called positive for the antigen, or absent, and the individual is called negative for the antigen.
    [Show full text]
  • A Case of Hemolytic Disease of the Fetus with Ten Intrauterine Blood
    14th World Congress in Fetal Medicine A case of hemolytic disease of the fetus with ten intrauterine blood transfusions Braga JRS, Pritsivelis C, Andrade RP, Marzano MOC, Pereira MR, Amin Jr J, Cunha AA Maternidade Escola da Universidade Federal do Rio de Janeiro, RIO DE JANEIRO, Brazil Objective The widespread administration of rhesus immunoglobulin has resulted in a marked decrease in the alloimunization caused by the RhD antigen. However, cases continue to occur because of maternal sensitization in the two first trimesters of pregnancy, inadvert omission of RhIG and inadequate dosing after delivery where there has been an excessive fetomaternal haemorrhage. The literature refers to a series of hundreds of cases with a mean of three intrauterine transfusions. Sometimes, they are not enough, demanding some extra transfusions. The objective of this study is to report a case with ten intrauterine blood transfusions. Methods Case report. Results On 07/30/2014, a 29 year old patient, at 20 weeks of gestation was referred to Maternidade Escola da Universidade Federal do Rio de Janeiro, located at Rio de Janeiro, Brazil, with the diagnosis of perinatal hemolytic disease. She had two previous pregnancies, one with a vaginal birth and a caesarean section. The second child had a history of neonatal jaundice and cerebral palsy. She had taken anti-Rh immunoglobulin after the last pregnancy. Her blood type is 0 (-). The Coombs test was 1/256. The red blood cells panel showed anti-D antibodies. On the same day an obstetric ultrasound revealed polyhydramnios and a placental thickness of 32mm. The fetus had biometric measurements compatible with 21 weeks, consistent with her gestational age.
    [Show full text]
  • Alloimmune Disorders of Pregnancy Anaemia, Thrombocytopenia and Neutropenia in the Fetus and Newborn
    Alloimmune disorders of pregnancy Anaemia, thrombocytopenia and neutropenia in the fetus and newborn Collectively known as the alloimmune cytopenias, haemolytic disease of the fetus and newborn, alloimmune thrombocytopenia and alloimmune neutropenia are all consequences of maternal immunization to fetal blood cells. The effective prevention, diagnosis and management of these disorders has become a team effort involving haematologists, obstetricians, paediatricians, immunologists, laboratory technicians, midwives and research scientists. This book has been written by experts in their respective fields to bring together the issues of pathogenesis, epidemi- ology, prevention, diagnosis and clinical management. This comprehensive but accessible account is extensively cross-referenced to emphasize the links between pathogenesis and clinical sequelae, between epidemiology and the rationale for screening programmes, and between diag- nosis and therapeutic intervention. This is an authoritative overview suitable for trainees in obstetrics, maternal and fetal medi- cine, transfusion medicine and clinical immunology. Dr Andrew Hadley is Division Manager at the International Blood Group Reference Laboratory and Senior Scientist at the Bristol Institute for Transfusion Sciences, University of Bristol. Professor Peter Soothill is Professor of Maternal and Fetal Medicine and Head of the Department of Obstetrics and Gynaecology, St Michael’s Hospital and University of Bristol. Alloimmune disorders of pregnancy Anaemia, thrombocytopenia and neutropenia in
    [Show full text]
  • Red Cell Antibodies During Pregnancy
    The Management of Women with Red Cell Antibodies during Pregnancy Green-top Guideline No. 65 May 2014 The Management of Women with Red Cell Antibodies during Pregnancy This is the first edition of this guideline. Executive summary of recommendations Prepregnancy counselling Women with red cell antibodies, particularly if there is a risk of fetal anaemia or if compatible donor red P cells for transfusion may be difficult to obtain, should attend for prepregnancy counselling with a clinician with knowledge and expertise of this condition. Red cell antibodies in pregnancy What red cell antibodies are clinically significant (maternal and fetal) during pregnancy? All women should have their blood group and antibody status determined at booking and at 28 weeks D of gestation (Appendix 2). What are the implications for the fetus and neonate from red cell antibodies? Clinicians should be aware that severe fetal anaemia can result in hydrops which significantly worsens D the perinatal outcome. When and how should paternal and fetal genotyping be performed? Non-invasive fetal genotyping using maternal blood is now possible for D, C, c, E, e and K antigens. This C should be performed in the first instance for the relevant antigen when maternal red cell antibodies are present. For other antigens, invasive testing (chorionic villus sampling [CVS] or amniocentesis) may be considered P if fetal anaemia is a concern or if invasive testing is performed for another reason (e.g. karyotyping). Is karyotyping contraindicated in the presence of maternal red cell antibodies? Invasive testing is not contraindicated if alloimmunisation has occurred. P Anti-D prophylaxis should be given to cover invasive testing if the mother is rhesus D (RhD) negative D and is not sensitised.
    [Show full text]
  • Successful Management of Rh Isoimmunized Pregnancies at a Tertiary Care Centre-Our Experience
    Research Article Journal of Clinical Obstetrics, Gynecology & Infertility Published: 20 Jul, 2020 Successful Management of Rh Isoimmunized Pregnancies at a Tertiary Care Centre-Our Experience Gunjan Rai*, Sudhir Mansingh and Bikram Bhardwaj Department of Obstetrics and Gynecology, Command Hospital, India Abstract Alloimmunization, often called Rh-isoimmunization, was first described in Rh negative women with an Rh-positive fetus, but it can occur with many other blood type incompatibilities. It is a condition that may occur during pregnancy when there is an incompatibility between mother’s blood type and fetus blood type. During pregnancy, red blood cells from fetus can cross placental barrier and there is formation of antibodies. Those antibodies can cross back through the placenta and destroy fetal RBCs causing fetal anemia and fetal hydrops. This is called hemolytic disease of the fetus. Still the fetal anemia due to red cell alloimmunization in Rh isoimmunized pregnancy is the leading cause of intra-uterine blood transfusion. However intra-uterine transfusion can be considered in severe fetal anemia of any other cause like Parvo B 19 viral infection. Access of umbilical vein also helps in transfusion of platelets in alloimmune thrombocytopenia and injection of drugs to fetus like anti-arrhythmic drugs in fetal arrhythmia. Ultrasound guided access of umbilical vein is common for all type of intra-uterine transfusion. We managed Rh isoimmunized pregnancies at our centre by intrauterine transfusions and even conservatively. Keywords: Rh isoimmunization; Intrauterine transfusion; Phototherapy; Exchange transfusion Introduction Maternal Rhesus (or red cell) isoimmunization occurs when a pregnant woman develops an OPEN ACCESS immunological response to a paternally derived red blood cell antigen (D) foreign to the mother and inherited by the fetus.
    [Show full text]
  • Guidelines on Transfusion for Fetuses, Neonates and Older Children
    Guidelines on transfusion for fetuses, neonates and older children Helen V. New1,2, Jennifer Berryman3, Paula H.B. Bolton-Maggs4, Carol Cantwell2, Elizabeth A. Chalmers5, Tony Davies6, Ruth Gottstein7, Andrea Kelleher8, Sailesh Kumar9, Sarah L Morley10, Simon J. Stanworth11 on behalf of the British Committee for Standards in Haematology 1NHS Blood and Transplant; 2Imperial College Healthcare NHS Trust, London; 3University College Hospitals NHS Trust; 4Serious Hazards of Transfusion, NHS Blood and Transplant, Manchester/TTF member; 5Royal Hospital for Sick Children, Glasgow; 6NHS Blood and Transplant, Manchester; 7St. Mary’s Hospital, Manchester/University of Manchester; 8Royal Brompton Hospital, London; 9Mater Research Institute, University of Queensland, Australia; 10Addenbrookes Hospital/NHS Blood and Transplant, Cambridge; 11Oxford University Hospitals NHS Trust/NHS Blood and Transplant, Oxford. Address for correspondence: BCSH Secretary British Society for Haematology 100 White Lion Street London N1 9PF Tel: 0207 713 0990 Fax: 0207 837 1931 e-mail [email protected] Competing interests: the authors have no competing interests. Keywords: fetus; neonate; infant; paediatric; transfusion. Introduction The guideline is a revision of the 2004 British Committee for Standards in Haematology (BCSH) guideline on transfusion in neonates and older children (BCSH, 2004). Although there has been little evidence on which to base paediatric clinical transfusion decisions in the past, there have been a number of studies and national audits published over recent years that contribute to decision-making in this area. In addition there have been changes to other guidance, including the management of neonatal jaundice (NICE, 2010) and the requirement for cytomegalovirus (CMV) seronegative components. The clinical section focuses largely on aspects relating to transfusion indications and administration, whereas the laboratory section contains most of the information relating to pre-transfusion testing and component selection.
    [Show full text]