Predictive factors of perinatal mortality in transfused fetuses due to maternal alloimmunization: what really matters?

INTRODUCTION: Alloimmunization is the main cause of fetal anemia. There are not many consistent analyses associating antenatal parameters to perinatal mortality in transfused fetuses due to maternal alloimmunization. The study aimed to determine the prognostic variables related to perinatal death. MATERIAL AND METHODS: A cohort study analyzed 128 fetuses treated with intrauterine transfusion (IUT), until the early neonatal period. Perinatal mortality was associated with prognostic conditions related to prematurity, severity of fetal anemia and IUT procedure by univariated logistic regression. Multiple logistic regression was used to compute the odds ratio (OR) for adjusting the hemoglobin deficit at the last IUT, gestational age at birth, complications of IUT, antenatal corticosteroid and hydrops. RESULTS: Perinatal mortality rate found in this study was 18.1%. The hemoglobin deficit at the last IUT (OR: 1.26, 95% CI: 1.04-1.53), gestational age at birth (OR: 0.53, 95% CI: 0.38-0.74) and the presence of transfusional complications (OR: 5.43, 95% CI: 142-20.76) were significant in predicting fetal death. CONCLUSION: Perinatal mortality prediction in transfused fetuses is not associated only to severity of anemia, but also to the risks of IUT and prematurity.

Sickle-cell disease not identified by newborn screening because of prior transfusion.

Erythrocyte transfusion can impair detection of sickle-cell disease, galactosemia, or biotinidase deficiency with newborn screening. We report on 4 infants with SCD in whom delayed diagnosis was associated with neonatal transfusion. In 2 cases, the initial newborn screening showed no hemoglobin S. In no case was the recommended screening >/=120 days from the last transfusion obtained. Two children had significant SCD-related morbidity before diagnosis.

High-dose intravenous immunoglobulin in non-ABO transfusion incompatibility.

The administration of intravenous immunoglobulin (IVIG) in immune and autoimmune diseases led us to use this agent to ameliorate or prevent the consequences of non-ABO incompatible transfusions in patients who need this form of therapy. IVIG (400 mg/kg/day) was infused within 24 h of transfusion in 5 patients with: (1) intestinal angiodysplasia, gastrointestinal bleeding, and anti-Kpb; (2) paroxysmal nocturnal hemoglobinuria, anti-c, anti E, anti Fyb, anti-K and autoantibodies; (3) lymphoma and autoimmune hemolytic anemia (AIHA); (4) systemic lupus erythematosus (SLE), AIHA, and anti-D, and (5) SLE and AHIA. A sustained increase in hematocrit was noted and no transfusion reaction developed in any of the cases. A single dose of pretransfusion IVIG may therefore be a useful therapeutic alternative in patients for whom no compatible blood is available. Patients with severe anemia, allo- and autoantibodies, either showing hemolysis in their pathophysiology or not, cause a serious problem in any transfusion center, especially when dealing with emergencies. In order to reduce the risks of incompatible transfusions, different modalities have previously been attempted, all with poor results. In 1989 we reported the successful use of pretransfusional high-dose intravenous immunoglobulin (IVIG) in a patient with gastrointestinal bleeding and anti-Kpb. The transfusion of incompatible red blood cells improved the anemia and allowed the exploratory laparotomy to take place. A protocol was then developed based on this case administering pretransfusion IVIG in high doses for patients for whom no compatible blood (non-ABO) is available.

The definition of ABO factors in transplantation: relation to other humoral antibody states.

The first examples of hyperacute rejection of renal hemografts were seen almost 25 years ago when kidneys were transplanted to ABO incompatible recipients whose plasma contained antigraft isoagglutinins. Hyperacute rejection caused in sensitized recipients by lymphocytotoxic antibodies is similar in that the immune reaction triggers an acute inflammatory reaction that leads to widespread thrombotic occlusion and devascularization of the graft. The events after xenotransplantation between certain species are essentially the same. Potential strategies to avoid the precipitating antigen antibody reaction or to mitigate the resulting effector cascade are described.

[Neonatal Landry-Guillain-Barré-Strohl syndrome]. / Síndrome de Landry-Guillain-Barré-Strohl neonatal.

Landry-Guillain-Barré-Strohl syndrome found in a three-days-old newborn is presented at the Mexican Navy Medical Center Hospital with an acute state after exchanges transfusion due to incompatibility of blood type was done. The case has the same clinical characteristics, such as those found by other authors in children, even though the statistics in this syndrome during the childhood and in the newborn periods are limited. It is frequent that the child dies before the diagnosis is made because motor and sensitive immaturity are present. This renders even more difficult the appropriate treatment and diagnosis, because the paralysis initiated in an ascending and progressive manner involving the spinal bulb may lead to confusion with other pathology, such as respiratory or neurological distress that may need respiratory mechanical assistance. It is very important to dissociated the relation albumin-citology of the spinal fluid to confirm the diagnosis. Corticoides do not modify the evolution of the clinical picture. In this paper we reviewed the modern ideas on pathogenesis and their possible allergic and immunologic association.

[Electrocardiography and central venous pressure during exchange transfusion]. / Electrocardiografía y presión venosa central durante la exsanguinotransfusión

Electrocardiographic and central venous pressure (CVP) records were taken during 30 exchange transfusions practiced to 26 newborns. The technique of two vessels was employed in 26 cases. Operations lasted 84.8 minutes as an average. There was only one death and the transfusion was discontinued in another case because of clinical aggravation and many disorders in the ECG. These disorders reached 40% of the cases with marked predominance of hypocalcemia which appeared as "initial" in three babies with previous history of transfusion. CVP was usually higher than reported for normal newborns and was equal to values found in a similar group of isoimmuned infants. It was high in seven cases, out of which, four complained of severe hemolytic disease and obviously, of anemia. Initial removal of 10 to 20 ml. of blood in these cases, allowed a drop of 3 to 4 cm. of H2O in CVP and its further maintenance at stable levels.