The Spectrum of Malignant Neoplasms among Liver Transplant Recipients: Sociodemographic Factors, Mortality, and Hospital Burden.

Objective: To determine the nationwide prevalence of malignant neoplasms (excluding hepatocellular carcinoma-HCC) in hospitalized liver transplant recipients and to study the hospital utilization, and mortality to the incidence of malignancies. To the best of our knowledge, few epidemiological studies addressed outcomes in post-liver transplant patients, such as the annual number of hospitalizations, mortality, patient characteristics regarding malignancies. Methods: NIS database was queried between 2016 and 2018 to retrieve records of patients admitted with a principal or secondary diagnosis of liver transplant following the International Classification of Diseases, tenth Revision (ICD-10). The population was divided into case and control groups according to the presence and absence of malignant neoplasm (MN) except for HCC. We also compared the incidence of MN in LTX patients and non-LTX matched cohort. Results: A total of 7.28% admissions were associated with malignant neoplasms (except HCC) in LTX patients. Lymphomas, respiratory, gastrointestinal (excluding HCC), leukemia, and head/neck were commonest cancers with estimated admission rates of 0.97%, 0.90%, 0.80%, 0.53%, and 0.49%, respectively. Lung cancer was the most frequent malignant neoplasm among White and Black racial/ethnic groups (15.78% and 14.8%), whereas lymphoma was pervasive among Hispanics (20.3%). Lung cancer had the highest in-hospital mortality (10.55%), followed by the cancer of the nervous system (9.09%). The LTX and non-LTX cohort comparison showed that LTX patients are at increased risk of head and neck cancers, skin cancers, lymphomas, tumors, and Myelodysplastic syndrome. According to a multivariate analysis, a statistically significant association existed between malignant neoplasms in LTX patients and the following factors: increasing age (P < .001), higher mortality (P < .001), females with 29% lesser odds than males (P < .001), Black race and Hispanic ethnicity with 20% and 26% lesser odds as compared to White (P < .05). Clinical factors included smoking, Alcoholic cirrhosis, Hepatitis B, and Hepatitis C, were statistically significant risk factors of post-liver transplantation malignancies. Conclusions: Malignancies were frequent among elderly patients and predominantly in males. Lymphoproliferative diseases were the most prevalent malignancy types, followed by respiratory/lung cancer- which showed the highest mortality risk of all cancers. LTX patients are at increased risk of head and neck cancers, skin cancers, lymphoma, tumors, and Myelodysplastic syndrome compared to non-LTX patients.

Cord-Blood Derived Chemistry Reference Values in Preterm Infants for Sodium, Chloride, Potassium, Glucose, and Creatinine.

OBJECTIVES: International guidelines recommend that preterm infants should be supported to maintain their serum electrolytes within "normal" ranges. In term babies, cord blood values differed in pathological pregnancies from healthy ones. STUDY DESIGN: We examined cord blood sodium, chloride, potassium, glucose, and creatinine to derive maturity-related reference intervals. We examined associations with gestational age, delivery mode, singleton versus multiple, and prenatal maternal adverse conditions. We compared preterm cord values to term, and to adult reference ranges. RESULTS: There were 591 infants, 537 preterm and 54 term. Preterm cord glucose levels were steady (3.7 ± 1.1 mmol/L), while sodium, chloride, and creatinine increased over GA by 0.17, 0.14 mmol/L/week, and 1.07 µmol/L/week, respectively (p < 0.003). Average preterm cord potassium and chloride were higher than the term (p < 0.05). Compared with adult reference intervals, cord preterm reference intervals were higher for chloride (100-111 vs. 98-106 mmol/L), lower for creatinine (29-84 vs. 62-115 µmol/L), and more variable for potassium (2.7-7.9 vs. 3.5-5.0 mmol/L) and sodium (130-141 vs. 136-145 mmol/L). Cesarean section was associated with higher potassium and lower glucose, multiple births with higher chloride and creatinine and lower glucose, and SGA with lower glucose. CONCLUSIONS: Cord blood values varied across the GA range with increases in sodium, chloride, and creatinine, while glucose remained steady. Average preterm reference values were higher than term values for potassium and chloride. Preterm reference values differed from published adults' reference values. The changes across GA and by delivery mode, SGA, and being a multiple, which may have direct implications for neonatal care and fluid management. KEY POINTS: · Cord blood electrolyte, creatinine, and glucose values vary across neonatal gestational age.. · Average preterm cord values of potassium and chloride were higher than term values.. · Cord reference values differ by delivery mode, growth, and multiple impacting neonatal care decisions..

Fluid handling and blood flow patterns in neonatal respiratory distress syndrome versus transient tachypnea: a pilot study.

BACKGROUND: Cardiovascular and renal adaptation in neonates with Respiratory Distress Syndrome (RDS) and Transient Tachypnea of the Newborn (TTN) may be different. METHODS: Neonates ≥32 weeks were diagnosed with RDS or TTN based on clinical, radiologic and lung sonographic criteria. Weight loss, feeding, urine output, and sodium levels were recorded for the first 3 days, and serial ultrasounds assessed central and organ Doppler blood flow. A linear mixed model was used to compare the two groups. RESULTS: Twenty-one neonates were included, 11 with TTN and 10 with RDS. Those with RDS showed less weight loss (- 2.8 +/- 2.7% versus - 5.6 +/- 3.4%), and less enteral feeds (79.2 vs 116 ml/kg/day) than those with TTN, despite similar fluid prescription. We found no difference in urine output, or serum sodium levels. Doppler parameters for any renal or central parameters were similar. However, Anterior Cerebral Artery maximum velocity was lower (p = 0.03), Superior Mesenteric Artery Resistance Index was higher in RDS, compared to TTN (p = 0.02). CONCLUSION: In cohort of moderately preterm to term neonates, those with RDS retained more fluid and were fed less on day 3 than those with TTN. While there were no renal or central blood flow differences, there were some cerebral and mesenteric perfusion differences which may account for different pathophysiology and management.

Abstracts From the First Annual Research Day Hosted by the Michigan State University College of Osteopathic Medicine, Novi, Michigan, May 15, 2023.

The Spartan Medical Research Journal (SMRJ) is pleased to publish abstracts from the First Annual Research Day hosted by the Michigan State University College of Osteopathic Medicine (MSUCOM), held in Novi, Michigan, on May 15, 2023. Sponsored by MSUCOM, the Statewide Campus System (SCS), and Research, Innovation, and Scholarly Engagement (RISE), this event showcased a total of 139 selected research abstracts following a meticulous blinded review by the MSUCOM Research Day Planning Committee and SMRJ editorial staff. These abstracts were subsequently presented at the MSUCOM First Annual Research Day in 2023, with awards for exceptional oral and poster presentations conferred on May 15, 2023. Of the 139 presentations that were ultimately chosen, 45 authors consented and elected to have their abstracts published in SMRJ. The abstracts from 2023 encompass a wide array of contemporary medical and clinical subjects, incorporating a variety of research designs that cover basic science, clinical research, case reports, medical education, and quality improvement. While abstracts offer concise overview of research projects or presentations, they do not permit a comprehensive evaluation of the scientific rigor employed in the respective works. Although these abstracts offer preliminary results that may necessitate further refinement and validation, they serve a vital function in disseminating novel research concepts and advancements in the discipline of medicine. This knowledge-sharing promotes meaningful dialogue among researchers, clinicians, and educators, thereby making a valuable contribution to the collective body of knowledge in the fields of medical sciences and osteopathic medicine. Andrea Amalfitano, DO, PhD Osteopathic Heritage Foundation Professor of Pediatrics, Microbiology and Molecular Genetics Professor, BioMolecular Science Gateway Editor-in-Chief, Spartan Medical Research Journal (SMRJ) MSU College of Osteopathic Medicine- Statewide Campus System C. Patricia Obando S., PhD Associate Dean and DIO, Graduate Medical Education Associate Professor- MSU College of Osteopathic Medicine- Statewide Campus System Rana Ismail, PhD, MSc, CPHQ Director of Research Editor, Spartan Medical Research Journal (SMRJ) MSU College of Osteopathic Medicine- Statewide Campus System Francis Akenami, BMLS, PhD, MSc, FIMLS Managing Editor Spartan Medical Research Journal (SMRJ) MSU College of Osteopathic Medicine- Statewide Campus System.

Copper and Zinc Feud: Is This Myelodysplasia or Myelodysplastic Syndrome?

We report a case of a 59-year-old male who developed pancytopenia and multiorgan failure attributed to copper deficiency from exogenous consumption of zinc tablets. During the six months preceding his presentation, he had experienced increasing shortness of breath, lightheadedness, and fatigue. Laboratory studies revealed pancytopenia with profound anemia (hemoglobin level 2.8 g/dL) along with evidence of acute kidney injury and acute heart failure; the patient was presumed to have multiorgan failure due to profound anemia. Bone marrow biopsy revealed dyspoiesis suggestive of myelodysplastic syndrome (MDS). There were no cytogenetic abnormalities observed. However, the blood workup analysis found low copper and ceruloplasmin levels, whereas zinc levels were excessively elevated (257 mg/dL). Upon inquiry, the patient reported taking an over-the-counter zinc supplement of an unknown quantity for over a year. After two months of copper treatment, his blood count returned to normal. This case highlights a rare presentation of zinc-induced copper deficiency resulting in pancytopenia and severe anemia-related multiorgan failure. A growing number of hematological disorders are being linked to copper deficiency. Copper deficiency pancytopenia is a reversible condition that often goes unnoticed and can be misdiagnosed as MDS because it has similar hematological characteristics.

Oncocytic Cell Carcinoma of the Thyroid: A Case Report and an Overview of the Diagnosis, Treatment Modalities, and Prognosis.

Cancers of the thyroid gland are uncommon, accounting for 1% of malignant tumors. Oncocytic carcinoma of the thyroid (OCA), previously known as "Hürthle cell" carcinomas, make up 3% to 5% of all thyroid cancers and are extremely rare. In the United States, the incidence of thyroid cancer is approximately 12 per 100,000 per year and increases with age. The prevalence of thyroid cancers in women is estimated to be twice that in men, with the male gender correlating with a worse prognosis. A definitive diagnosis of OCA is confirmed after complete excision and histopathological examination. OCA is an aggressive tumor with an exceedingly low incidence, a high risk of metastasis, and a poor prognosis. The mainstay of therapy for OCA is surgery. In order to recognize and treat the disease as early as possible, healthcare providers must consider the probability of OCA in patients presenting with a thyroid mass. We hereby present a case of OCA identified incidentally status post tracheostomy and subsequent biopsy. We have an opportunity to review this disease with the hope of improving outcomes by raising awareness and with early recognition.

UTI-Associated Septic Cardiomyopathy: Saving the Heart in the Nick of Time.

A patient with gram-negative sepsis developed acute global biventricular dysfunction with reduced left ventricular ejection fraction. A diagnosis of sepsis-induced cardiomyopathy (SICM) was made following the complete resolution of cardiac dysfunction. This case highlights the importance of the early diagnosis of SICM and treatment of the underlying cause.

Severe Gastroenteritis From Giardia lamblia and Salmonella Saintpaul Co-Infection Causing Acute Renal Failure.

Giardiasis, a feco-oral route parasitic intestinal infection, and Salmonellosis, a foodborne enteric and extraintestinal bacterial infection, remain major public health issues in countries that lack adequate sanitation, safe water supply, and proper food handling. Here we report a case of Giardia lamblia and invasive non-typhoidal Salmonella disease co-infection in a patient with a history of recent travel to Mexico.

The Triad of Legionnaires' Disease, Rhabdomyolysis, and Acute Kidney Injury: A Case Report.

BACKGROUND Legionella infection is a common cause of atypical pneumonia, known as Legionnaires' disease when infection extends to extrapulmonary involvement, which often leads to hospitalization. The triad of Legionella pneumonia, rhabdomyolysis, and renal failure displays a rare yet fatal complication without prompt management. CASE REPORT Our patient was a 62-year-old man with no significant medical history who developed Legionnaires' disease with severely elevated creatinine phosphokinase (CPK) of 9614 mcg/L, consistent with rhabdomyolysis. He experienced severe headache, anorexia, and hematuria, which prompted him to seek medical care. Pertinent social history included recent flooding in his neighborhood, which surrounded the outer perimeter of his home. His clinical manifestations and laboratory findings were consistent with Legionella infection, with concomitant acute kidney injury. A chest X-ray revealed hazy left perihilar opacities concerning for atypical pneumonia. Immediate interventions of hydration and antigen-directed azithromycin were initiated to prevent rapid decompensation. His clinical symptoms resolved without further complications, and he was not transferred to the Intensive Care Unit (ICU). CONCLUSIONS Legionella-induced rhabdomyolysis is an uncommon association that can lead to acute kidney failure and rapid clinical deterioration. Early and aggressive management with fluid repletion and appropriate antibiotics can improve clinical manifestations and hospital length of stay. Our patient's reduction in CPK levels and clinical improvement confirmed that extrapulmonary involvement in Legionella infection can lead to rhabdomyolysis. It is important for healthcare providers to recognize the clinical triad of Legionella pneumonia, rhabdomyolysis, and renal failure as prompt and timely management to reduce associated morbidity.

A Rare Case of Recurrent Arterial Thrombosis Secondary to Iron Deficiency Anemia.

Iron deficiency anemia is the leading cause of anemia all over the world. Iron deficiency is known to cause reactive thrombocytosis. However, arterial thrombosis secondary to reactive thrombocytosis is a rare entity. In this article, we present a case of a 37-year-old female with recurrent arterial thrombosis due to severe thrombocytosis caused by iron deficiency anemia. The patient developed spleen and kidney infractions, as well as abdominal aortic thrombosis. She was subsequently treated with iron and aspirin with an improvement of the anemia and thrombocytosis, with no further thrombotic complications. Arterial thrombosis is a very serious condition as the thrombus can embolize to carotid arteries leading to stroke or to peripheral blood vessels causing peripheral ischemia and gangrene. Iron deficiency anemia is a reversible cause of thrombocytosis that can be treated very easily to avoid thrombotic complications.

Solitary Cystic Mediastinal Lymphangioma: A Rare Incidental Case in an Adult Female.

Introduction: Lymphangiomas are rare, congenital malformations arising from lymphatic hyperplasia. More than 90% of cases are found in children under 2 years of age. Cystic lymphangiomas usually occur in the neck and axillary region and only rarely extend to the mediastinum. Case Description: We present the case of a middle-aged woman who presented with dyspnoea and productive cough. A chest x-ray showed right lower medial lung opacity, and a CT scan of the thorax showed a cystic mediastinal mass, encroaching on the superior vena cava and approaching the trachea and mainstem bronchus. An anterior thoracotomy with tumour resection was performed to relieve compression symptoms. The final pathology report confirmed the diagnosis of mediastinal lymphangioma. Discussion: Lymphangioma should be considered as one of the differential diagnoses when mediastinal widening is found on chest x-ray, and it should be investigated further with a CT scan and biopsy. Infiltration of surrounding structures can cause compression symptoms and can also make surgical resection more challenging. LEARNING POINTS: Lymphangiomas are benign tumours of the paediatric population that can rarely occur in middle-aged adults as an acquired form.It is essential to investigate mediastinal enlargement seen on chest x-ray images even in the absence of any symptoms, as mediastinal lymphangiomas can grow to involve nearby anatomical structures.Although benign, lymphangiomas should be excised at the time of diagnosis to avoid anticipated complications and compression of anatomical structures causing respiratory difficulty, hoarseness and superior vena cava syndrome.Complete surgical resection is the mainstay of treatment and provides an excellent postoperative prognosis.

Phentermine-Associated Atrial Fibrillation: A Case Report and Literature Review.

Obesity has become a major public health problem with increased prevalence and is associated with cardiovascular mortality. Phentermine is approved for short-term obesity treatment in conjunction with lifestyle modifications. Palpitations are a well-documented side effect of phentermine, but atrial fibrillation (AF) is rarely reported. We present a case of new-onset AF in a healthy woman who had been recently started on phentermine for weight loss. LEARNING POINTS: Atrial fibrillation usually occurs secondary to intrinsic disorders such as hypertension, coronary artery disease, abnormal heart valves, thyroid dysfunction and medication side effects.Phentermine is used for a short period together with diet and exercise to treat obesity; atrial fibrillation is an unusual cardiovascular side effect of phentermine that warrants clinician caution.The importance of medication reconciliation is exemplified in this case as it is essential to rule out secondary causes of atrial fibrillation, including medication side effects.

Left Ventricular Thrombus Formation in a Structurally and Functionally Normal Heart: A Case Report and Literature Review.

Left ventricular (LV) thrombosis usually occurs as a complication of acute anterior myocardial infarction (MI) and dilated cardiomyopathy. It also occurs in patients with a hypercoagulable state. However, in the setting of normal systolic function, LV thrombi are extremely rare. We present a case of a healthy woman who had LV thrombus despite normal LV systolic function that presented as an acute aortoiliac embolism.

Weathering the Storm: Thyroid Storm Precipitated by Radioiodine Contrast in Metastatic Thyroid Carcinoma.

Thyroid storm is an extremely rare yet life-threatening medical emergency. It results from the decompensation of undiagnosed or undertreated hyperthyroidism in the presence of an acute stressor such as trauma to the thyroid, infections, acute iodine load, withdrawal from the antithyroid medication, or surgical procedures (including thyroid surgery). Clinical features of thyroid storm include hyperthermia, tachycardia, respiratory distress, gastrointestinal and hepatic symptoms, and central nervous system dysfunction. It is primarily a clinical diagnosis, further aided by abnormal thyroid function tests. Thyroid storm is associated with significant mortality and morbidity - the latter mostly related to complications from thyrotoxicosis or hyperthyroidism. Treatment with iodine (or iodide-ionized active form of iodine) supplements or with radioactive iodine, also known as radioiodine, such as in the treatment of thyroid cancer, is a common and mostly safe practice; however, iodine contrast in tomography imaging may precipitate a thyroid storm in sporadic cases. Here, we report a remarkable case of a 62-year-old African American female with a history of total thyroidectomy secondary to follicular thyroid cancer three years before the current presentation; she developed left lung pneumonia complicated by thyroid storm status post a computed tomography angiogram of the abdomen. She exhibited signs and symptoms of thyrotoxicosis a few days after receiving the iodinated contrast. The recommended daily iodide intake for adults with hyperthyroidism is about 150 mcg per day, while a computed tomography scan exposes patients to 14 to 35 million mcg of iodinated contrast at once, which could have triggered a storm. In this case, the patient was diagnosed with thyroid storm, which was presumed to be a consequence of the Jod-Basedow phenomenon secondary to metastatic thyroid carcinoma lesions discovered later. This clinical diagnosis was reinforced by laboratory results showing elevated serum free T4 and undetectable thyroid-stimulating hormone. She was treated with supportive measures, steroids, beta-blockers, and antithyroid medications with a positive outcome. This case demonstrated that, in the setting of recurrent metastatic thyroid cancer, clinicians should approach the use of intravenous iodine medium contrast in imaging with some level of caution when dealing with patients at risk of thyrotoxicosis or with underlying hyperthyroidism state at the brink of a storm.

Herpes Simplex Virus Esophagitis in the Setting of Acute Use of Corticosteroids for COPD Exacerbation in an Immunocompetent Middle-Aged Woman.

Herpes simplex (HSV) esophagitis is usually identified in patients with significant immunosuppressive conditions such as AIDS. Short course of immunosuppressive therapy is an uncommon risk factor for this condition. We present a case of acute gastrointestinal bleeding secondary to HSV type 1-induced esophageal ulcers. A 63-year-old woman developed acute hypoxic hypercapnic respiratory failure. Past medical history was significant for COPD for which the patient was taking short-acting bronchodilator inhalers. The patient was intubated and started on mechanical ventilation. Intravenous Solu-Medrol 40 mg Q6 was started. Hospital course was complicated by sepsis of unknown source. Empiric broad-spectrum antibiotic therapy was started. On the 11th hospital day, the patient experienced multiple episodes of coffee ground emesis. There was abdominal tenderness on physical examination. Significant laboratory results were lipase 1,911 U/L and lymphopenia (ALC = 300/mm3). Endoscopy revealed severe erosive esophagitis and multiple punched-out ulcerations of the esophagus. Empiric treatment with valacyclovir 500 mg OD was started. The patient required PEG tube insertion for dysphagia. Complete resolution of esophagitis was noted then. Immunohistochemical staining for HSV was strongly positive in the cells with inclusions. Short course of intravenous corticosteroids is an uncommon cause of HSV-1 esophagitis. Corticosteroid-induced lymphopenia impedes underlying cellular immunity, which might explain the reactivation of latent herpes and esophageal ulcer formation. Given the rarity of the disease, evidence of treatment is available from case reports only. We found complete resolution of esophageal ulcers after the patient received valacyclovir therapy for 10 days.

Multidisciplinary Management of Legionella Disease in Immunocompromised Patients.

Legionella pneumonia is a gram-negative bacterial infection commonly associated with aerosol transmission from contaminated water sources. Impaired immunity leads to delayed clearance of infection and further predisposes individuals with Legionella pneumonia at risk of developing complications. We present a case report on a renal transplant patient with comorbid cardiac and renal dysfunction who developed community-acquired Legionella pneumonia. The case emphasizes the importance of adopting a multidisciplinary approach when managing Legionella infection in patients with multiple comorbidities and immunosuppressive states.

Type I Gastric Neuroendocrine Tumor Presenting as Acute Upper Gastrointestinal Bleed.

Gastric neuroendocrine tumors (GNETs) are rare and subdivided into type I, type II, and type III. Types I and II are gastrin-dependent and are usually benign, whereas type III is gastrin-independent and more aggressive. Type I accounts for 70-80% of all GNETs. Most of them are asymptomatic and incidentally detected on endoscopy. It can sometimes present with iron and B12 deficiency, dyspepsia, and less commonly with an upper GI bleed. We present a case of type I GNET who came to the hospital with melena and esophagogastroduodenoscopy (EGD) showing a 3-cm bleeding polyp and histopathology revealing a well-differentiated neuroendocrine tumor with angioinvasion.

A Case of COVID-19 With Memory Impairment and Delayed Presentation as Stroke.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory pathogen with remarkable properties of multisystem involvement and numerous complications. The coronavirus disease of 2019 (COVID-19) presenting as stroke is becoming more common. Herein, we describe an unusual case of COVID-19 in a patient who initially presented with myalgia, fatigue, loss of taste and smell, and non-specific memory impairment. Two months after infection with SARS-CoV-2, the patient presented with acute onset of right-sided weakness, sensory loss, and worsening cognitive impairment. Reverse transcription-polymerase chain reaction was performed to detect the SARS-CoV-2 virus, and the results were positive at the time of initial infection as well as during the current admission. Neuroimaging suggested a subacute ischemic infarct in the middle cerebral artery. The patient was re-tested for SARS-CoV-2 and found to be positive, but the cycle threshold was high (40.4) along with a positive test for immunoglobulin-G (IgG) for SARS-CoV-2. This report highlights a unique case of stroke-related to COVID-19 infection in a middle-aged woman with otherwise mild symptomatic illness. The patient had a chronic ischemic stroke with delayed presentation two months after the initial symptomatic viral infection. This case underscores the importance of neurological assessment as well as timely evaluation of patients presenting with COVID-19 and any neurological concerns to recognize stroke as a complication of COVID-19 promptly.

Non-invasive diagnosis of fetal anemia due to maternal red-cell alloimmunization.

OBJECTIVE: To determine the value of measurement of velocity of the middle cerebral artery (MCA) in the prediction of fetal anemia in alloimmunized pregnancies without ultrasound evidence of hydrops and to see if this could replace the invasive techniques in the diagnosis and management of this condition. METHODS: In a prospective cohort study, 65 non-hydropic fetuses with red blood cell alloimmunization were evaluated with ultrasound and Doppler imaging. This study was carried out at Feto Maternal Medicine Unit at Women's Hospital, Hamad Medical Corporation, Doha, Qatar from January 2003 to December 2003. Middle cerebral artery-peak systolic velocity (PSV) was measured. We interfered only if there is a sign of fetal anemia as indicated by changes in blood velocity in MCA using the table designed by Giancarlo Mari or the fetus developed signs of hydrops fetalis. Immediately after delivery, the blood was taken from umbilical cord for full blood count, blood group, bilirubin and antibodies level. Results before first fetal blood sampling (FBS) or delivery were analyzed. RESULTS: Sixty-five patients met the inclusion criteria for the study and were managed. Sixty-three women were alloimmunized with rhesus (Rh)-D antibodies and 2 with anti-C. With the conventional management, all 65 patients undergone amniocentesis to determine bilirubin levels. However, with non-invasive management, 60 women were safely prevented from undergoing invasive testing or invasive procedures. Amniocentesis was performed for only one (1.54%) patient, despite having a normal MCV-PSV which was carried out solely due to the care provider was insisting on this procedure and the result was normal. Planning delivery based on MCA-PSV allowed us to deliver 97% (63/65) of these babies without any signs of severe anemia between 28-38 weeks. Two (3%) of the fetuses were diagnosed as severely anemic with MCA-PSV. In both cases, anemia was confirmed by FBS and intra uterine transfusion was carried out immediately to the test. Only 2 babies were diagnosed anemic after birth and underwent blood transfusion. CONCLUSION: Doppler evaluation of MCA-PSV is effective in the prediction of fetal anemia in red blood cell alloimmunization. Using this technique will reduce the number of invasive procedures needed with the added risks of these procedures with good fetal outcome.