Nationwide survey of intrauterine blood transfusion for fetal anemia in Japan

Abstract

Aim The present study investigated the current situation regarding intrauterine blood transfusion (IUT) for fetal anemia in Japan. Methods We conducted a nationwide, multicenter, retrospective cohort questionnaire survey for cases that underwent IUT from 2011 to 2015. The questionnaire required perioperative information, indications, details of the procedure, procedure‐related complications, and neonatal morbidity. Results A total of 100 IUT procedures were performed in 66 cases at 19 institutions during the study period. The most frequent indication of IUT was complicated monochorionic diamniotic (MCDA) twins in 28 (42.4%) cases, followed by 16 (24.2%) cases of red‐cell alloimmunization, and 10 (15.2%) cases of parvovirus B19 infection. IUT was performed through the umbilical cord in the vast of majority cases (92%). Bleeding from the IUT site was the most common adverse event (40%). Two cases (2%) underwent emergency cesarean section after the procedure. There were no cases of rupture of membrane or intrauterine infection after IUT. The neonatal survival rate was 77.3% in the 66 total cases and 64% in the hydrops cases. The neonatal survival rates in MCDA twins, red‐cell alloimmunization, and parvovirus B19 infection were 75%, 93.8%, and 70%, respectively. Conclusions IUT was performed for mainly three indications in Japan: MCDA twins, red‐cell alloimmunization, and parvovirus B19 infection. The incidences of severe adverse events seemed very low. The outcomes after IUT were favorable with variations in survival rates according to indications. However, further studies with long‐term follow‐up will be required to assess the effectiveness of IUT, especially for complicated MCDA twins.

Intrauterine Transfusion for Rhesus Alloimmunization: A Historical Retrospective Cohort from A Single Reference Center in Brazil

“…Independent of hydrops, the authors found an overall survival rate of 71.6% and a procedure-related fetal loss of 14.6%. In a study from 19 Japanese centers between 2011 and 2015, Mizuuchi et al [ 29 ] evaluated 100 IUTs performed on 66 fetuses diagnosed with anemia not only due to Rh alloimmunization. The authors found a survival rate of 77.3% in those who did not have hydrops at the time of the first procedure and 64% in those who already had hydrops.…”

Extremely Rare Case of Fetal Anemia Due to Mitochondrial Disease Managed with Intrauterine Transfusion

“…Known causes of fetal anemia include alloimmune anemia, congenital infection, hemorrhage, monochorionic pregnancy complications, and fetal or placental tumors [ 2 , 7 ]. However, only a few reports have described rare causes of fetal anemia.…”

“…However, the leading cause is an alloimmune disease, and the incidence has been rapidly decreasing owing to the use of immunoglobulins [ 1 ]. Nonimmune-related causes include parvovirus B19 infection, fetomaternal hemorrhage, monochorionic pregnancy complications, and other rare diseases [ 2 ]. Intrauterine transfusion (IUT) effectively treats fetal alloimmune anemia and nonimmune-related diseases [ 3 ].…”

New challenges of fetal therapy in Japan

“…37 In addition, in 2020, IUT, which remains the oldest type of fetal therapy, was the fourth fetal therapy to be approved for coverage by Japan National Health Insurance based on the findings of recent studies. 38,39 In the past 20 years, we have been engaged in clinical research of existing fetal therapies in Japan to establish them as standard prenatal care with the approval of National Health Insurance coverage. As a result, FLS, TAS, RFA, and IUT have become standard prenatal treatments in Japan.…”

“…FLS, TAS, and RFA are minimally invasive fetal therapies that have been recognized as standard prenatal care in Japan 37 . In addition, in 2020, IUT, which remains the oldest type of fetal therapy, was the fourth fetal therapy to be approved for coverage by Japan National Health Insurance based on the findings of recent studies 38,39 …”