Association of hemorrhagic disease and the syndrome of persistent fetal circulation with the fetal hydantoin syndrome

Abstract

indicate that death was due to massive intravascular sickling of red blood cells introduced during the procedure. The only other report of an occurrence similar to this involved a newborn infant who died seven days following an exchange transfusion in which donor blood with sickle cell trait was used? Intravascular sickling with resulting death can occur from the injection of the quantity of blood used in exchange transfusions if that blood contains cells with the potential for sickling. This reaction is likely if there is hypoxemia during or after the exchange transfusion. The need for both of these factors to be present (or others such as acidosis or dehydration) probably accounts for the paucity of reports such as this. In our patient, early findings indicated pulmonary hypertension with much right-to-left shunting ~ (persistent fetal circulation). The infant had repeated episodes of enhanced right-to-left shunting as suggested by periods of diminished Pa% without changes in Pae% or pH. Although he seemed to be improving, such an episode might have occurred after the exchange transfusion. The use of CPAP can result in a rapid fall of Pao2 if it is applied through nasal prongs; that System has been shown to have intrinsic problems which can lead to hypoxemia? -6 In any event, it is likely that our patient experienced an episode of hypoxemia which caused the intravascular sickling and death.