Neonatal management and outcome in alloimmune hemolytic disease

Ree, Isabelle M C; Smits-Wintjens, Vivianne E.H.J.; Bom, Johanna G. van der; Klink, Jeanine M.M. van; Oepkes, Dick; Lopriore, Enrico

doi:10.1080/17474086.2017.1331124

Cited by 88 publications

(126 citation statements)

References 95 publications

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“…We hypothesize that the found reduction in need for exchange transfusions is mainly caused by the gradual replacement of this invasive procedure by high‐quality intensive phototherapy and the corresponding more restrictive exchange transfusion protocol in 2004 …”

Section: Discussionmentioning

confidence: 99%

“…31 We hypothesize that the found reduction in need for exchange transfusions is mainly caused by the gradual replacement of this invasive procedure by high-quality intensive phototherapy and the corresponding more restrictive exchange transfusion protocol in 2004. 32 This study is conducted in a well-organized health care system for alloimmunized pregnant women. The centralization of screening and treatment gives us great insight and overview in the prevalence of alloimmunization and the details of intrauterine therapy.…”

Section: Discussionmentioning

confidence: 99%

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The near disappearance of fetal hydrops in relation to current state‐of‐the‐art management of red cell alloimmunization

et al. 2018

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ObjectiveIn this study, we aim to evaluate trends in the condition of fetuses and neonates with hemolytic disease at the time of first intrauterine transfusion (IUT) and at birth, in relation to routine first‐trimester antibody screening, referral guidelines, and centralization of fetal therapy.MethodWe conducted a 30‐year cohort study including all women and fetuses treated with IUT for red cell alloimmunization at the Dutch national referral center for fetal therapy.ResultsSix hundred forty‐five fetuses received 1852 transfusions between 1 January 1987 and 31 December 2016. After the introduction of routine first‐trimester antibody screening, the hydrops rate declined from 39% to 15% (OR 0.284, 95% CI, 0.19‐0.42, P < 0.001). In the last time cohort, only one fetus presented with severe hydrops (OR 0.482, 95% CI, 0.38‐0.62, P < 0.001). Infants are born less often <32 weeks (OR 0.572, 95% CI, 0.39‐0.83, P = 0.004) and with higher neonatal hemoglobin (P < 0.001). Neonatal hemoglobin was positively independently associated with gestational age at birth, fetal hemoglobin, and additional intraperitoneal transfusion at last IUT.ConclusionSevere alloimmune hydrops, a formerly often lethal condition, has practically disappeared, most likely as a result of the introduction of routine early alloantibody screening, use of national guidelines, and pooling of expertise in national reference laboratories and a referral center for fetal therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The near disappearance of fetal hydrops in relation to current state‐of‐the‐art management of red cell alloimmunization

et al. 2018

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“…Once the decision is made to perform a cytoreductive procedure, clinicians should consider the availability of a trained apheresis team experienced with the procedure in small patients. In centers without trained on‐call apheresis teams comfortable with small patients, leukoreduction via manual WB exchange should proceed in consultation with critical care and transfusion services trained in this procedure for treating hemolytic disease of the newborn …”

Section: Discussionmentioning

confidence: 99%

“…In centers without trained on-call apheresis teams comfortable with small patients, leukoreduction via manual WB exchange should proceed in consultation with critical care and transfusion services trained in this procedure for treating hemolytic disease of the newborn. 20 Patient weight, the presence of coagulopathy including thrombocytopenia, and risk for other metabolic or organ dysfunction are additional factors to consider in deciding to proceed with manual versus automated exchange. The most important consideration is the weight of the infant.…”

Section: Discussionmentioning

confidence: 99%

Hyperleukocytosis in infant acute leukemia: a role for manual exchange transfusion for leukoreduction

et al. 2018

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BACKGROUND Hyperleukocytosis is a serious, life-threatening complication of pediatric acute leukemia that can cause neurologic injury, pulmonary leukostasis, metabolic derangements, and coagulopathy. Acute leukemia has the highest risk of mortality and morbidity at presentation when associated with hyperleukocytosis. Infant leukemia presents unique challenges and treatment considerations due to the disease itself and size and overall health of the patient. While medical management of hyperleukocytosis in older patients with acute leukemia has been described, including cytoreductive procedures with automated leukapheresis (AL) or manual whole blood (WB) exchange transfusion, very little data exist for standardized management of hyperleukocytosis in infant leukemia patients. CASE REPORTS We describe four cases of infant acute leukemia presenting with hyperleukocytosis and leukostasis who each received manual WB exchange transfusions in conjunction with induction chemotherapy and review the existing literature on the use of procedural leukoreduction in infants with hyperleukocytosis. Special attention is given to challenges and technical aspects of leukapheresis in infants: when to perform manual WB exchange versus AL, optimal vascular access, blood product selection, exchange rates, and the monitoring for complications. Using published cases, we outline benefits versus risks of manual WB exchange and AL in infants less than 10 kg. CONCLUSION If providers perform procedural leukoreduction, the literature and our experience demonstrate manual WB exchange transfusion is favored over AL in infants less than 10 kg because of technical and complication risks associated with AL. Additional studies are needed to understand the impact of cytoreduction on long-term outcomes.

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“…A history of miscarriage has been reported in 30% of births, this percentage is almost double that of Assumani et al in a general population of Lushoises births 15.6%. It appears that our population has experienced more miscarriages; it should be noted that a history of abortion is both a possible route of immunization and a manifestation of maternal foeto allo immunization [3,36,38].…”

Section: Obstetrical Historymentioning

confidence: 99%

Blood Group Cartography (ABO, RHESUS, KELL and DUFFY) and Hemogram of Icteric Newborn in Sendwe Hospital, Lubumbashi/D.R.C

Kalenga¹,

Davidson²,

Serge³

et al. 2020

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Background: Allo immunization jaundice is a common cause of neonatal jaundice. According to racial group the concerned blood group may not be the same. In our Country people are exposed to high transfusionnal risk because of malaria and sicklanemia and the blood group research in laboratory include only ABO/D. Objective: Our objective was to establish a blood group cartography of this icteric newborn population and their mother; the frequency of rare blood group and the compatibility level between mother and newborn. Our interest was also to study hemogram of this population. Methodology: We studied blood group ABO/D; RH/Kell and Duffy of 56 newborn whom developped an indirect bilirubin and their mothers. We performed bilrubin level and hemogram. Results: The frequency of icteric newborn was 17.17%. The mother blood mapping was O (60.71%), RhD positive (83.9%), C negative (91.07%) E negative (89.29%) c positive (91.07%), epositive (92.86%), kell negative (100%) and duffy null (100%). The most common phenotype was ccDee (67.9%) Neonatal was ex aequo O and B (37.50% respectivly), RH D positive (87.50%), RhC negative (87.50%), Rh E negative (89.29%), Rhc positive (96.43%), Rh e positive (96.43%), Kell negative (98.21%) and duffy null (100%), 75% of newborn had the phenotype ccDee. We noticed 9% of extremely rare blood group in maternal population. Mean level of bilirubin was 11.48 mg% at H48. Analyse of hemogram reveal a normocytic and normochromic anemia. Conclusions: Mapping blood group of this population reveal the importance of extended blood grouping in icteric newborn and their mother. Our population presents a blood group that is widely open to allo immunization in all studied blood group.

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Neonatal management and outcome in alloimmune hemolytic disease

Cited by 88 publications

References 95 publications

The near disappearance of fetal hydrops in relation to current state‐of‐the‐art management of red cell alloimmunization

The near disappearance of fetal hydrops in relation to current state‐of‐the‐art management of red cell alloimmunization

Hyperleukocytosis in infant acute leukemia: a role for manual exchange transfusion for leukoreduction

Blood Group Cartography (ABO, RHESUS, KELL and DUFFY) and Hemogram of Icteric Newborn in Sendwe Hospital, Lubumbashi/D.R.C

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