Erhöhte Parvovirus B19 Infektion bei Schwangeren 2024 und intrauterine Transfusionen zur Behandlung der dadurch verursachten fetalen Komplikationen
Sergio Origel-Romero (Tübingen / DE), Günalp Uzun (Tübingen / DE), Karl Oliver Kagan (Tübingen / DE), Tamam Bakchoul (Tübingen / DE), Stefanie Nowak-Harnau (Tübingen / DE)
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Background: Between the end of 2023 and now, Germany has seen an outbreak of Parvovirus B19 (B19V) infection among pregnant women. B19V infection during pregnancy can lead to potentially life-threatening non-immune fetal hydrops in 1-5% of cases, which can be managed through intrauterine transfusion (IUT). Additionally, neurodevelopmental outcomes following fetal B19V infection are impacted by fetal anemia. IUT of red blood cells can alleviate anemia and reduce both the risk of hydrops and mortality associated with B19V. To minimize complications, it is recommended to perform intrauterine transfusions between 18 and 34 weeks of gestation. Study cohort/Results: Since 2024, 21 cases of B19V-associated fetal anemia have been admitted to our university hospital. All 21 pregnant women showed severe fetal anemia confirmed by Doppler ultrasonographic assessment of the peak velocity of systolic blood flow in the fetal middle cerebral artery. For 9 patients, fetal blood sampling was performed before and after IUT. Red cells from B19V-PCR negative blood donors were prepared in our blood bank to reach a hematocrit of 80%. IUT was performed within < 12 hours after preparation. 21 cases of B19V-associated fetal anemia were treated with IUT of red cells. The gestational age of the patients ranged from 16 to 38 weeks, with an average of 21 weeks. Fetal hemoglobin levels ranged from 3.0 to 15.0 g/dL before intrauterine transfusion (n=15, Median 5.6 g/dL). Post-transfusion levels ranged from 11.2 to 15.8 g/dL (n=9, Median 14.4 g/dL). Most patients (20 out of 21) received a single IVT, while one patient additionally received IPT. Follow-up was conducted using MCA-PSV Doppler measurements: in 11 cases, a decrease from >1.5 MoM to <1.5 MoM was found; 2 cases showed an increase. Hydrops fetalis was observed in 7 cases. None of the pregnant women showed alterations in placental implantation or amniotic fluid. One case was complicated by a late miscarriage with fetal malformation. By the end of July, 7 deliveries between 38 and 38+6 weeks of gestation were recorded. Intrauterine transfusion appears to be a viable tool to treat severe B19V-associated fetal anemia. Further studies need to assess the long-term outcomes of IUT.