Procedure-Related Complications and Perinatal Outcome after Intrauterine Transfusions in Red Cell Alloimmunization in Stockholm

Abstract

Introduction: We present a review of all cases of intravascular transfusions in red cell alloimmunization over a time span of 20 years in Stockholm. The aim of the study is to compare our results with published results from larger centers and to identify areas that can be further improved. Material and Methods: A retrospective cohort study was conducted of all women treated with intrauterine transfusions due to erythrocyte immunization in our hospital between June 1990 and June 2010. Primary outcome variables were fetal and neonatal survival, procedure-related complications and gestational age at delivery. Results: A total of 284 intrauterine transfusions were performed in 84 pregnancies, with an overall survival rate of 91.8%. Procedure-related and fatal complications occurred in the present study in 4.9 and 1.4% of fetuses or neonates, respectively. Procedure-related complications were significantly more common in free-loop transfusions than in transfusions in the intrahepatic part of the umbilical vein (OR: 5.4, p = 0.025). There was no significant difference between the intrahepatic and the placental cord insertion route (p = 0.83). Gestational age at first transfusion was significantly associated with an increased risk of a procedure-related complication (OR: 0.8, p = 0.019). Of the live-born infants, 24% of the neonates were born before gestational week 34. Discussion: Our study confirms previous studies demonstrating favorable results with intravascular transfusions.

Stable long-term mixed chimerism achieved in a canine model of allogeneic in utero hematopoietic cell transplantation

“…Although the size of the canine fetus requires that IC injection be used as a surrogate, clinical IUHCT will likely be performed using ultrasound-guided, fetoscopic intravascular injection, a modification of the well-established technique for treatment of Rh disease and fetal blood sampling. [44][45][46] The other primary impediment to successful allogeneic IUHCT is the immune barrier. The rationale for IUHCT is based on exploitation of normal immune ontogeny, with delivery of donor cells prior to the development of self-tolerance, a series of positive and negative selection events in the fetal thymus that result in a repertoire of lymphocytes reactive to foreign antigen but not to "self."…”

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

“…Authors agree that IUTs need to be performed under aseptic conditions, guided by continuous ultrasound/Doppler, using a 20-22 gauge needle [27,34,35,37,38]. No data are available on the influence of needle size on procedure complications.…”

“…All transfusions should be aimed intravenously, as arterial punctures are associated with high complication rates [29,63]. The fetal liver and placental cord insertion are shown to be the safest puncture sites, whereas free loop needling is a higher risk procedure and should in our view best be avoided [29,30,[38][39][40].…”

“…A summary of (procedure-related) complications in recent studies is shown in Table 2 [29,30,[37][38][39][40]64,65].…”

“…The intrahepatic transfusion route is probably the preferred route, as the surrounding tissue makes it easier to keep the needle in place, despite the small vessel size in early pregnancy (<3-5 mm before 20 weeks' gestation) [38,50]. Some authors promote intraperitoneal transfusions instead [72] or noninvasive treatment options to postpone early intravascular transfusions [71].…”