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Assessment of fetal blood after therapeutic intrauterine transfusion
Abstract Number: F-48
Abstract Type: Original Research
Introduction: Fetal anemia is a complication of pregnancy that may progress to hydrops, with significant fetal morbidity and mortality. Current treatment involves intrauterine transfusion (IUT), with an overall fetal survival rate of about 90%. There are risks associated with this procedure, the most common being fetal bradycardia, seen in approximately 8% of IUTs.
The blood used for transfusion is frequently unwashed O-negative, irradiated, fully screened, CMV negative with a hematocrit of about 70%. The relatively high-volume transfusions likely impart large citrate and potassium loads to the fetus, which may contribute to arrhythmias and other complications during the procedure. Our study examines fetal electrolytes before and after successful IUT.
Methods: IRB approval and written subject consents were obtained. Once the umbilical cord was accessed, 0.25ml of additional fetal blood was sampled both prior to and after completion of the transfusion. These samples, as well as the donor blood, were analyzed from 3 IUT procedures. Due to the small sample size, all of the data is presented.
Results: All donor blood, despite being only 3 to 5 days old, had notably elevated levels of potassium (11.2, 12.3, 17.2 mEq/L) and undetectable (less than 0.25 mg/dL) amounts of ionized calcium (likely related to the sodium citrate storage solution). After intrauterine transfusion, increases in fetal potassium (4.1 to8.4, 3.4 to4.8, 3.5 to5.2) and decreases in calcium (1.52to 0.75, 1.47 to0.69, 1.46 to0.98) were seen consistently.
Discussion: IUTs may require substantial blood transfusion, sometimes more than 25% of a fetus’s blood volume. Results from these three initial study patients suggest that the use of unwashed banked blood for IUTs can impact fetal electrolytes, particularly ionized calcium as well as potassium. The clinical implications of this are unknown, and further evaluation is warranted.
Lindenburg IT, et al; on behalf of the LOTUS study group. Long-term neurodevelopmental outcome after intrauterine transfusion for hemolytic disease of the fetus/newborn: the LOTUS study. Am J Obstet Gynecol 2012; 206:141.e1-8.
Oepkes D, van Scheltema PA. Intrauterine fetal transfusions in the management of fetal anemia and fetal thrombocytopenia. Semin Fetal Neonatal Med 2007; 12(6): 432-8.