Intrauterine transfusion: an international review of practice and policy

Abstract

Background Intrauterine transfusion (IUT) is a treatment for fetal anemia. This technique involves ultrasound guided needle placement followed by transfusion of a specially prepared blood component. The most common indications include hemolytic disease of the fetus and newborn (HDFN) and prenatal infection. Methods The literature was reviewed, and blood component characteristics and preparatory techniques identified. An international survey of IUT was conducted. Results Component preparation for IUT differs from preparation for other transfusions. Differences relate to unique characteristics of the fetus including a small blood volume, invasive access for transfusion and immune deficiency. The techniques for preparation of red blood cells (RBC) are variable with limited evidence. Most use fresh concentrated RBC. Irradiation is uniformly recommended. RBC that are antigen negative for the maternal alloantibody are provided, and the product is selected or modified to minimize risk for cytomegalovirus transmission. Selection of ABO group and the degree of additional prophylactic phenotype matching are variable. While maternal RBC transfusion may be used, compatible allogeneic RBC are more common. For maternal antibodies to high prevalence antigens rare phenotype deglycerolized RBC may be used. There are challenges in providing RBC for IUT. Pre and post transfusion blood samples must be correctly managed in the medical record. Hemovigilance requires that both the fetus and the mother be documented as recipients. Preparation may be urgent, and sterile technique is required. Records of IUT must be conveyed to neonatal care providers as the transfused blood may mask the true blood group for weeks to months post transfusion, and component modifications may be required for any postnatal transfusion in neonates who were treated with IUT.