Fetal liver dysfunction in Rh alloimmunization

Abstract

Summary. The liver enzymes, aspartate transaminase (AST), alanine transaminase (ALT), gamma glutamyl transpeptidase (GGT) and alkaline phosphatase (ALP), were measured in the blood of 25 fetuses with severe Rh alloimmunization at the time of their first, second and third intravascular transfusions and in 17 comparison fetuses. In the comparison group, GGT increased with advancing gestation (r = 0.7; P = 0.002), whereas ALP, AST and ALT did not correlate with gestational age. Rh hydropic fetuses (n = 8) had higher blood ALT levels than the comparison fetuses (P = 0.008) and significantly increased transaminases when compared with non hydropic fetuses (n = 17). In hydropic fetuses, AST correlated with the nucleated red cell count before transfusion (r = 0.94; P = <0.0001). Fetal transaminases were no longer increased in hydropic fetuses by the second (AST) or third (ALT) transfusion. In both hydropic and non hydropic fetuses, GGT increased by the second transfusion (median percentage change +85%, range −83% to +596%; P = 0.003). The rise in fetal GGT was transitory and correlated with the increase in fetal haematocrit at the first transfusion (r = 0.58; P = 0.006). This study reports liver dysfunction secondary to extramedullary erythropoiesis in Rh alloimmunization and implicates portal hypertension for the rise in fetal GGT with transfusion.

The effects of serial intravascular transfusions in ascitic/hydropic RhD‐alloimmunized fetuses

“…The degree of anemia at the first transfusion correlated directly with two indices of liver synthesis, protein and PCHE concentrations, which had also normalized by the second transfusion. We have already reported this liver dysfunction in anemic fetuses6.…”

Thrombopoietin in Thrombocytopenias of Childhood

“…Some of these patients were hydropic during gestation or at birth. Because hydrops is often associated with liver dysfunction in Rh hemolytic disease, 72 it raises the question whether these TPO concentrations are inadequately low and contribute to thrombocytopenia.…”

Fluid shift from intravascular compartment during fetal red blood cell transfusion

“…Alongside transfusion speed, the severity of anemia and presence of hydrops were suspected to influence fluid shift. Fetuses with severe anemia have a decreased concentration of plasma albumin, possibly because of decreased synthesis in the fetal liver or a relative increase in plasma volume, or albumin is lost from the intravascular compartment as a result of endothelial damage, which implies an increase in the capillary filtration coefficient. Furthermore, a smaller difference between the concentration of albumin in the intravascular compartment and in the interstitial compartment results in a diminished capacity to contain water in the vascular compartment.…”