Intrauterine Fetal Blood Transfusion: Descriptive study of the first four years' experience in Oman.

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.

Predicción de anemia fetal por isoinmunización tras transfusiones intrauterinas. Revisión de los casos tratados en nuestra unidad / Prediction of fetal anemia in red blood cell alloimmunization after intrauterine transfusions. Review of the cases treated in our unit

Objetivo. Evaluar las transfusiones de sangre intrauterinas realizadas en fetos con anemia por isoinmunización a Rh en nuestra unidad y la sensibilidad del estudio con Doppler de la arteria cerebral media para predecir anemia fetal tras la primera transfusión. Material y métodos. Se realizaron 53 transfusiones de sangre intrauterinas en 15 pacientes afectados por isoinmunización a Rh. Se analizan las características de los casos y la capacidad del estudio Doppler de la arteria cerebral media como factor predictivo de anemia fetal. Resultados. La tasa de detección de anemia fetal de la velocidad sistólica pico de la arteria cerebral media fue del 85% tras la primera transfusión y del 72% tras la segunda y sucesivas, no se detectaron falsos positivos de la prueba en nuestra serie. Conclusiones. La valoración Doppler de la arteria cerebral media como predictor de anemia fetal presenta menor tasa de detección tras sucesivas transfusiones sanguíneas (AU)

Objetive. Evaluate the intrauterine blood transfusions performed in fetuses with anemia due to red blood cell alloimmunization in our unit and the detection rate of the middle cerebral artery Doppler to predict anemia after the first transfusion. Material and methods. Ee performed 53 intrauterine blood transfusions in 15 patients with red blood cell alloimmunization. We analyze the characteristics of the cases and the value of the middle cerebral artery Doppler to predict fetal anemia. Results. The detection rate of fetal anemia with the peak systolic velocity Doppler in the middle cerebral artery was 85% after the first transfusion and 72% after the second or more. There were no false positive results of the test in our series. Conclusions. Doppler evaluation of the middle cerebral artery as predictor of fetal anemia has a lower detection rate after consecutive transfusions (AU)

Fetal transfusion: the spectrum of clinical research in the past year.

PURPOSE OF REVIEW: Our goal is to review recent articles that examine the current state of fetal transfusion therapy from technique to education. RECENT FINDINGS: Even as technology facilitates physicians' diagnosis and treatment of rare disorders requiring fetal transfusion therapy, longstanding questions remain such as the use of intravascular versus intraperitoneal transfusion sites. However, the recent progress seen with molecular techniques, disease markers, and mathematical models demonstrates that despite unanswered questions, there is much to be hopeful about in improving our understanding of fetal transfusions and their application to a variety of diseases. SUMMARY: Systematic and collaborative approaches to studying low-frequency disorders treatable by fetal transfusions are necessary. Continued refinement of techniques should improve the timeliness and accuracy of diagnosis, as well as assist in determining the appropriate timing, site, and duration of treatments.

[Diagnostic and therapeutic proceedings in pregnancies with blood group incompatibility: A retrospective analysis over 30 years]. / Diagnostisches und therapeutisches Vorgehen bei Schwangerschaften mit Blutgruppeninkompatibilitäten: Eine retrospektive Analyse über 30 Jahre.

PURPOSE: To examine the development during the past 30 years of diagnostic and therapeutic procedures in pregnancies with blood group incompatibility. PATIENTS AND METHODS: We evaluated 193 pregnancies with maternal red blood alloimmunisation treated at our hospital. At least one amniotic fluid spectrophotometry was performed. RESULTS: We observed a reduced average age of the patients, a reduced parity and an increase in the number of amniotic fluid examinations per pregnancy in the course of time. Amniotic fluid examinations tended to be performed earlier in pregnancy. Gestational time was reduced, the rate of spontaneous vaginal deliveries remained unchanged. The proportion of anti-D-alloimmunisation decreased in relation to other antigens and the severity of the cases increased (assessed according to the findings of the spectrophotometric amniotic fluid examinations performed while using the semiquantitative method of Liley). The haemoglobin values of the newborn, without intrauterine transfusions, were unchanged and the number of intrauterine deaths decreased. The rate of postnatal transfusions decreased dramatically, whereas the rate of phototherapeutic approaches increased. CONCLUSION: The spectrum of the antigens causing fetal haemolytic disease has changed during the last 30 years and so have the diagnostic and therapeutic procedures.