RESUMEN
Intrauterine transfusion is one of the mainstays of treatment in isoimmunised pregnancies guided by the changes in middle cerebral artery Doppler of the fetus. The common postnatal complications associated with Rh isoimmunisation are high unconjugated bilirubin requiring blood exchange transfusions, cholestasis due to bile inspissation, thrombocytopenia and anaemia. Hyperferritinaemia is an uncommon adverse effect observed in Rh isoimmunised pregnancies. In this case report, we describe the clinical course of a Rh isoimmunised neonate with hyperferritinaemia and transfusion acquired cytomegalovirus disease which resolved. Iron chelation therapy was not necessary.
Asunto(s)
Transfusión de Sangre Intrauterina/efectos adversos , Insuficiencia de Crecimiento/terapia , Sobrecarga de Hierro/diagnóstico , Fototerapia/métodos , Complicaciones Hematológicas del Embarazo/terapia , Isoinmunización Rh/terapia , Adulto , Antivirales/uso terapéutico , Bilirrubina/sangre , Velocidad del Flujo Sanguíneo , Transfusión de Sangre Intrauterina/métodos , Insuficiencia de Crecimiento/fisiopatología , Femenino , Ferritinas/sangre , Humanos , Recién Nacido , Sobrecarga de Hierro/fisiopatología , Sobrecarga de Hierro/terapia , Arteria Cerebral Media , Embarazo , Complicaciones Hematológicas del Embarazo/fisiopatología , Isoinmunización Rh/complicaciones , Isoinmunización Rh/fisiopatología , Resultado del Tratamiento , Valganciclovir/uso terapéuticoRESUMEN
OBJECTIVE: To evaluate the efficacy of pre-exchange transfusion albumin priming in neonates with non-hemolytic hyperbilirubinemia. DESIGN: Single center, randomized controlled trial. SETTING: Level III Neonatal unit. PARTICIPANTS: Fifty healthy term and late preterm neonates with non-hemolytic hyperbilirubinemia requiring exchange transfusion. INTERVENTIONS: 5 mL/kg of either 20% human albumin (n=23) or 0.9% saline (n=27) infusion one hour prior to exchange transfusion. MAIN OUTCOME MEASURE: Post-exchange transfusion phototherapy duration. RESULTS: The post-exchange transfusion phototherapy duration was not different between albumin and saline groups [Median (IQR): 29 (24-48) h vs. 33 (24-43) h; P=0.76]. The total amount of bilirubin removed during exchange transfusion was also similar [Median (IQR): 34 (28-46) mg vs. 33 (27-38) mg; P=0.46]. Serial changes in total serum bilirubin following exchange transfusion and need for repeat exchange transfusion were comparable between the groups. CONCLUSIONS: In healthy late preterm and term neonates with non-hemolytic hyperbilirubinemia, priming with 1 g/kg of 20% albumin prior to exchange transfusion is not superior to equi-volume 0.9% saline in reducing post- exchange transfusion phototherapy duration or amount of bilirubin mass removed.