Successful Intrauterine Intracardiac Transfusion in Monochorionic Twins Affected by Parvovirus B19

Kaisenberg, Constantin S. von; Grebe, Sandra; Schleider, Stephanie; Kaisenberg, H. Kühling-von; Venhoff, Lars; Meinhold‐Heerlein, Ivo

doi:10.1159/000106346

Cited by 14 publications

(11 citation statements)

References 14 publications

(7 reference statements)

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“…Von Kaisenberg et al. successfully performed intrauterine erythrocyte transfusion directly into the right ventricles of infected twins [64].…”

Section: Parvovirus B19mentioning

confidence: 99%

Infectious exanthemas in childhood

Fölster‐Holst

2020

J Deutsche Derma Gesell

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Most childhood exanthemas are harmless. However, recognizing serious diseases with life-threatening complications at an early stage is important for the timely initiation of adequate therapy. This requires knowledge of the specific patterns of the exanthema, obtained from the medical history and the clinic, including the patient's general condition and physical examination. In unclear cases, additional diagnostic measures are undertaken, such as blood tests and smears (cutaneous, mucocutaneous). Viruses are the most common cause of childhood exanthemas. New variants of infectious agents, improved diagnostics and stays in tropical and subtropical countries have expanded the spectrum of infectious exanthemas.

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“…Von Kaisenberg et al. successfully performed intrauterine erythrocyte transfusion directly into the right ventricles of infected twins [64].…”

Section: Parvovirus B19mentioning

confidence: 99%

Infectious exanthemas in childhood

Fölster‐Holst

2020

J Deutsche Derma Gesell

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“…The diagnosis was performed by identification of virus particles using immunogold labeling electron microscopy, but maternal serum, fetal ascites, and cord sera were always negative for anti-B19 IgM and IgG antibodies. Infection with B19 of both twins had been reported for three other cases (Graesslin et al, 2005;Wolff et al, 1999;von Kaisenberg et al, 2007), in two of these cases a fatal outcome was described for one of the twins. Since failure to mount an appropriate antibody response to viral infection, the antenatal diagnosis of parvovirus B19 requires a multifaceted approach, including serology and detection of viral DNA by PCR.…”

Section: Discussionmentioning

confidence: 91%

Discordant Outcomes in a Case of Parvovirus B19 Transmission Into Both Dichorionic Twins

Schiesser

Sergi

Enders³

et al. 2009

Twin Res Hum Genet

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Maternal infection with parvovirus B19 during pregnancy can cause aplastic anemia in the fetus and may lead to nonimmune fetal hydrops and fetal demise. Twin pregnancies complicated by infection due to parvovirus B19 are very rare clinical events. We present a dichorionic, diamniotic, dizygotic twin pregnancy after in vitro fertilization with parvovirus B19 infection and viral transmission to both twins, but different outcomes. At 19 weeks gestation, hydrops fetalis was diagnosed for male twin A, female twin B did not show any abnormalities. At 22 weeks gestation an acute parvovirus B19 infection was detected and twin A was diagnosed with intrauterine fetal death (IUFD) by ultrasound at 23 weeks gestation. Viral DNA was detected in maternal blood as well as in placenta and liver tissue of this twin. Twin B was born at 35 weeks gestation asymptomatically and no signs of hydrops or other congenital anomalies but viral DNA was detected by PCR in serum. At the age of 2 years, both IgG titres against B19 and parvovirus DNA amplification copies were still positive in plasma of the surviving twin, but no clinical signs were detectable. It is remarkable that both twins were infected with parvovirus B19 early in pregnancy but showed a discordant clinical outcome. Our case report describes the rare occurrence of an intrauterine fetal death (IUFD) of one twin and the asymptomatic infection of the other in a twin pregnancy.

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“…Single case studies have described a successful outcome in a severely anemic fetus secondary to parvovirus infection undergoing intracardiac transfusion [13]. In such pregnancies, with human parvovirus being the etiology of fetal anemia, even with fetal in-utero transfusion, survival is lower (60-77%) than reported for ‘Rhesus' disease, possibly due to associated significant anemia, thrombocytopenia, and impaired myocardial contractility [14,15].…”

Section: Discussionmentioning

confidence: 99%

Fetal Intracardiac Transfusions in Hydropic Fetuses with Severe Anemia

et al. 2015

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Introduction: Fetal anemia can have significant perinatal morbidity and mortality, particularly with onset prior to 20 weeks of gestation. Materials and Methods: We detail a case-cohort study (n = 8) of all women who underwent fetal in-utero, intracardiac transfusion prior to 24 weeks of gestation (7 women before 20 + 1 weeks), between March 2004 and September 2014, in a supraregional Fetal Medicine Center in the United Kingdom, comprising 2.2% of all transfusions performed during this period. All the fetuses were hydropic, with high maternal BMI, and had severe anemia as an indicator for transfusion. It was an attempt to perform intravascular transfusion when other common routes of fetal vascular access had failed. Results: There were 2 intrauterine deaths (25%), both of which were associated with in-utero transfusion and fulminant parvovirus B19 infection. The perinatal survival rate was 75% (6/8). Discussion: Fetal in-utero, intravascular transfusion by the intracardiac route may be used to correct severe early-onset anemia. It is particularly useful when technical issues of fetal size, early gestation (<20 weeks), maternal adiposity, and hydrops fetalis make umbilical cord or intrahepatic vein puncture technically difficult. Survival rates appear comparable to other series of pregnancies where in-utero transfusion is performed at early gestation.

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Successful Intrauterine Intracardiac Transfusion in Monochorionic Twins Affected by Parvovirus B19

Cited by 14 publications

References 14 publications

Infectious exanthemas in childhood

Infectious exanthemas in childhood

Discordant Outcomes in a Case of Parvovirus B19 Transmission Into Both Dichorionic Twins

Fetal Intracardiac Transfusions in Hydropic Fetuses with Severe Anemia

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