Fetal Intravascular Transfusion Research Articles

Feasibility and safety of fetal intravascular transfusion via the intrahepatic vein in the treatment of fetal anemia

Objective: To investigate the feasibility and safety of fetal intravascular transfusion via the intrahepatic vein in the treatment of fetal anemia. Methods: This was a retrospective analysis of all fetuses requiring intrauterine transfusion (IUT) in the Shanghai First Maternity and Infant Hospital between January 2010 and December 2019. According to the different ways of IUT, they were divided into intrahepatic venous transfusion group and umbilical venous transfusion group, fetal outcomes and the incidence of procedure-related complications between the two groups were compared. Results: A total of 97 IUTs were performed on 48 fetuses. Among them, 16 cases were performed in the intrahepatic vein (31 transfusions), 32 cases were performed in the cord of the umbilical vein (66 transfusions).There were no significant differences between the two groups in age, labor history and the proportion of fetal hydrops before the first transfusion. In the intrahepatic venous transfusion group, the posterior placenta was 14/16, which was significantly higher than 78% (25/32) in the umbilical venous transfusion group (P<0.01). The live-birth rates of the two groups were 13/16 and 75% (24/32). There was no significant difference between the two groups (P>0.05). Before intrahepatic venous transfusion, the proportion of fetal hydrops was significantly higher than that of umbilical venous transfusion [55% (17/31) vs 24% (16/66), P<0.05]. Puncture success rate of intrahepatic venous transfusion and umbilical venous transfusion were both 100%. In the umbilical venous transfasion group, the incidence of needle slippage (5%, 3/66) and the abnormality of fetal heart rate (11%, 7/66) were higher than those in the intrahepatic venous transfasion group [0 and 3% (1/31)], but there were no significant differences between the two groups (all P>0.05). There were no cases of fetal loss within 24 hours, premature rupture of membranes, infection within 7 days and emergency cesarean section after IUT in both groups. Conclusions: Fetal intravascular transfusion via the intrahepatic vein is safe and feasible in the treatment of fetal anemia. But the requirements of puncture technique are relatively high, so it is recommended to be carried out in experienced fetal treatment center.

Fetal Blood Transfusion: The Saviour

The purpose of this oration is to discuss the modality of highly specialized Intra vascular fetal blood transfusion and its various sites to perform fetal blood transfusion with the role of middle cerebral artery-peak systolic velocity (MCA-PSV), as measured by Doppler ultrasound, in managing fetal anemia in Rh-alloimmunized pregnancies. Intra-uterine fetal blood transfusion was performed in such anemic fetuses to tide over the crisis of fetal immaturity till considered fit for extra-uterine survival. Rh-alloimmunized pregnancies with or without hydrops reporting to our tertiary care institute from January, 2005 to December, 2015 were screened by Doppler ultrasound to estimate MCA-PSV to detect fetal anemia. During follow-up, if the fetus developed MCA-PSV values more than 1.5 MoM for the gestational age, fetal blood sampling through cordocentesis was performed to confirm fetal anemia. This was followed by intra-uterine fetal blood transfusion to all the anemic fetuses at the same sitting. The neonatal outcome was evaluated by recording gestational age at the time of delivery, duration of gestational time gained, and need for blood transfusion in the neonatal period. A total of 226 Rh-alloimmunized pregnancies were evaluated. Three hundred ninety six intra-uterine fetal blood transfusions were performed. In their neonatal period, 137 neonates received blood transfusion. Intra-uterine fetal death occurred in 11 fetuses out of which 7 were grossly hydropic fetus. Favorable neonatal outcome was recorded in the rest including 42 hydropic fetuses. The clinical outcome of these pregnancies justifies the use of Doppler studies of MCA-PSV in detecting fetal anemia as these were found to correlate well. Intra-uterine fetal blood transfusion in the anemic fetuses is the only hope of prolonging pregnancy salvaging such fetuses.

Current clinical management of anti-Kell alloimmunization in pregnancy

Objectives Few reports have been published of the current clinical management of anti-Kell alloimmunization in pregnancy; its low frequency of occurrence means that the few long series published have covered very ample time periods in which different kinds of clinical management have overlapped. The objective of the present paper is to present our experience in the current clinical management of pregnant women who are positive for the anti-Kell antibody. Study design A retrospective analysis was carried out of the case histories of pregnant women who were alloimmunized for the Kell antigen and who were studied and/or treated at the Department of Fetal Medicine in the Virgen de las Nieves University Hospital in Granada (Spain), between 2000 and 2004. The clinical management included the basal measurement of the titre of antibodies, the identification of the paternal phenotype (and that of the fetus, if necessary), the ultrasonographic monitoring of the fetus to detect signs of anaemia, sampling of fetal blood by cordocentesis when fetal anaemia was suspected, and fetal intravascular transfusion when necessary. Results Of the 10 pregnancies with anti-Kell antibodies, The Kell antigen was confirmed in the fetus in three cases, in all of which moderate to severe fetal anaemia developed, requiring fetal intravascular transfusions. Although one of the fetus developed antenatal hydrops, a good perinatal result was advised. Conclusions The current approach to anti-Kell alloimmunization enables pregnant women who have Kell-positive fetuses to be treated successfully.

Successful treatment of fetal erythroblastosis due to anti‐M alloimmunization with fetal intravascular transfusion

Prenatal DiagnosisVolume 27, Issue 4 p. 385-387 Letter to the Editor Successful treatment of fetal erythroblastosis due to anti-M alloimmunization with fetal intravascular transfusion Mee Won Seo, Corresponding Author Mee Won Seo Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaDepartment of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaSearch for more papers by this authorHye-Sung Won, Hye-Sung Won Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaSearch for more papers by this authorSun-Kwon Kim, Sun-Kwon Kim Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaSearch for more papers by this authorJae-Yoon Shim, Jae-Yoon Shim Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaSearch for more papers by this authorSeog-Woon Kwon, Seog-Woon Kwon Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaSearch for more papers by this authorPil Ryang Lee, Pil Ryang Lee Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaSearch for more papers by this authorAhm Kim, Ahm Kim Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaSearch for more papers by this author Mee Won Seo, Corresponding Author Mee Won Seo Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaDepartment of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaSearch for more papers by this authorHye-Sung Won, Hye-Sung Won Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaSearch for more papers by this authorSun-Kwon Kim, Sun-Kwon Kim Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaSearch for more papers by this authorJae-Yoon Shim, Jae-Yoon Shim Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaSearch for more papers by this authorSeog-Woon Kwon, Seog-Woon Kwon Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaSearch for more papers by this authorPil Ryang Lee, Pil Ryang Lee Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaSearch for more papers by this authorAhm Kim, Ahm Kim Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, KoreaSearch for more papers by this author First published: 29 March 2007 https://doi.org/10.1002/pd.1679Citations: 2AboutPDF 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 onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume27, Issue4April 2007Pages 385-387 RelatedInformation

Discordant Fetal Infection for Parvovirus B19 in a Dichorionic Twin Pregnancy

There are only a few reports of fetal parvovirus infection in the circumstance of a twin pregnancy. We report a case of differential fetal infection following maternal parvovirus B19 infection in a dichorionic twin pregnancy culminating in a dual live-birth. A 32-year-old woman was diagnosed with parvovirus infection following exposure to her infected child at 19 weeks' gestation in a dichorionic twin gestation. Maternal IgG seroconversion was documented and maternal blood parvovirus B19 DNA was detected by PCR testing. Fetal monitoring with serial ultrasound assessment was instituted. At 25 weeks' gestation Twin I (male) displayed minor ascites, small pericardial effusion, placentomegaly and oligohydramnios. Middle cerebral artery peak systolic velocity (MCA PSV) studies were abnormal. Twin II (female) was sonographically unremarkable. A single fetal intravascular transfusion for Twin I was performed (pretransfusion Hb 80 g/L). Twin I fetal blood parvovirus B19 DNA was detected by polymerase chain reaction (PCR) and serum demonstrated both B19 IgG and IgM. Following fetal transfusion the hydrops resolved, although the placentomegaly persisted. Two live infants were delivered at 37 weeks' gestation. Individual neonatal venepuncture detected B19 DNA by PCR in Twin I but not in Twin II. B19 IgM was present in Twin I but not Twin II. Both neonates had B19 IgG antibodies. Placental histopathology demonstrated mild edema for Twin I but no inclusion cells. The placenta of Twin II was unremarkable. This case demonstrates the ability for differential transplacental infection of this virus and the assistance of fetal MCA flow studies to guide therapy in a multiple pregnancy at risk of parvovirus infection.

Discordant Fetal Infection for Parvovirus B19 in a Dichorionic Twin Pregnancy

AbstractThere are only a few reports of fetal parvovirus infection in the circumstance of a twin pregnancy. We report a case of differential fetal infection following maternal parvovirus B19 infection in a dichorionic twin pregnancy culminating in a dual live-birth. A 32-year-old woman was diagnosed with parvovirus infection following exposure to her infected child at 19 weeks' gestation in a dichorionic twin gestation. Maternal IgG seroconversion was documented and maternal blood parvovirus B19 DNA was detected by PCR testing. Fetal monitoring with serial ultrasound assessment was instituted. At 25 weeks' gestation Twin I (male) displayed minor ascites, small pericardial effusion, placentomegaly and oligohydramnios. Middle cerebral artery peak systolic velocity (MCA PSV) studies were abnormal. Twin II (female) was sonographically unremarkable. A single fetal intravascular transfusion for Twin I was performed (pretransfusion Hb 80 g/L). Twin I fetal blood parvovirus B19 DNA was detected by polymerase chain reaction (PCR) and serum demonstrated both B19 IgG and IgM. Following fetal transfusion the hydrops resolved, although the placentomegaly persisted. Two live infants were delivered at 37 weeks' gestation. Individual neonatal venepuncture detected B19 DNA by PCR in Twin I but not in Twin II. B19 IgM was present in Twin I but not Twin II. Both neonates had B19 IgG antibodies. Placental histopathology demonstrated mild edema for Twin I but no inclusion cells. The placenta of Twin II was unremarkable. This case demonstrates the ability for differential transplacental infection of this virus and the assistance of fetal MCA flow studies to guide therapy in a multiple pregnancy at risk of parvovirus infection.

An Audit of Outcome in Intravascular Transfusions Using the Intrahepatic Portion of the Fetal Umbilical Vein Compared to Cordocentesis

Introduction: Maternal red cell alloimmunization is a potential cause of perinatal morbidity and mortality. The outcome of severe disease has been transformed by the use of in-utero and particularly, fetal intravascular transfusion. In the majority of instances this is performed by cordocentesis. However, this cohort study represents the experience in a large tertiary referral centre in performing fetal intravascular transfusions via the intrahepatic vein (IHV). Methods: Over an 8-year period, 1997–2004, 221 in-utero transfusions (IUT) were performed for rhesus disease in 66 pregnancies. 86% had severe fetal anaemia caused by anti-D, 10.6% by anti-Kell and 3.4% by anti-c. The median maternal age of the cohort was 31 years (range 19–43). The median gestation at initial IUT was 25 weeks (interquartile range (IQR) 23–29 weeks). Results: A median number of three IUT were performed in each fetus (IQR 2–5) with a median haemoglobin at first fetal blood sampling of 7.3 g% (IQR 4.6–8.8 g%) (73% ≤5 SD and 27% ≤2 SD). Of the total intravascular transfusions, 170 were performed via the IHV (71.7%), 33 via cordocentesis (13.9%) and 1 by intracardiac puncture (0.5%). There were ‘transient’ bradycardias complicating 4.1% of all transfusions and amniorrhexis following 1.4%. 92% of babies were live born at a median gestation of 34 weeks (range 21–38) with a birth weight centile of 50 (range 3–90). There was no significant difference in intravascular transfusion complication rate when the procedure was performed via the IHV (7.6%) as compared to cord root puncture (3.0%) (Fisher’s exact test, p < 0.47). Conclusion: IUT performed by fetal IHV puncture is safe and carries no excess morbidity when performed for severe rhesus disease.

P06.03: Discordant fetal infection for parvovirus in a dichorionic twin pregnancy

There are only a very few reports of fetal parvovirus infection in the circumstance of a twin pregnancy. We report a case of differential fetal infection following maternal parvovirus infection in a dichorionic twin pregnancy. A 32-year-old woman was diagnosed with parvovirus infection following exposure to her infected child at 19 weeks’ gestation in a dichorionic diamniotic twin gestation. Maternal seroconversion was documented and parvovirus B19 DNA was present on PCR testing. Fetal monitoring with serial ultrasound assessment was instituted and at 25 weeks gestation Twin I (male) displayed mild ascites, pericardial effusion, placentomegaly and oligohydramnios. The MCA PSV was elevated. Twin II (female) was sonographically unremarkable and the MCA PSV was not elevated. A single fetal intravascular transfusion for Twin I was performed (pretransfusion Hb 80 g/L). Twin I fetal blood was positive for parvovirus B19 DNA and serum demonstrated both IgG and IgM. Following the fetal transfusion the sonographic hydrops resolved, although the placentomegaly persisted. Delivery at 37 weeks’ gestation resulted in live male and female fetuses. Both were vigorous at delivery. Individual neonatal venepuncture showed B19 DNA on PCR to be present in Twin I but absent in Twin II. IgM was present for B19 in Twin I but not Twin II. Both neonates had B19 IgG antibodies, passively acquired from the mother. Histopathology of the placentae demonstrated mild edema in that of Twin I but no inclusion cells. The placenta of Twin II was unremarkable. In conclusion, we present a case of discordant fetal infection in a dizygotic dichorionic twin pregnancy for parvovirus, with a dual live birth at term and no adverse perinatal sequelae. This case demonstrates the ability for differential transplacental infection of this virus and the assistance of MCA flow studies to guide therapy in a multiple pregnancy at risk of parvovirus infection.

Fetal Intravascular Transfusion for Hydropic Disease due to Rhesus Isoimmunization

Objective: To evaluate the management of hydropic fetuses, due to rhesus isoimmunization, with fetal intrauterine intravascular transfusions. Material and Methods: This is a retrospective analysis of 18 rhesus-negative pregnant women presenting at our hospital with fetal hydrops during a 7-year period. All cases were managed with serial intrauterine intravascular transfusions with the goal of delivery by cesarean section beyond 33 weeks of gestation. All patients received prophylactic ampicillin and ritodrine for 4 days after the procedure. Results: There were 11 mildly and 7 severely hydropic fetuses. All fetuses with mild hydrops and 5 of the 7 with severe hydrops were delivered alive after 32 weeks of gestation in a good condition. Two fetuses both with severe hydrops died in utero, at 28 weeks of gestation. Intrauterine reversal of hydrops occurred in 90.9% of fetuses with mild hydrops and in 57.1% of severely hydropic fetuses. Conclusions: The survival rate for the hydropic fetuses in our study was 88.9% and it was associated with the severity of fetal hydrops.

Transfusión intravascular fetal en el tratamiento de la isoinmunización

Objective To assess perinatal outcome after fetal intravascular transfusion in the treatment of alloimmunization between 1990 and 2003. Subjects and methods Fetal blood sampling was offered to immunized pregnant women when significant fetal anemia was suspected. Intravascular fetal transfusion was performed when the fetal hematocrit was below –2 standard deviations for gestational age. Serial transfusions were scheduled every 3 weeks until approximately 34-35 weeks. Results Cordocentesis was performed in 32 singleton pregnancies. In 11 (34%) of these, no fetal anemia as defined by the established criteria was detected. Fifty intravascular fetal transfusions were performed in 19 pregnancies, from the 21st to the 35th week. No spontaneous fetal losses were observed. At 0-13 years of age, all the children showed normal development for their age. Conclusion Fetal intravascular transfusion is an effective procedure in the prenatal treatment of fetal anemia with favorable long-term outcome.

Unusual antibody titer in a severe case of rhesus incompatibility

Unusual antibody titer in a severe case of rhesus incompatibility

Historical Perspectives: The Underpinnings of Neonatal/Perinatal Medicine

The accompanying article by Dr. John Bowman was contributed in response to a request to place his important paper (1) into context. Dr. Bowman is the former Medical Director of the Winnipeg Rh Laboratory and a Distinguished Professor Emeritus at the University of Manitoba. Although not the first to describe the use of Rh immune globulin, the clinicians in Winnipeg were leaders in the use of antenatal prophylaxis. At present, Rh isoimmunization is extremely rare, in large measure because of the pioneers described by Dr. Bowman. Antenatal administration of anti-D immune globulin now is “standard operating procedure,” but this was not always the case. It is important to understand how the problem of Rh isoimmunization has been virtually eliminated from neonatal practice. 1. ↵ Bowman JM, Chown B, Lewis M, Pollock JM. Rh isoimmunization during pregnancy: antenatal prophylaxis. Can Med Assoc J. 1978;118:623–627 [OpenUrl][1][Abstract][2] # Historical Perspectives: The Underpinnings of Neonatal/Perinatal Medicine {#article-title-2} Rh hemolytic disease was reported initially by a French midwife in 1609. She described the birth of twins: the first, who was pale and bloated with fluid (hydrops fetalis), died within minutes of birth; the second, in much better condition, became deeply jaundiced in the first 3 days after birth, developed rigidity, lay in a position of opisthotonus (kernicterus), and died on the fourth day after birth. Hydrops fetalis and kernicterus were not linked again until 323 years later. In 1932, Diamond and associates determined that they were simply different aspects of a spectrum representing the same disorder. The more severe, hydrops, was characterized by hemolysis of fetal red blood cells that produced severe anemia, followed by hepatosplenomegaly, extramedullary erythropoiesis, and the outpouring of immature nucleated fetal red cells, from which Diamond coined the diagnostic term “erythroblastosis fetalis.” Uncovering the cause of the fetal red blood cell hemolysis had to await the discovery of the Rh blood group system by Landsteiner and Wiener in 1940 and the subsequent determination in 1941 by Levine that the cause of hemolytic … [1]: {openurl}?query=rft.jtitle%253DCanadian%2BMedical%2BAssociation%2BJournal%26rft.stitle%253DCMAJ%26rft.issn%253D0008-4409%26rft.aulast%253DBowman%26rft.auinit1%253DJ.%2BM.%26rft.volume%253D118%26rft.issue%253D6%26rft.spage%253D623%26rft.epage%253D627%26rft.atitle%253DRh%2Bisoimmunization%2Bduring%2Bpregnancy%253A%2Bantenatal%2Bprophylaxis%26rft_id%253Dinfo%253Apmid%252F77714%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=cmaj&resid=118/6/623&atom=%2Fneoreviews%2F3%2F11%2Fe223.atom

655 Middle cerebral artery flow velocity alterations before and immediately after fetal intravascular transfusion

655 Middle cerebral artery flow velocity alterations before and immediately after fetal intravascular transfusion

Nonimmune hydrops from fetomaternal hemorrhage treated with serial fetal intravascular transfusion

Nonimmune hydrops from fetomaternal hemorrhage treated with serial fetal intravascular transfusion

The Effect of Fetal Hydrops on the Rate of Fall of Hemoglobin after Fetal Intravascular Transfusion for Red Cell Alloimmunization

Objective: We aimed to assess whether there is a difference between hydropic and nonhydropic fetuses in the rate of fall of hemoglobin (Hb) following intravascular transfusions. Methods: Eighty-three intravascular transfusions in 34 fetuses were analyzed. The pretransfusion and posttransfusion Hb values, the gestational age, the volume of blood transfused, the number of days between transfusions and the rate of fall of Hb per day following a transfusion were assessed. Hb levels were expressed as multiples of standard deviation from the normal mean for gestational age. Results: Eleven fetuses were hydropic at presentation and 23 were not. Twenty-three transfusions were undertaken in the 11 fetuses while they were hydropic and 60 transfusions were performed in nonhydropic fetuses. Comparisons of transfusion variables between the two groups were performed both for the first transfusion only and also for the total number of transfusions. The rate of Hb fall per day following a transfusion was similar in the two groups on both comparisons. The posttransfusion Hb level tended to be lower and the intervals between transfusions were a little shorter in the hydropic group, but these differences were not statistically significant. Conclusion: The posttransfusion Hb tended to be lower in the hydropic fetuses, but the fall in Hb was not faster in these cases. Therefore, with a similar rate of daily Hb decline in both groups, the hydropic fetuses are expected to become anemic again sooner than the nonhydropic fetuses only because of the lower posttransfusion Hb. The timing of the next transfusion should therefore be based on the posttransfusion Hb and the normal predicted drop per day irrespective of the presence or absence of hydrops.

Fetal intravascular transfusion - clinical report

International Journal of Gynecology & ObstetricsVolume 70, Issue S4 p. D119-D119 High-risk pregnancy Fetal intravascular transfusion - clinical report D. Ilimonovic, D. IlimonovicSearch for more papers by this authorZ. Mikovic, Z. MikovicSearch for more papers by this authorA. Cirovic, A. CirovicSearch for more papers by this authorA. Hajric, A. HajricSearch for more papers by this author D. Ilimonovic, D. IlimonovicSearch for more papers by this authorZ. Mikovic, Z. MikovicSearch for more papers by this authorA. Cirovic, A. CirovicSearch for more papers by this authorA. Hajric, A. HajricSearch for more papers by this author First published: 11 December 2003 https://doi.org/10.1016/S0020-7292(00)84565-8AboutPDF 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. Volume70, IssueS42000Pages D119-D119 RelatedInformation

Umbilical artery regression: a rare complication of intravascular fetal transfusion

Background: Intravascular fetal transfusion is an important therapeutic advance but is associated with several complications. Regression of an umbilical artery associated with transfusion is rare. Case: A case of red blood cell alloimmunization managed by serial transfusions was complicated by functional loss of an umbilical artery during pregnancy. Refractory fetal bradycardia occurred during the last transfusion procedure, requiring emergency preterm cesarean delivery. Coagulative necrosis, thrombosis, and focal calcification of one umbilical artery was confirmed after delivery. Conclusion: Umbilical artery regression associated with transfusion therapy is rare and may complicate subsequent fetal transfusions.

The Effect of Fetal Intravascular Blood Transfusion on Plasma Endothelin Levels in Fetuses With Rhesus Alloimmunization

In Brief Objective To determine if intrauterine intravascular fetal transfusion affects fetal umbilical venous endothelin levels. Methods Endothelin concentrations were measured by radioimmunoassay in fetal umbilical venous blood obtained immediately before and after 36 fetal transfusions performed for Rh alloimmune hemolytic anemia. Umbilical venous pressures also were recorded before and after transfusion. Results The mean (± standard deviation [SD]) gestational age at transfusion was 27.0 ± 4.6 weeks, whereas the initial and post-transfusion hematocrits were 23.3 ± 8.5% and 41.8 ± 6.3%, respectively. Post-transfusion endothelin levels correlated significantly with the volume of transfused blood (r = .41; P = .03) and with post-transfusion increases in umbilical vein pressure (r = .86; P < .001). Among fetuses undergoing initial transfusion, there were significant differences between mean (± SD) pre- and post-transfusion endothelin levels [3.6 (± 2.2) pg/mL versus 6.3 (± 4.0) pg/mL, respectively; P = .02]. In contrast, among fetuses undergoing a repeat fetal transfusion, no differences in mean (± SD) pre-versus post-transfusion endothelin levels were observed [3.8 (± 1.8) pg/mL versus 2.2 (± 1.77) pg/mL, respectively; P = .3)]. Step-wise multiple regression analysis identified order of transfusion as a significant predictor of change in endothelin levels from pre- to post-transfusion measurements (adjusted r2 = .26; P = .003). Conclusion Rapid expansion of fetal intravascular volume by intravenous transfusion of packed red blood cells with a high hematocrit enhances fetal endothelin levels in those fetuses undergoing initial but not subsequent transfusions. Endothelin concentrations increase with initial intravascular transfusion for fetal anemia in cases of Rh alloimmunization.

The Effect of Fetal Intravascular Blood Transfusion on Plasma Endothelin Levels in Fetuses With Rhesus Alloimmunization

Objective: To determine if intrauterine intravascular fetal transfusion affects fetal umbilical venous endothelin levels. Methods: Endothelin concentrations were measured by radioimmunoassay in fetal umbilical venous blood obtained immediately before and after 36 fetal transfusions performed for Rh alloimmune hemolytic anemia. Umbilical venous pressures also were recorded before and after transfusion. Results: The mean (± standard deviation [SD]) gestational age at transfusion was 27.0 ± 4.6 weeks, whereas the initial and post-transfusion hematocrits were 23.3 ± 8.5% and 41.8 ± 6.3%, respectively. Post-transfusion endothelin levels correlated significantly with the volume of transfused blood ( r = .41; P = .03) and with post-transfusion increases in umbilical vein pressure ( r = .86; P < .001). Among fetuses undergoing initial transfusion, there were significant differences between mean (± SD) pre- and post-transfusion endothelin levels [3.6 (± 2.2) pg/mL versus 6.3 (± 4.0) pg/mL, respectively; P = .02]. In contrast, among fetuses undergoing a repeat fetal transfusion, no differences in mean (± SD) pre- versus post-transfusion endothelin levels were observed [3.8 (± 1.8) pg/mL versus 2.2 (± 1.77) pg/mL, respectively; P = .3)]. Step-wise multiple regression analysis identified order of transfusion as a significant predictor of change in endothelin levels from pre- to post-transfusion measurements (adjusted r 2 = .26; P = .003). Conclusion: Rapid expansion of fetal intravascular volume by intravenous transfusion of packed red blood cells with a high hematocrit enhances fetal endothelin levels in those fetuses undergoing initial but not subsequent transfusions.

A Simple Method to Estimate Volume for Fetal Intravascular Transfusions

We derived a constant termed the transfusion coefficient to simplify the estimation of the fetal intravascular transfusion volume. The product of the estimated fetal weight (g) and 0.02 (transfusion coefficient), estimates the transfusion volume (ml) required to increase the fetal hematocrit by approximately 10 percentage points. Our estimation was comparable to Mandelbrot’s technique and better than Plecas’ method for estimating fetal transfusion volumes. Utilizing the transfusion coefficient to estimate the intravascular transfusion volume for an anemic fetus is simple, rapid and accurate.