Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn – review on current management and outcome

Abstract

Introduction: Hemolytic disease of the fetus and newborn (HDFN) remains a serious pregnancy complication which can lead to severe fetal anemia, hydrops and perinatal death. Areas covered: This review focusses on the current prenatal management, treatment with intrauterine transfusion (IUT) and promising non-invasive treatment options for HDFN. Expert commentary: IUTs are the cornerstone in prenatal management of HDFN and have significantly improved perinatal outcome in the past decades. IUT is now a relatively safe procedure, however the risk of complications is still high when performed early in the second trimester. Non-invasive management using intravenous immunoglobulin may be a safe alternative and requires further investigation. ARTICLE HISTORY

Nieimmunologiczny obrzęk płodu w wyniku talasemii alfa. Opis przypadku zdiagnozowanego i leczonego prenatalnie w Polsce

“…Hemoglobina jest białkiem, którego funkcją jest transport tlenu z płuc do [11]. Leczenie prenatalne anemii w przebiegu talasemii polega na wykonywaniu seryjnych transfuzji dopłodowych masy erytrocytarnej [12]. Po porodzie dziecko wymaga regularnych przetoczeń krwi, terapii chelatującej i innych działań leczniczych [13].…”

Knowledge, attitude and practices of obstetric care providers towards maternal red‐blood‐cell immunization during pregnancy

“…If laboratory findings indicate that a pregnancy is at risk for development of HDFN, frequent monitoring is started with ultrasound and Doppler middle cerebral artery (MCA) peak systolic velocity (PSV) measurements, to reliably predict fetal anaemia . If severe fetal anaemia develops, treatment with intrauterine transfusions (IUT) is started and/or preterm delivery is induced, usually followed by neonatal phototherapy and/or (exchange) transfusions .…”

An unusual case of rapidly progressive hemolytic anemia in the late preterm period: case report and literature review

“…However, if the hepatic, splenic, bone marrow and extramedullary (skin, placenta) erythropoiesis do not compensate for the hemolysis, hydropsfetalis(advanced expression of cardiac failure) develops and intrauterine death can occur. 3 Strict monitoring is mandatory, since, even intrauterine transfusion (IUT) can suppress erythropoiesis and cause late onset severe anemia. 4 Furthermore, the survivors can develop medium and long term complications including heart function and morphology alterations 5 or cerebellar lesions, especially in fetuses between 24-32 weeks.…”