Perinatal outcomes of intrauterine transfusion for foetal anaemia due to red blood cell alloimmunisation

Savkli, Ayse Ozge; Çetin, Berna Aslan; Acar, Züat; Özköse, Zeynep Gedik; Behram, Mustafa; Çaypınar, Sema Süzen; Tayyar, Ahmet; Yüksel, Mehmet Aytaç

doi:10.1080/01443615.2019.1647521

Cited by 11 publications

(15 citation statements)

References 18 publications

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“…Finally, in the study by Şavkli et al, 20 whose population was more similar to ours, with a prevalence of hydrops of 33% and median gestational age at the first transfusion of 27 weeks, the survival rate was 81%. It is not easy to find the reason for the discrepancy in the baseline characteristics.…”

Section: Discussionsupporting

confidence: 72%

“…Thus, in our study, 32% of the fetuses were hydropic at the first transfusion, the median gestational age at the first transfusion was 26 weeks, and the overall survival rate was 85%, while other studies, with a survival rate of 92% to 100%, had reported fetal hydrops in 12%-to 14% of the cases, and the gestational age at first transfusion was between 27 and 31 weeks. 7,[17][18][19] Finally, in the study by Şavkli et al, 20 whose population was more similar to ours, with a prevalence of hydrops of 33% and median gestational age at the first transfusion of 27 weeks, the survival rate was 81%. It is not easy to find the reason for the discrepancy in the baseline characteristics.…”

Section: Comparison To the Literaturesupporting

confidence: 56%

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Perinatal outcomes and central nervous system abnormalities following intrauterine fetal transfusion: 17 years' experience in a tertiary center

et al. 2020

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Background: This study aimed to describe the perinatal outcome and central nervous system (CNS) anomalies in fetuses undergoing red blood cell (RBC) intrauterine transfusion (IUT). Methods and Materials: This was an observational single-cohort study carried out at Vall d'Hebron University Hospital in Barcelona, Spain, between 2002 and 2018 in women undergoing RBC IUT for suspected fetal anemia. Primary outcomes were adverse perinatal outcome (intrauterine or neonatal death and termination of pregnancy [TOP]), prenatal or postnatal CNS anomalies, and significant neurological impairment. Results: A total of 145 RBC transfusions were performed in 68 pregnancies of 60 women. The median gestational age for the first transfusion was 26 weeks (range, 18-32). Twenty-two (32%) fetuses were hydropic at the first transfusion. Fifty-eight pregnancies (85.3%) resulted in live births and 10 (14.7%) in adverse perinatal outcomes. Adverse perinatal outcomes were associated with hydrops (odds ratio [OR], 6.69; 95% confidence interval [CI], 1.53-29.23; P = .012) and gestational age at first transfusion (OR, 0.69; 95% CI, 0.54-0.89; P = .04). Four (5.9%) cases of cerebellar hemorrhage were diagnosed prenatally. In 14 (35%) of the 41 neonates undergoing brain ultrasound and/or magnetic resonance imaging (MRI) abnormalities were reported. The median follow-up was 6.5 years (range, 3 months to 19 years). Significant neurological impairment was reported in two cases (4.2%). Conclusion: In fetuses undergoing intrauterine RBC transfusion, the survival rate is high, particularly in the absence of hydrops and if the gestational age at first transfusion is above 22 weeks. Significant neurological impairment is uncommon, despite the fact that postnatal CNS anomalies at ultrasound or MRI are frequent.

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Section: Discussionsupporting

confidence: 72%

Section: Comparison To the Literaturesupporting

confidence: 56%

Perinatal outcomes and central nervous system abnormalities following intrauterine fetal transfusion: 17 years' experience in a tertiary center

et al. 2020

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“…The most commonly reported maternal/fetal clinical outcome across studies was hydrops fetalis ( n = 19 with representative data [ 23 , 28 , 31 , 32 , 41 , 42 , 47 , 49 , 51 , 53 , 59 , 64 , 66 , 67 , 69 , 75 , 76 , 79 , 80 ] (Table S 8 ); n = 10 with nonrepresentative data [ 24 , 39 , 40 , 44 , 46 , 52 , 55 , 68 , 70 , 74 ]). The rate of hydrops fetalis among pregnancies with Rh(D)-mediated HDFN treated with IUT was 14.9% (range, 0–50%) in 72/483 reported cases [ 31 , 32 , 49 , 53 , 66 , 76 , 79 ]. The rate of hydrops fetalis among pregnancies with K-mediated HDFN treated with IUT was 39.2% in 49/125 reported cases [ 69 , 75 , 76 , 79 ].…”

Section: Resultsmentioning

confidence: 99%

Hemolytic disease of the fetus and newborn: systematic literature review of the antenatal landscape

Winter

Kaminski

Tjoa

et al. 2023

BMC Pregnancy Childbirth

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Background Prevention of pregnancy-related alloimmunization and the management of hemolytic disease of the fetus and newborn (HDFN) has significantly improved over the past decades. Considering improvements in HDFN care, the objectives of this systematic literature review were to assess the prenatal treatment landscape and outcomes of Rh(D)- and K-mediated HDFN in mothers and fetuses, to identify the burden of disease, to identify evidence gaps in the literature, and to provide recommendations for future research. Methods We performed a systematic search on MEDLINE, EMBASE and clinicaltrials.gov. Observational studies, trials, modelling studies, systematic reviews of cohort studies, and case reports and series of women and/or their fetus with HDFN caused by Rhesus (Rh)D or Kell alloimmunization. Extracted data included prevalence; treatment patterns; clinical outcomes; treatment efficacy; and mortality. Results We identified 2,541 articles. After excluding 2,482 articles and adding 1 article from screening systematic reviews, 60 articles were selected. Most abstracted data were from case reports and case series. Prevalence was 0.047% and 0.006% for Rh(D)- and K-mediated HDFN, respectively. Most commonly reported antenatal treatment was intrauterine transfusion (IUT; median frequency [interquartile range]: 13.0% [7.2–66.0]). Average gestational age at first IUT ranged between 25 and 27 weeks. weeks. This timing is early and carries risks, which were observed in outcomes associated with IUTs. The rate of hydrops fetalis among pregnancies with Rh(D)-mediated HDFN treated with IUT was 14.8% (range, 0–50%) and 39.2% in K-mediated HDFN. Overall mean ± SD fetal mortality rate that was found to be 19.8%±29.4% across 19 studies. Mean gestational age at birth ranged between 34 and 36 weeks. Conclusion These findings corroborate the rareness of HDFN and frequently needed intrauterine transfusion with inherent risks, and most births occur at a late preterm gestational age. We identified several evidence gaps providing opportunities for future studies.

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“…near term (usually 36 weeks) to increase fetal survival and improve pregnancy outcomes. 1,2 IUTs are performed by maternal-fetal medicine (MFM) specialists and require close communication with specialists in transfusion medicine for blood product selection and modification. Published guidelines from the Society for MFM indicate that RBCs utilized for IUT should be type O, Rh(D) negative, cytomegalovirus (CMV) negative, relatively fresh, irradiated, and leukoreduced.…”

Section: Introductionmentioning

confidence: 99%

“…Fetal blood sampling with IUT is performed if the fetus is deemed at a significant risk for severe anemia after screening by middle cerebral artery (MCA) Doppler. IUT can allow the pregnancy to carry to near term (usually 36 weeks) to increase fetal survival and improve pregnancy outcomes 1,2 . IUTs are performed by maternal‐fetal medicine (MFM) specialists and require close communication with specialists in transfusion medicine for blood product selection and modification.…”

Section: Introductionmentioning

confidence: 99%

Survey of intrauterine red blood cell (RBC) transfusion practices in the United States

et al. 2022

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Background A paucity of data exists about the current practice of fetal red blood cell (RBC) transfusion in the United States (US). This investigation describes intrauterine transfusion (IUT) RBC product selection and processing practices at different US institutions. Methods A transfusion medicine and maternal‐fetal medicine (MFM) team designed a survey to interrogate and characterize RBCs utilized for IUT. This survey was distributed to seventy US institutions with fetal treatment centers (October 2020–April 2021) identified through the NAFTNet (North American Fetal Therapy Network). Results Thirty‐seven institutions responded (response rate 53%, 37/70), but five were excluded for not performing IUTs. Most (84%; 27/32) performed 1–24 IUTs annually; two performed >50 IUTs/year. Group O, Rh(D) negative RBC units were always used by 66% (21/32), and 75% (24/32) provided hemoconcentrated RBCs by washing (17/24) or dry packing (6/24). Overall, 66% (21/32) targeted a hematocrit ≥75%. Fifty percent provided both leukocyte‐reduced and CMV‐negative RBC units. Irradiation of RBC units was performed within 6 h of issue at 63% (20/32) of sites. Most (81%, 26/32) used RBC units at <7 days of age after collection, 56% (18/32) always provided washed RBC units, while 19% (6/32) issued washed RBC only if fresh units are unavailable. Implicated maternal RBC alloantibodies were matched for 78% (25/32) of the time. The transfused volume was universally determined by the MFMs. Discussion Heterogeneity and lack of standardization exist in RBC product selection and special processing steps for IUTs in the US. Hence, the establishment of a consensus to standardize IUT protocols is needed.

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Perinatal outcomes of intrauterine transfusion for foetal anaemia due to red blood cell alloimmunisation

Cited by 11 publications

References 18 publications

Perinatal outcomes and central nervous system abnormalities following intrauterine fetal transfusion: 17 years' experience in a tertiary center

Perinatal outcomes and central nervous system abnormalities following intrauterine fetal transfusion: 17 years' experience in a tertiary center

Hemolytic disease of the fetus and newborn: systematic literature review of the antenatal landscape

Survey of intrauterine red blood cell (RBC) transfusion practices in the United States

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