Fetal Intracardiac Transfusions in Hydropic Fetuses with Severe Anemia

Abstract

Introduction: Fetal anemia can have significant perinatal morbidity and mortality, particularly with onset prior to 20 weeks of gestation. Materials and Methods: We detail a case-cohort study (n = 8) of all women who underwent fetal in-utero, intracardiac transfusion prior to 24 weeks of gestation (7 women before 20 + 1 weeks), between March 2004 and September 2014, in a supraregional Fetal Medicine Center in the United Kingdom, comprising 2.2% of all transfusions performed during this period. All the fetuses were hydropic, with high maternal BMI, and had severe anemia as an indicator for transfusion. It was an attempt to perform intravascular transfusion when other common routes of fetal vascular access had failed. Results: There were 2 intrauterine deaths (25%), both of which were associated with in-utero transfusion and fulminant parvovirus B19 infection. The perinatal survival rate was 75% (6/8). Discussion: Fetal in-utero, intravascular transfusion by the intracardiac route may be used to correct severe early-onset anemia. It is particularly useful when technical issues of fetal size, early gestation (<20 weeks), maternal adiposity, and hydrops fetalis make umbilical cord or intrahepatic vein puncture technically difficult. Survival rates appear comparable to other series of pregnancies where in-utero transfusion is performed at early gestation.

Human Parvoviruses

“…Anemia due to infection with B19V in utero may be fatal or resolve as the infant produces appropriate anti-B19V antibodies (582)(583)(584). Immunoglobulin infusions for persistent infection diminished viremia and led to apparent remission (585,586) but in other instances have not been effective (529,587,588). Other infants resolved anemia and infection with blood transfusion support alone (584).…”

Early Intrauterine Transfusion in Fetuses with Severe Anemia Caused by Parvovirus B19 Infection

“…An intracardiac approach between 17 +1 and 23 +1 weeks of gestation in fetal hydrops due to red blood cell alloimmunization (n = 3) and parvovirus B19 infection (n = 5) was reported by Mackie et al [19]. Due to increased maternal body mass index the intravenous route of transfusion had failed.…”

“…An intravascular approach was possible in the majority (85.0%) of all IUTs in spite of early GA. An intraperitoneal access was chosen in selected cases as described before [18]. Intracardiac PRBC transfusion or drug injection were only performed as a trial of rescue due to complications [19].…”

Outcome of fetuses with congenital parvovirus B19 infection: systematic review and meta‐analysis

“…Of the 896 articles identified through the search, 87 were assessed for their eligibility (Table S2) and 35 studies were eventually included in the systematic review (Figure and Table ). These 35 studies included 611 fetuses affected by PB19 infection based on serological or virological confirmation or presence of signs of fetal anemia, such as hydrops, on ultrasound in fetuses with infected mothers. The definition of fetal hydrops in each included study is reported in Table S3.…”