Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: The Fetus at Risk for Anemia—Diagnosis and Management

Abstract

(Am J Obstet Gynecol. 2015;212(6):697–710) Fetal anemia is a life-threatening condition that is typically caused by red cell alloimmunization or parvovirus infection, but can also result from a variety of other causes. The purpose of this review was to enumerate the various causes of fetal anemia and outline surveillance options and management strategies. The authors performed a systematic search for relevant articles in the following online databases: MEDLINE, PubMed, EMBASE, and the Cochrane Library, searching for English-language original research articles published between 1966 and May 2014. Reviews, commentaries, evidence reports, and published guidelines were also considered and evaluated using the Grading of Recommendations Assessment, Development, and Evaluation methodology to determine the strength of the findings. The authors synthesized this information into a coherent set of evidence-based guidelines for diagnosis and treatment.

Hyporegenerative anemia in anti‐M‐associated hemolytic disease of the fetus

“…For the cases without the results of fetal serological tests, the diagnosis was made by the parental phenotypes of the MN blood group and the clinical manifestations of the anemia fetus. Cordocentesis was performed when the peak systolic velocity of the middle cerebral artery (MCA‐PSV) was >1.50 multiples of the median 20 . The intrauterine transfusion (IUT) indication was followed by the fetal anemia guidelines 20 .…”

“…Cordocentesis was performed when the peak systolic velocity of the middle cerebral artery (MCA‐PSV) was >1.50 multiples of the median 20 . The intrauterine transfusion (IUT) indication was followed by the fetal anemia guidelines 20 . During the study period, 19 women had a pregnancy with anti‐M, but only 11 had HDFN cases related to anti‐M.…”

“…Fetal therapy including the number of IUTs, the first IUT interval, and the rate of decreasing hemoglobin in the first IUT interval were collected to evaluate the therapy. Fetal outcomes were evaluated by the survival rate, gestational age at birth, birth weight, numbers of blood transfusion, and exchange transfusion after birth, and neonatal complications 20,22 . Neonatal complications were defined as respiratory distress syndrome, necrotizing enterocolitis, 23 sepsis, cholestasis, and severe cerebral injury detected with radiography evidence 22 …”

Nationwide survey of intrauterine blood transfusion for fetal anemia in Japan

“…In this survey, it was noteworthy that 5 of 16 cases (31%) of red‐cell alloimmunization were caused by the anti‐Jra antibody. The anti‐Jra antibody has generally been believed to be a relatively uncommon cause of hemolytic disease in fetuses and newborns (HDFN) for decades 12, 13 . However, some investigators recently reported several cases of HDFN induced by anti‐Jra antibody 14, 15, 16 .…”

Fetal haemoglobin H‐Constant Spring disease: a role for intrauterine management

“…Once the fetuses develop pre‐hydropic signs, especially cardiomegaly or increased MCA‐PSV, fetal anaemia should be assessed and IUT should be offered when the haematocrit is <30%, as practiced in other causes of fetal anaemia, e.g. rhesus isoimmunisation 11 . However, the blood of these fetuses consists of a significant proportion of Hb Barts, which has a limitation in oxygen transfer.…”