Background

Maternal red-cell alloimmunization is frequent cause of fetal anemia, mainly due to Rhesus antibodies. Monitoring of infants for anemia potentially receiving intrauterine transfusion (IUTs) to prevent hydrops is a common tool. We report our experiences with the management of fetal anemia including intrauterine fetal transfusion and neonatal transfusion requirement.

Methods

Between 2017 to 2022 29 pregnancies were managed of intrauterine transfusion for severe fetal anemia by 59 IUTs. Indication and timing for the IUT were based on doppler measurement of peak systolic velocity in the fetal middle cerebral artery to predict severe fetal anemia.

Results

12 out of 29 patients had red-cell alloimmunization causing fetal anemia, 17 patients received IUT for viral anemia or other causes. 7 out of 12 red-cell allo-immunized mothers delivered in our hospital. 4 childs out of these 7 childs managed in our hospital had additional transfusion requirement 4-8 weeks after discharge from the hospital. Free maternal antibodies were still detectable in all postpartal samples from the affected neonates. Possibly hyporegenerative anemia is caused following persisting maternal antibodies.

Conclusion

Anti-D remains the most common antibody in fetuses requiring intrauterine transfusion. Intrauterine transfusion seems to be an effective and save procedure to treat fetal anemia. Infants receiving IUT for fetal anemia following maternal alloimmunization could be at risk for hyporegenerative anemia first 3 months after birth.

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