Vox Sanguinis International Forum on the selection and preparation of blood components for intrauterine transfusion: Summary

Clarke, Gwen; Bodnar, Melanie; Lozano, Miguel; Nadarajan, Veera Sekaran; Lee, Christina; Baud, David; Canellini, Giorgia; Gleich‐Nagel, Tobias; Torres, Oscar Walter; Rey, Patricia L.; Bub, Carolina Bonet; Kutner, José Mauro; Castilho, Lilian; Saifee, Nabiha Huq; Delaney, Meghan; Nester, Theresa; Wikman, Agneta; Tiblad, Eleonor; Pierelli, Luca; Matteocci, Antonella; Maresca, Maddalena; Maisonneuve, Emeline; Cortey, A.; Jouannic, J.‐M.; Fornells, Jordi; Albersen, Arjan; Haas, Masja de; Oepkes, Dick; Lieberman, Lani

doi:10.1111/vox.12901

Cited by 4 publications

(8 citation statements)

References 18 publications

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“…An American study (with representation from adult and pediatric hospitals), reports that most centers (23/35; 66%) always provide SCT‐negative RBCs to individuals with SCD 46 . While the current survey showed homogeneity in Canadian IUT SCT testing practice, one international forum reported that only a minority of surveyed sites (2/10; 20%) select SCT‐negative units for IUT 47 …”

Section: Discussionmentioning

confidence: 62%

“…46 While the current survey showed homogeneity in Canadian IUT SCT testing practice, one international forum reported that only a minority of surveyed sites (2/10; 20%) select SCT-negative units for IUT. 47 Policies for testing RBC allocated to neonates continues at six of the surveyed Canadian pediatric hospitals. Support for this practice was found in one guideline with the clause that policy implementation depends on geographic SCT prevalence and may be unnecessary if the blood center declares it so.…”

Section: Discussionmentioning

confidence: 99%

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Reconsidering sickle cell trait testing of red blood cell units allocated to children with sickle cell disease

et al. 2022

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Background Sickle cell trait (SCT) testing of red blood cell (RBC) units is sometimes performed to identify and divert units containing hemoglobin S (HbS). Recipients strategically guarded against this exposure include fetuses, neonates, and children with sickle cell disease (SCD). The clinical necessity of this practice is unclear. Study Design and Methods A one‐year audit (2018) was performed at a pediatric tertiary care hospital that tests for SCT in RBC units prescribed to children with SCD and neonates. The impact of incorporating varying numbers of SCT RBC units in a single‐unit top‐up, partial‐manual red cell exchange, and automated erythrocytapheresis was modeled in four typical‐parameter age scenarios (2, 5, 10, and 18 years) sharing a high baseline HbS. Additionally, a survey assessing SCT testing practices was administered to Canadian pediatric hospital transfusion laboratories serving hemoglobinopathy programs. Results Of 2268 donor RBC units tested, one was positive for SCT (0.04% [95% CI: 0.01%–0.24%]), at a cost of $19,384.56 CAD. The impact of SCT unit incorporation on lost HbS reduction was modest (Δ1%–3% [automated erythrocytapheresis] and Δ4%–15% [top‐up/partial manual exchange]). The survey (with all 13 sites responding) showed variable SCT testing practice; four (31%) do not test, four (31%) test for children with SCD, and six (46%) test for neonates. Conclusion RBC SCT testing may be more costly than beneficial or necessary in children with SCD. As of 2019, our transfusion service has ceased SCT testing for this population. Further research in the fetal/neonatal populations is needed to overturn this entrenched practice.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Reconsidering sickle cell trait testing of red blood cell units allocated to children with sickle cell disease

et al. 2022

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“…IUT is indicated to treat severe fetal anemia, which can arise from impairments of RBC production and/or the loss or destruction of normal fetal RBC 8 . In the US, maternal alloimmunization and parvovirus B19 infection represent the most common immune and non‐immune causes of fetal anemia, respectively 1 ; however, the overall most common indication for IUT worldwide is maternal alloimmunization 5,8 . In this condition, the maternal immune system becomes sensitized following exposure to non‐self RBC antigens through transfusion or pregnancy.…”

Section: What Are the Indications For Iut?mentioning

confidence: 99%

“…Given that reports of IUT for these indications are limited, more studies are necessary to understand the role and risks of IUT in their management. Additionally, IUT has been used to treat inherited conditions such as thalassemias, 23 hemoglobinopathies, 24 and erythrocyte membrane 25 or enzyme defects 5,8,26 . In the case of alpha thalassemia major, which is often fatal in utero due to severe hydrops, antenatal diagnosis and IUT have resulted in some surviving patients, but eventual long‐term survival is dependent on hematopoietic stem cell transplantation 3 …”

Section: What Are the Indications For Iut?mentioning

confidence: 99%

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How do we perform intrauterine transfusions?

Crowe,

Hasan,

Saifee

et al. 2023

Transfusion

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BackgroundIntrauterine transfusion (IUT) is an invasive but critical and potentially life‐saving intervention for severe fetal anemia with demonstrated improvement in outcomes. The fetus is vulnerable to hemodynamic alterations and transfusion‐related adverse events; therefore, special consideration must be given to blood component selection and modification. There is widespread IUT practice variability, and existing guidance primarily relies on expert opinion and single center experiences.Study Design and MethodsExperts in Maternal Fetal Medicine, Pediatric Hematology, and Transfusion Medicine from centers across the United States, collectively performing about 120 IUT annually, offer a multidisciplinary perspective on the performance of IUT and preparation of blood components. This perspective includes strategies for identifying an at‐risk fetus, communicating between disciplines, determining the necessary blood volume, selecting and processing blood components, documenting the procedure in medical record, and managing the neonate.ResultsIdentifying an at‐risk fetus relies on review of the clinical history, non‐invasive monitoring, and laboratory evaluation. We recommend the use of relatively fresh, group O, cytomegalovirus‐safe, freshly irradiated, red blood cells (RBC) that are Hemoglobin S negative and antigen‐negative for any maternal antibody, if indicated. These RBC units should be concentrated to remove additives and increase the hematocrit thus minimizing fluctuations in fetal volume status. The units intended for IUT should be labeled clearly and the documentation of transfusion differentiated in the maternal medical record.DiscussionAn awareness of the technical, logistical, and regulatory considerations for IUT performance will facilitate improved communication and patient care, especially when rare units of RBC are required.

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Immunohematological testing and transfusion management of the prenatal patient

Quraishy,

Sapatnekar

2023

Advances in Clinical Chemistry

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Vox Sanguinis International Forum on the selection and preparation of blood components for intrauterine transfusion: Summary

Cited by 4 publications

References 18 publications

Reconsidering sickle cell trait testing of red blood cell units allocated to children with sickle cell disease

Reconsidering sickle cell trait testing of red blood cell units allocated to children with sickle cell disease

How do we perform intrauterine transfusions?

Immunohematological testing and transfusion management of the prenatal patient

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