Introduction of a Programme for intravascular transfusions at severe rhesus isoimmunization

Westgren, Magnus; Jabbar, Fahad Al-Abdul; Larsen, Joergen Falk; Rahman, Feryal; Selbing, Anders; Stangenberg, Magnus

doi:10.1515/jpme.1988.16.5-6.417

Cited by 9 publications

(4 citation statements)

References 13 publications

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“…The excess of perinatal losses in hydropic fetuses might be attributed to a higher procedure‐related complications rate, given that more anaemic fetuses require transfusions of greater volumes which thus take longer to perform. However, review of reports published between 1986 and 1989 indicates that survival after revérsal of hydrops (38 of 42; 90%) is significantly better than in fetuses with persistent hydrops after intravascular transfusion (10 of 24, 42%) ( P < 0.001) (Berkowitz et al 1986; Nicolaides et al 1986; McKenzie et al 1987; Socol et al 1987; Westgren et al 1988; Parer 1988; Harman et al 1988; Grannum et al 1988). These findings suggest that the pathological changes associated with hydrops, rather than anaemia, may predispose to perinatal loss.…”

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confidence: 99%

Fetal liver dysfunction in Rh alloimmunization

Nicolini

Nicolaidis

Tannirandorn

et al. 1991

BJOG

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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.

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confidence: 99%

Fetal liver dysfunction in Rh alloimmunization

Nicolini

Nicolaidis

Tannirandorn

et al. 1991

BJOG

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“…As we established the collaborative FCI program, our primary aims were to increase the likelihood of biventricular circulation at birth, while also minimizing fetal loss rate. Based on historical rates of fetal loss from intracardiac sampling (3.8%) and intracardiac transfusions (10.0%) for thalassemia, an estimated fetal loss rate of 10% was proposed as an acceptable upper bound …”

Section: Development Of a Fetal Cardiac Intervention Programmentioning

confidence: 99%

“…Based on historical rates of fetal loss from intracardiac sampling (3.8%) and intracardiac transfusions (10.0%) for thalassemia, an estimated fetal loss rate of 10% was proposed as an acceptable upper bound. 7,8…”

Section: Development Of a Fetal Cardiac Intervention Programmentioning

confidence: 99%

Fetal cardiac intervention—Perspectives from a single center

2020

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Fetal cardiac intervention was first proposed in the early 1990s to impact cardiac development and survival of fetuses with fetal aortic stenosis and evolving hypoplastic left heart syndrome (HLHS). Although initial attempts of fetal aortic valvuloplasty were unsuccessful and carried a high rate of morbidity and mortality, our collaborative group at the Brigham and Women's Hospital and Boston Children's Hospital have reinvigorated the procedure using improvements in imaging, anesthesia, balloon catheters, and surgical techniques. Two decades of experience have now allowed us to document the safety of in utero intervention and to achieve a better understanding of the impact of midgestation intervention on developing HLHS. Research into underlying genetics, predictive biomarkers, and ways to incorporate stem cell technology will hopefully allow us to further refine the procedure to most benefit children with this historically lethal disease.

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“…Visibility of IHV is less difficult in sampling situations, and it provides an alternative to several attempts at cord root, and it does not allow cord tamponade. The intrahepatic vein is used for more than half of all intravascular transfusions 18 .…”

Section: Intrahepatic Vein Is More Preferred Than Umbilical Cord Tran...mentioning

confidence: 99%

Management of Fetal Anemia and Thrombocytopenia With Intrauterine Blood Transfusion

Pal¹,

Shree²,

Jana³

et al. 2022

IJAR

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Fetal anemia and fetal thrombocytopenia are two of the most unsmiling complications in pregnant women, and they can lead to perinatal mortality and morbidity. After long years of study with intravascular intrauterine blood transfusion, a number of varieties of implications have been described. Intrauterine Blood Transfusion (IUBT) is considered the best method in the case of fetal anemia because it is caused by red cell alloimmunization. Not only for red blood cell transfusion, this method can also be used for the transfusion of platelets to thrombocytopenic fetuses in pregnant women. It is generally detected after a child is born who is symptomatic and shows signs of bleeding in the brain and skin. The biggest milestone for the clinician is to give preventive treatment in next pregnancy. Pregnancies at risk require serial monitoring, and Fetal Middle Cerebral arterial (MCA) Doppler is the non-invasive test that is now proving to be the choice for monitoring. IVIG (Intravenous immunoglobulin) is used to manage severe Rh-immunization and is now showing promising effects. Indications like Parvovirus B19, Fetomaternal hemorrhage (FMH), Fetal SacrococcygealTeratoma (SCT), Twin-twin transfusion syndrome, placental chorioangioma diseases, or other infections can be treated with this method. This review covers fetal transfusion techniques and explores current management of fetal anemia and thrombocytopenia.

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Introduction of a Programme for intravascular transfusions at severe rhesus isoimmunization

Cited by 9 publications

References 13 publications

Fetal liver dysfunction in Rh alloimmunization

Fetal liver dysfunction in Rh alloimmunization

Fetal cardiac intervention—Perspectives from a single center

Management of Fetal Anemia and Thrombocytopenia With Intrauterine Blood Transfusion

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