Intravascular exchange and bolus transfusion in the severely isoimmunized fetus

Ronkin, Sheila; Chayen, Benjamin; Wapner, Ronald J.; Blocklinger, A; Davis, George D.; Roberts, Nancy S.; Hux, Charles H.

doi:10.1016/0002-9378(89)90459-6

Cited by 16 publications

(4 citation statements)

References 9 publications

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“…More recently, the Queen Charlotte's group in London, UK [17] , have described the use of fetal blood sampling via percutaneous puncture of the intrahepatic portion of the umbilical vein to reduce the risk of maternal alloimmunization. Although there has been debate regarding the technique of transfusion in terms of exchange [22] versus direct transfusion [23,24] , most data indicate that intravascular transfusion is superior to intraperitoneal All comparisons of complication rates were analyzed using Fischer's exact test. No signifi cant differences in complication rates were present between transfusions performed intravascularly via the intrahepatic vein and cord route puncture.…”

Section: Discussionmentioning

confidence: 99%

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

Somerset

Moore²,

Whittle³

et al. 2006

Fetal Diagn Ther

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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.

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Section: Discussionmentioning

confidence: 99%

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

Somerset

Moore²,

Whittle³

et al. 2006

Fetal Diagn Ther

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“…Transfusion of blood straight to the fetus without removing blood (top-up process) from it has been a larger concern because it can lead to volume overload and cardiac problems. Blood is collected from the fetus at regular intervals to prevent hypervolemia 25 (exchange transfusion). Monitoring of umbilical venous pressure is required continuously because if the pressure level rises by 10 mmHg, then blood must be removed and exchanged with the same volume of saline.…”

Section: Exchange and Top-up Transfusionmentioning

confidence: 99%

Management of Fetal Anemia and Thrombocytopenia With Intrauterine Blood Transfusion

Pal¹,

Shree²,

Jana³

et al. 2022

IJAR

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Fetal anemia and fetal thrombocytopenia are two of the most unsmiling complications in pregnant women, and they can lead to perinatal mortality and morbidity. After long years of study with intravascular intrauterine blood transfusion, a number of varieties of implications have been described. Intrauterine Blood Transfusion (IUBT) is considered the best method in the case of fetal anemia because it is caused by red cell alloimmunization. Not only for red blood cell transfusion, this method can also be used for the transfusion of platelets to thrombocytopenic fetuses in pregnant women. It is generally detected after a child is born who is symptomatic and shows signs of bleeding in the brain and skin. The biggest milestone for the clinician is to give preventive treatment in next pregnancy. Pregnancies at risk require serial monitoring, and Fetal Middle Cerebral arterial (MCA) Doppler is the non-invasive test that is now proving to be the choice for monitoring. IVIG (Intravenous immunoglobulin) is used to manage severe Rh-immunization and is now showing promising effects. Indications like Parvovirus B19, Fetomaternal hemorrhage (FMH), Fetal SacrococcygealTeratoma (SCT), Twin-twin transfusion syndrome, placental chorioangioma diseases, or other infections can be treated with this method. This review covers fetal transfusion techniques and explores current management of fetal anemia and thrombocytopenia.

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“…Concern has been raised that directly transfusing blood into the foetus without removing any blood (the top‐up procedure) may lead to volume overload and cardiac compromise. Some operators aspirate small amounts of blood from the foetus at regular intervals during the transfusion with the intention of preventing hypervolemia (the exchange procedure) [36,37]. Others suggest that the umbilical venous pressure should be routinely monitored and if the change in pressure exceeds 10 mmHg then blood should be removed and replaced with an equal volume of saline [38].…”

Section: Top‐up Versus Exchange Transfusionmentioning

confidence: 99%