Intraperitoneal Transfusion Research Articles

Current Technique of Intraperitoneal Transfusion: Do Not Throw Away the Renografin

The original description of intraperitoneal transfusion calls for contrast-dye infusion and X-ray confirmation of placement of the needle free in the peritoneal cavity. Ultrasound methods, using air or saline as contrast media, have been described to replace the X-rays. This report illustrates at least one way in which the ultrasound findings at intraperitoneal transfusion may be illusory, allowing misplaced transfusion into the fetal colon. In specific instances, use of radiopaque dye at intraperitoneal transfusion may still be helpful.

Comparison of Four Types of Intrauterine Transfusion: Effect on Fetal Hematocrit

The advent of cordocentesis has made it possible to treat fetuses affected by severe red cell alloimmunization by infusing red cells into umbilical vessels. In addition, serial hematocrits can be followed between transfusions. Twenty fetuses underwent a total of 118 intrauterine procedures. Four transfusion techniques were compared to assess the effect of each method on the stability of the fetal hematocrit between procedures. The change in hematocrit per day for direct intravascular transfusion was -1.06 +/- 0.68%, for intraperitoneal transfusion: +0.03 +/- 0.6%, for combined exchange intravascular and intraperitoneal transfusion: +0.02 +/- 0.3% and for combined direct intravascular and intraperitoneal technique: -0.01 +/- 0.4%. The greatest fall in hematocrit was noted with the use of the direct intravascular technique alone (p less than 0.001). The combined direct intravascular/intraperitoneal approach produces a stable hematocrit between procedures and offers the possibility of performing intrauterine transfusions at less frequent intervals.

Management of serious alloimmunization in pregnancy.

In the past 40 years, tremendous advances in the treatment of hemolytic disease have been made. The perinatal mortality has been reduced considerably. Rh immunoprophylaxis has decreased the incidence of Rh immunization to around 6 per 100,000 live births. Nevertheless, treatment of severe hemolytic disease is still essential. Increased reliability of diagnostic procedures have made early detection and optimal treatment of hemolytic disease possible. Treatment by plasmapheresis is still controversial. Although believed to be beneficial by some authors, conclusive evidence of its efficacy has not been obtained. With preterm induction of birth at 32 weeks of gestation, the chances for survival are 95%. Improvement of techniques and the use of modern real-time ultrasound equipment have made intrauterine intraperitoneal transfusion, in experienced hands, a relatively safe and successful procedure. Intravascular transfusion appears beneficial in early pregnancy. Combination of both techniques will probably be the answer for the future. The development of neonatal intensive care facilities has made a major contribution to the survival of children with haemolytic disease. The relative low incidence of haemolytic disease has made it imperative that treatment should take place in centers where experience and special skill are available.

The reversal of hydrops fetalis by intravascular intrauterine transfusion in severe isoimmune fetal anemia

Seventy-two intrauterine intravascular transfusions were performed on 26 patients with severe erythroblastosis fetalis. Twenty of the 26 fetuses were hydropic at the time of referral. Of the 20 hydropic fetuses, 16 (80%) survived. Hydrops was completely reversed in 13 of the 16 fetuses (81%). Total protein of <3 gm/dl, albumin <2 gm/dl, and a hematocrit level of <15% were associated with hydrops fetalis. After hydrops was reversed, total protein 3 gm/dl, albumin 2 gm/dl, along with a sustained hematocrit level of 15%, were found. Only three neonates were born with minimal ascites, two of whom had had intraperitoneal transfusions before intravascular treatments. There were 21 survivors of the total group, giving an overall survival rate of 82%. There was one neonatal death from severe respiratory distress syndrome. Thirty-eight percent of the neonates did not require exchange transfusions in the newborn period. Intrauterine intravascular transfusions appear to be an effective mode of therapy in severe erythroblastosis fetalis and not only increase survival rates but also decrease neonatal morbidity and mortality.

Improved Care for Rh-Isoimmunized Patients in Saudi Arabia

ABSTRACT Although the number of patients with Rh isoimmunization in pregnancy has been decreasing in recent years, this category of patients contributes significantly to the perinatal mortality in ...

Absorption of fetal intraperitoneal blood after intrauterine transfusion.

We reviewed the sonograms and medical records of all patients who underwent intrauterine transfusions between December 1981 and December 1984 in order to determine the time course for disappearance of the intraperitoneal blood. Seventy-two sonographic examinations were performed on 22 patients who underwent 51 intrauterine transfusions. Nonhydropic fetuses who received less than or equal to 50 cc of intraperitoneal blood exhibited no ultrasonic evidence of intraperitoneal fluid after 8 days. Nonhydropic fetuses receiving greater than 50 cc of intraperitoneal blood showed resolution of intraperitoneal fluid after 12 days. Hydropic fetuses, after intraperitoneal transfusion, all demonstrated persistence of intraperitoneal fluid. Intraperitoneal fluid was seen as long as 24 days after transfusion in hydropic fetuses.

Technical aspects of intravascular intrauterine transfusions: Lessons learned from thirty-three procedures

Our technique for performing intravascular transfusions is described and four failed attempts are presented. The appropriate choice of needle, insertion site, and premedication are discussed. A rationale for intravenous fetal muscle blockade in selected cases is presented and a transfusion setup designed to minimize movement of the needle hub is described. Finally, the judicious use of intraperitoneal transfusions in some cases is suggested.

Sonographic detection of fetal intraperitoneal fluid.

The sonograms from 15 patients who underwent 40 intrauterine transfusions at the University of California San Francisco School of Medicine, between December 1981 and December 1984 were retrospectively reviewed. The authors found that 12 to 14 ml of fluid were easily seen in 18- to 20-menstrual-week fetuses and that 30 to 40 ml were seen in fetuses at greater than or equal to 30 menstrual weeks. Since the study was retrospective, the absolute minimum of detectable fetal intraperitoneal fluid was not recorded for each fetus. The above represent amounts that were consistently documented during each intrauterine transfusion. In order to gain information about the minimum detectable fetal intraperitoneal fluid, two fetuses undergoing intraperitoneal transfusions were studied prospectively. The minimum fetal intraperitoneal fluid volumes observed were 10 ml in a 22-week fetus and 15 ml in a 26-week fetus.

The management of severe rhesus isoimmunization by fetoscopic intravascular transfusions

Twenty-five severely rhesus-isoimmunized fetuses, including 15 with hydrops fetalis, underwent a total of 77 intrauterine transfusions between 19 and 32 weeks' gestation. Fifty-eight of the procedures were fetoscopically directed intravascular transfusions, nine were ultrasound-guided intraperitoneal transfusions, and 10 were a combination of intravascular transfusion, fetal paracentesis, and intraperitoneal transfusion. The average number of antenatal procedures per patient was three (range, one to five). The survival rate for the 19 fetuses that received their initial intrauterine transfusion at or before 25 weeks' gestation was 84%; 11 of the 13 hydropic fetuses and five of the six fetuses without antenatal evidence of hydrops survived. In six cases hydrops fetalis was reversed in utero. The outcome in patients referred after 25 weeks' gestation was poor; neither of the two hydropic fetuses and only two of the four nonhydropic ones survived, which suggests the importance of early referral to a team experienced in the management of this problem. However, most of these fetal losses occurred early in the series. Seven of the 20 neonates were hydropic, and nine had severe thrombocytopenia (platelet count, <50,000 × 106/L). The mean cord blood hematocrit and bilirubin of the neonates were 25.1% and 82 μmol/L, respectively. The babies required a total of 69 exchange transfusions (range, 0 to 9) and 68 simple transfusions (range, 0 to 25). One newborn infant who had had ultrasound evidence of hydrops fetalis at 22 weeks' gestation did not require any exchange transfusions. Nine patients required intermittent positive pressure ventilation (eight had respiratory distress syndrome and one had apnea) for a range of 1 to 86 days. The neonatal survival rate was 90% (1820).

Studies on the sequestration of chemically and enzymatically modified erythrocytes.

We have developed an experimental animal model to establish the patterns of sequestration of untreated, as well as chemically and enzymatically modified red blood cells (RBC). The intraperitoneal route of transfusion provides a useful way of transferring large numbers of untreated RBC into small animals and assuring their introduction into the circulation within 24 hr. Moreover, this route "filters" some types of modified erythrocytes, eg, glutaraldehyde treated RBC. From the pattern of sequestration, the RBC in the peritoneal cavity then pass through the liver where other types of modified RBC are sequestered, eg, after trypsin, pronase, protease, or sialidase treatment. Some modified RBC show a preference for the spleen as the site of sequestration, eg, galactose oxidase or N-ethylmaleimide treated RBC. These appear in the spleen despite intraperitoneal transfusion. Relevant to this study is the observation that in the rat old RBC are sequestered both by liver and spleen, while asialoerythrocytes are sequestered by liver only. A possible reason for this difference is discussed in the text.

Ultrasound-guided Fetal Intravenous Transfusion for Severe Rhesus Haemolytic Disease

Intraperitoneal transfusion of unborn infants with severe rhesus hemolytic disease gives poor results when the fetus is of low gestational age and has hydrops. Direct intravascular transfusion of fetuses under feto-scopic control at 23 to 26 weeks of gestation is more efficient, but it cannot be used beyond that age because of fetoscopic limitations. The authors have therefore tried direct intravenous transfusion of fetuses through the hepatic part of the umbilical vein using a thin needle guided by ultrasound. The procedures conformed with the Declaration of Helsinki of 1975. Results in two cases are described. Case 1, a 33-year-old woman (blood group O, rhesus-negative) was in her fifth pregnancy. Ultrasonic assessment showed a fetus of normal size for 29 weeks. Fetal ascites was present, and the amniotic fluid bilirubin concentration was 14 μmol/liter(0.8 mg/100 ml), which was in the “severely affected” zone of the prognostic chart. The patient was treated with betamethazone (12 mg daily for 2 days), ritodrine (10 mg four times daily), and phe-nobarbitone (100 mg daily). An intraperitoneal transfusion was planned, with 50 ml of group O, rhesus-negative (cde/cde) erythrocytes suspended in sterile isotonic sodium chloride (packed cell volume, 0.60 (60 per cent)). To prevent immunological complications, the cell suspension was irradiated with 2160 rad for 4 minutes before use. During the transfusion, the authors observed a dilated umbilical vein and gave a further 10 ml of blood into the hepatic part of the vein. A fetal blood sample, which looked like reddish serum, showed the fetus to be group A, rhesus-positive, and gave a strongly positive reaction to a direct Coombs test. A second intravenous transfusion of 25 ml was given a week later. A fetal blood sample before the second transfusion showed a ratio of fetal to adult erythrocytes of 37:63. At 32 weeks, a girl of 1 700 g was delivered by cesar-ean section. The Apgar score was 3 at 1 minute and 10 at 5 minutes. The umbilical cord hemoglobin concentration was 6.4 g/dl and the bilirubin concentration 144 μmol/liter (8.4 mg/100 ml). The ratio of fetal to adult erythrocytes was 22:78. The infant had a slight bluish discoloration around the umbilicus, possibly a slight he-matoma. During the next 2 days, five exchange transfusions were given because of high and rising serum bilirubin concentrations, the highest being 393 μmol/liter (22.9 mg/100 ml). There were no further complications. Case 2, a 25-year-old woman in the 23rd week of pregnancy, was admitted for termination of pregnancy after a prenatal diagnosis of genetic disease (chromosomal abnormality). There was no evidence of rhesus isoimmunization. Ultrasound-guided puncture for fetal blood sampling was performed. Biparietal diameter was compatible with the age of gestation. Puncture of the hepatic part of the umbilical vein was performed under epidural anesthesia. The tip of the needle was visualized on the oscilloscope in the lumen of the vein and 0.5 ml of blood was withdrawn. Analysis on a Coulter counter showed 100 per cent fetal blood. Subsequently, 40 mg of dinoprost trometamol (Amoglandin) were instilled into the amniotic cavity for termination. Knowledge of various factors—for example, the size of transfusion, the cardiovascular effects of transfusion, the importance of different blood variables in fetal blood—should be established, but it is hoped that direct intravenous fetal tranfusion will improve the prognosis of high risk, rhesus-sensitized fetuses that cannot be saved by traditional methods.

58. Hemostatic failure in Rhesus isoimmunization

Labratory studies pritor to exchange transfusion in a group of babies with Rhesus isiommunization showed evidence of hemostatic failure in 6 out of 30. Findings in these infants included thrombocytopenia, low plasma fibringen, and abnormalities of the intrinsic coagulation system. five babies had a clinically recognizable bleeding tendency. Fibrin degradation products were found in 11 infants including babies aho had been treated by intra-uterine intraperitoneal transfusion, in addition to those with evidence of hemostatic failure. Eight babies in this group of 03 died, and at necropsy 4 out of 7 had subarachnoid and intracerebral hemorrhage. Three of the 4 had intravascular fibrin thrombi on microscopy of tissue section. An additional postmortem study on babies with Rhesus isoimmunization who died pror to the main investigation revealed massive intracranial hemorrhage associated with the presnce of intravascular fibrin thrombi in 5 cases out of 10. Babies at most risk of hemorrhagic complication are those with a cord Hb below 7 g/100 ml. It is concluded that disseminated intravascular coagulation is a major contributory cause of hemostatic failure in Rhesus isoimmunzation although hepatic dysfunction may play a part in some infants.

Intrauterine transfusion and fetal death: Relationship of intraperitoneal pressure to umbilical vein blood flow

In this report, the hypothesis is advanced that fetal intraperitoneal transfusion may elevate intraperitoneal pressure above that in the umbilical vein and produce fetal death by anoxia. Three experiments are described in which dye-containing fluid was infused intraperitoneally into fetal baboons. Umbilical vein pressure was measured directly at 14.5 mm. Hg. Infusion of 23 and 25 ml. fluid was required to elevate the intraperitoneal pressure above 15 mm. Hg in 2 fetuses. At that pressure, umbilical flow ceased. In the third fetus 65 ml. was required to elevate intraperitoneal pressure to 13 mm. Hg. At that pressure umbilical flow ceased. In the latter fetus, the infusion was continued and the fetus died. On the basis of three experiments, the hypothesis is confirmed. It is recommended that fetal intraperitoneal pressure be monitored during human intrauterine fetal transfusion.

Intraperitoneal blood transfusion in African adults with hookworm anaemia.

Twenty-nine patients were given an intraperitoneal transfusion of blood. The procedure was found to be free of serious complications. Study of the absorption of an (51)Cr-labelled cells from the peritoneum in 14 patients showed that between 35 and 100% of the blood was absorbed intact in 6 to 10 days. Intraperitoneal transfusion may be indicated as an alternative or as an addition to exchange transfusion in severe hookworm anaemia.

Intrauterine fetal transfusions for the management of erythroblastosis

Initial experience with the technique of intrauterine fetal transfusion is reported. Eight fetuses received 11 intraperitoneal transfusions for severe Rh erythroblastosis. Four infants survived, 3 died from persistent hydrops, and 1 died from intercurrent sepsis. Elavated concentrations of amniotic fluid protein relative to the stage of gestation were found to correlate with fetal hydrops. Following intrauterine therapy, decreasing amniotic fluid protein content correlated with an improving fetus; both amniotic fluid Δ O.D. 450 mμ units and the bilirubin/protein ratio values reflected the extent of residual fetal hemolytic disease. In 2 cases suppression of fetal erythropoiesis followed multiple intrauterine transfusions and eliminated the need for subsequent exchange transfusions. Positive antiglobulin tests of Rh-negative cord blood after intrauterine transfusions were encountered and found to be associated with a condition of maternal antibodies against penicillin and the prophylactic administration of intraperitoneal penicillin to the fetus.

TELEVISION INTERVIEW ON INTRAPERITONEAL TRANSFUSION FOR HÆMOLYTIC DISEASE

Medical Journal of AustraliaVolume 1, Issue 26 p. 1138-1138 Correspondence TELEVISION INTERVIEW ON INTRAPERITONEAL TRANSFUSION FOR HÆMOLYTIC DISEASE First published: 01 June 1966 https://doi.org/10.5694/j.1326-5377.1966.tb73301.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue26June 1966Pages 1138-1138 RelatedInformation

Fetomaternal Passage of Leukocytes and Platelets in Erythroblastosis Fetalis

Abstract Leukocytes and platelets labeled by the atabrine fluorescent technic have been demonstrated in the maternal circulation from ½ to 4 hours following intraperitoneal transfusion of the fetus in utero. The peak concentration of labeled cells was observed 2 hours after transfusion. The fetomaternal transfer of cells has been demonstrated in cases of erythroblastosis fetalis. It is not known whether this occurs in normal fetuses and the mechanism is not understood.

The Course of Plasmodium berghei Infection in the Polycythemic Mouse

The erythrocytic forms of P. berghei are reported to have a predilection for infecting young red cells in rodents. In an attempt to clarify the role of immature red cells, P. berghei infections were studied in the polycythemic mouse in which erythropoiesis was markedly inhibited. The infectivity of the parasite is directly related to the availability of immature red cells. The infection can be completely blocked even in the presence of a large population of mature red cells. The malaria parasite of rodents, Plasmodium berghei, is reported to preferentially invade immature erythrocytes (Galliard, 1948; Ramakrishnan, 1950; Baldi, 1950; Corradetti et al., 1951; Sergent, 1958). During the course of infection in the mouse the total number of red blood cells falls rapidly as reticulocytosis greatly increases (Singer, 1954). The appearance of parasites in reticulocytes may result from the anemic condition with the increased availability of young red cells. Hsii and Geiman (1952) reported the potentiation of P. berghei virulence in mice which were anemic from Eperythrozoan coccoides infection. The mice exhibited a marked reticulocytosis. Xirradiation of normal mice before and after the inoculation of a large number of parasites has certain effects on the course of P. berghei, which are apparently related more to inhibition of erythropoiesis than to a direct effect on the parasite (Singer, 1953). The infectivity and virulence of P. berghei has been compared in normal, anemic, and polycythemic mice in an attempt to better clarify the role of young red cells. Polycythemic mice can be prepared so that erythropoiesis is essentially halted as judged by the absence of reticulocytes in the peripheral blood (Jacobson et al., 1957; Filmanowicz and Gurney, 1961). This model permits the regulation of the availability of young red cells to the parasite under physiological conditions. MATERIALS AND METHODS Male CFW strain mice are maintained in this laboratory with Plasmodium berghei infections. Received for publication 15 September 1965. * This paper is contribution number 50 from the Army Research Program on Malaria. The work was supported by U. S. Army Contract No. DA49-193-MD-2545. Directed by Dr. John Arold. Hypertransfused mice were prepared in the following manner: 5 to 7 weeks old virgin male mice, weighing 15 to 20 g, were given daily intraperitoneal injections of washed homologous red cells. Red cells were collected from the jugular vein of stock mice in a heparinized glass beaker. Plasma was removed and the cells were washed three times with 0.85% NaCl. One-half ml of washed packed red cells was injected daily for 5 days. On day 6 a hematocrit and a reticulocyte count were prepared from the tail vein of each animal. Reticulocyte counts showed complete absence of young red cells peripherally. Hematocrits ranged from 70 to 80%. On day 7 a standard inoculum of approximately 30,000 parasitized red cells was injected intraperitoneally. This is approximately 300 times the minimum number of parasitized red cells required to produce an infection (Fabiani et al., 1951). A second group of hypertransfused mice were continually given IP red cell injections during the 10-day period following the inoculation of parasites. The red cells used in this experiment were taken from stock polycythemic animals which showed less than one reticulocyte per 1,000 red cells. The third and fourth groups of polycythemic animals were given 500 R or 750 R whole body X-irradiation 1 day following the final intraperitoneal transfusion. Three days later the animals were given the standard inoculum of approximately 30,000 parasitized red cells. Daily smears were prepared to follow the per cent parasitemia for 10 days and at 12, 15, and 24 days. Two groups of polycythemic animals receiving 750 R were given 106 and 10s parasitized red cells, respectively. Two animals from each group were killed and the blood from each animal was subinoculated into three normal mice on days 6 and 12. Thin smears from the subinoculated animals were prepared on day 6 for per cent parasitemia. Anemic mice were prepared by being bled once daily for 3 days from the medial aspect of the eye with a fine glass pipette. Hematocrit and reticulocyte counts were prepared on day 4 and the standard inoculum of parasitized red cells was given on day 5. Blood smears stained with Wright's stain were prepared daily from the tail veins of each mouse

Maternal and Neonatal Jaundice and Hepatitis Associated With Intrauterine Fetal Transfusion

ONE OF THE most exciting innovations in clinical medicine in recent years has been the treatment, by direct transfusion, of an intrauterine fetus whose red blood cells (RBC) are affected by maternal antibodies. Several investigators throughout the world1-3have attested to the prognostic value of spectrophotometric studies of amniotic fluid, which allow for more accurate evaluation of the degree of fetal involvement. Liley further confirmed the clinical value of the analytic procedure and described a technique of fetal transfusion.4 Jaundice is an infrequent complication of pregnancy. Although jaundice is common in the newborn, neonatal hepatitis is rare. This report relates the clinical histories of jaundice and hepatitis which occurred concomitantly in mother and fetus in association with intrauterine intraperitoneal fetal transfusion. Although unproved by viral identification or hepatic biopsy, it is suggested that the etiologic agent was a virus which was iatrically introduced into the fetal circulation with

Amniotic fluid evaluation and intrauterine transfusions for erythroblastosis fetalis

Amniotic fluid samples were evaluated by the method of Bevis, as modified by Liley, 166 times on 105 women suspected of bearing infants afflicted with erythroblastosis. The accuracy of prediction is 83 per cent. Eight patients were selected for intrauterine intraperitoneal transfusion because a prediction of imminent fetal death was made prior to the thirty-third week of pregnancy. Five of these infants proved to have hydrops fetalis and were stillborn. The remaining 3 cases were successful, as judged not only by survival, but by the high levels of adult hemoglobin present in the infant's circulation at birth.