In utero treatment of severe fetal anemia resulting from fetomaternal red blood cell incompatibility: a comparison of simple transfusion and exchange transfusion

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• 作者：Lucie Guilbaud^a ; ^{lucie.guilbaud@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Charles Garabedian^b ; Anne Cortey^a ; Thameur Rakza^b ; Bruno Carbonne^a ; ^c ; Vé ; ronique Houfflin-Debarge^b ; ^d
• 关键词：Red-blood cell alloimmunization ; Fetomaternal red blood cell incompatibility ; Fetal anemia ; Intrauterine transfusion ; Intrauterine exchange transfusion ; Rhesus hemolytic disease
• 刊名：European Journal of Obstetrics & Gynecology and Reproductive Biology
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：201
• 期：Complete
• 页码：85-88
• 全文大小：275 K

文摘

To compare in utero exchange transfusions (IUET) and in utero simple transfusions (IUST) for the treatment of fetal anemia resulting from red blood cell fetomaternal incompatibility.

Study design

Retrospective comparative study from January 2006 through December 2011. The two techniques were compared for effectiveness, complications, and neonatal outcomes.

Results

36 patients had 87 IUETs and 85 patients 241 IUSTs. Gestational age at the first transfusion was similar in both groups (IUET: 27 ± 3.8 weeks; IUST: 27 ± 4.7 weeks; NS) as was the initial fetal hemoglobin level (IUET: 6.4 ± 2.8 g/dL; IUST: 6.0 ± 2.5 g/dL; NS). No significant differences were noted for postprocedure complications or efficacy. The daily drop in hemoglobin level was similar in both groups (IUET: 0.41 ± 0.23 g/dL/day; IUST: 0.44 ± 0.17 g/dL/day; NS) as were the time intervals between two procedures. Gestational age at birth was earlier in the IUET group (34.4 ± 1.3 weeks vs 35.5 ± 1.8 weeks; p < 0.001), but the postnatal transfusions or exchange transfusions rates and the duration of intensive phototherapy did not differ. No significant differences were noted for the overall survival rates (IUET: 100%; IUST: 96.4%; p > 0.99).

Conclusion

IUET does not appear to provide any benefits compared with IUST, neither to be associated with a higher complication rate. The choice of the technique depends on availability of packed blood cells with high hematocrit (70–80%).