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1.
Transfusion ; 54(1): 238-43, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23829228

RESUMO

BACKGROUND: The management of pregnant women with anti-Jsb is challenging due to the paucity of antigen-negative blood for fetal and neonatal transfusion. CASE REPORT: A 29-year-old woman with anti-Jsb was referred for assessment of recurrent fetal losses. With the presence of the sister as a historically matched donor, she was planned for active surveillance for fetal anemia during pregnancy. STUDY DESIGN AND METHODS: The fetus remained well until 21 weeks of gestation when signs of fetal anemia and early hydrops fetalis were noted. Anti-Jsb titer was at 128. The sister's red blood cells (RBCs) were cross-match incompatible. Urgent intrauterine transfusion (IUT) was performed with washed irradiated maternal RBCs, donated after cessation of heparin. The mother was given intravenous iron (IV-Fe) and continued on weekly recombinant human erythropoietin (rHu-EPO). RESULTS: Repeated IUTs were needed every 1 to 3 weeks. Throughout a 7-week period, three maternal donations were performed with total donated whole blood volume of 1250 mL, supporting four IUTs. At 29 weeks of gestation, the procedure was complicated by umbilical cord hematoma necessitating urgent cesarean section. A male newborn was delivered, transfused at birth, and subsequently treated with phototherapy and five top-up transfusions. CONCLUSION: This case represents a successful example of managing hemolytic disease of the fetus due to a rare antibody using maternal blood. It also supports previous data on safety of maternal donations during pregnancy and the use of combination of rHu-EPO and IV-Fe as a supportive measure.


Assuntos
Transfusão de Sangue Intrauterina/métodos , Eritroblastose Fetal/terapia , Isoanticorpos/efeitos adversos , Sistema do Grupo Sanguíneo de Kell/imunologia , Adulto , Doadores de Sangue , Eritroblastose Fetal/etiologia , Feminino , Humanos , Recém-Nascido , Isoanticorpos/sangue , Masculino , Mães , Gravidez , Índice de Gravidade de Doença , Resultado do Tratamento
2.
Transfus Apher Sci ; 51(1): 42-6, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24816438

RESUMO

BACKGROUND: Thalassemia Intermedia (TI) has a wide clinical profile with many patients requiring only occasional transfusions. To prevent alloimmunization, we adopted a policy of issuing phenotype matched red blood cells in 2009. We examined transfusion indications and alloimmunization rate in TI patients. STUDY DESIGN AND METHODS: Clinical and blood bank records of 37 TI patients were reviewed. RESULTS: 23 Patients required transfusion for pregnancy (26), splenectomy (8) and anemia (11). Since 2009, total of 335 units were transfused with only one antibody developing after transfusing a non-phenotype matched unit. CONCLUSION: The commonest indication for blood transfusion was pregnancy. Providing phenotype matched blood has successfully reduced the rate of alloimmunization.


Assuntos
Transfusão de Eritrócitos/efeitos adversos , Talassemia beta/terapia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Omã , Gravidez , Complicações Hematológicas na Gravidez/sangue , Complicações Hematológicas na Gravidez/imunologia , Complicações Hematológicas na Gravidez/terapia , Centros de Atenção Terciária , Talassemia beta/sangue , Talassemia beta/imunologia
3.
Sultan Qaboos Univ Med J ; 18(1): e34-e42, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29666679

RESUMO

OBJECTIVES: Haemolytic disease of the fetus and newborn (HDFN) causes hydrops fetalis. The successful treatment of HDFN has been reported with intrauterine blood transfusion (IUT). This study aimed to describe the initial experience with IUT procedures in Oman. METHODS: This retrospective observational study took place at the Royal Hospital and Sultan Qaboos University Hospital Blood Bank, Muscat, Oman, and included all women who underwent IUT procedures in Oman between March 2012 and March 2016. Gestational and neonatal outcomes were assessed, including complications, morbidity, neurodevelopmental sequelae and mortality. RESULTS: A total of 28 IUT procedures for 13 fetuses carried by 11 women were performed. Gestational age at the time of referral ranged from 13-30 weeks, while the median gestational age at first IUT procedure was 26 weeks (range: 19-30 weeks). Indications for the procedure included HDFN caused by anti-D (n = 6), a combination of anti-D and anti-C (n = 4), anti-K (n = 1) and anti-Jsb (n = 1) antibodies and nonimmune hydrops fetalis due to a congenital parvovirus infection (n = 1). Median fetal haemoglobin levels at the beginning and end of the procedure were 4.6 g/dL and 12.8 g/dL, respectively. Most procedures were transplacental intravascular transfusions through the placental umbilical cord root (71.4%), followed by transamniotic intravascular transfusions (14.3%). The overall survival rate was 61.5%, with five deaths; of these, four were intrauterine and one was an early neonatal death due to non-resolved hydrops and severe cardiac dysfunction. CONCLUSION: As a relatively novel obstetric procedure in Oman, IUT seems to result in a favourable outcome for hydropic fetuses.


Assuntos
Transfusão de Sangue Intrauterina/métodos , Sangue Fetal , Adulto , Bancos de Sangue/tendências , Transfusão de Sangue Intrauterina/tendências , Feminino , Humanos , Lactente , Recém-Nascido , Omã , Avaliação de Resultados em Cuidados de Saúde/tendências , Gravidez , Estudos Retrospectivos , Armazenamento de Sangue/métodos
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