Intrauterine Blood Transfusion for Fetal Anemia Treatment – The Experience of 14 Years of a Prenatal Diagnosis Center in Portugal

Rijo, C; Cohen, A; Martins, AT; Cruz, J; Queirós, A; Ramos, H; Correia, J

http://hdl.handle.net/10400.17/4155

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Overview and aims: Intrauterine blood transfusion (IBT) is an established technique for the treatment of severe fetal anemia, increasing the survival of these fetuses. We aimed to describe the experience of a single center in pregnancies complicated with severe fetal anemia, that underwent IBT. Study design, Population, Methods: A retrospective cohort study was conducted from January 1996 to June 2014. Data were collected from 98 IBT performed in 44 pregnancies. Data included: anemia etiology, gestacional age at IBT, hemoglobin and hematocrit levels, presence of hydrops, number of IBTs, gestacional age at birth, sex and weight. Neonatal data included: number of exchange transfusions, respiratory distress syndrome, sepsis and other complications. Results: The main cause of fetal anemia was anti-D alloimmunization in 79.5% of the cases and the mean gestational age (GA) of the first IBT was 26 weeks. The minimum pre-transfusion hemoglobin was 1.5 g/dL, with an average of 6.4g/dL. The post transfusion hematocrit increased to the desired values in 90% of cases. Nine fetuses (20.5%) had hydrops at diagnosis. We had 4 cases of fetal death, and 40 pregnancies resulted in live births, with mean gestational age of 34.3 weeks, average weight of 2446g and mean hemoglobin of 11g/dL. A cesarean was performed in most cases. The overall survival was 86.4%, since in addition to the four fetal deaths there were two cases of early neonatal death. Fetal hydrops and early GA seemed to be associated with a poorer prognosis. Conclusions: IBT is a safe and effective procedure for the treatment of severe fetal anemia. Vigilance should be done in hospitals with experience to allow timely and proper treatment of this condition.