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PubMed1992

Intravenous anti-D gammaglobulin for the prevention of rhesus isoimmunization caused by platelet transfusions in patients with malignant diseases.

Previous studies of sensitization to RhD by RhD-positive platelet transfusions in RhD-negative cancer patients have shown different frequencies of alloimmunization (max. 19%). We studied 37 RhD-negative patients who received RhD-incompatible platelet transfusions and simultaneously anti-D-immune globulin. We provide evidence that in this setting RhD-prophylaxis is highly effective in preventing alloimmunization due to RhD antigen, since none of the patients studied developed anti-D. Detection of other red blood cell antibodies than anti-D proves the possibility of immunization in these patients. Prevention of isoimmunization in patients with malignant diseases is recommended especially in young females, since an increasing number of patients are having successful pregnancies, despite prior or even during cytotoxic therapy.

Adult↗
PubMed1987

Ultrasound-guided fetal intravascular transfusion in a case of severe rhesus isoimmunization.

Intrauterine intravascular transfusion is the most effective way of correcting the fetal haemoglobin level in severe rhesus haemolytic disease. Fetal anaemia should be corrected as early as possible before the development of hydrops and ascites. When required, the transfusion can be repeated several times. We present in this publication our own experience in a severe rhesus isoimmunization case, where the fetal haemoglobin level was corrected by a successful transfusion in the intra-abdominal part of the fetal umbilical vein in the 31st week of pregnancy and the child was delivered a week later by cesarean section.

Adult↗
PubMed1985

Percutaneous umbilical blood sampling.

This report describes a technique for the performance of a sonographically guided percutaneous umbilical blood sampling and its potential uses in the management of diagnostic problems in the second and third trimester of pregnancy. The method has been employed in the prenatal assessment of 13 fetuses at risk for hemostatic failure (hemophilia and idiopathic thrombocytopenic purpura), chromosomal disorders, isoimmunization, and fetal hypoxia. This simple and rapid procedure offers access to the fetal circulation for diagnostic and therapeutic purposes.

Adult↗
PubMed1994

Role of cordocentesis in perinatal medicine.

Cordocentesis is a feasible, reliable, and safe method for fetal evaluation of a wide variety of disorders. It has allowed for in-utero treatment of fetal red cell isoimmunization and opened future routes for other fetal therapies. In this review, results of a multicenter intrauterine fetal blood sampling registry will be presented, outlining current indications, techniques, and complications of the procedure. In addition, current research in the assessment and treatment of fetal erythrocyte isoimmunization and infection, as well as the role of cordocentesis in rapid genetic karyotyping, work-up of non-immune hydrops, fetal platelet abnormalities, and fetal growth restriction will be reviewed. Recent work using cordocentesis to better understand fetal metabolism, endocrinology, and immunology will also be reviewed.

Cordocentesis↗
PubMed1990

Thyroid function in anemic fetuses.

Thyroid function was studied in 75 fetal blood samples obtained by cordocentesis from red cell isoimmunized pregnancies at 18-37 weeks of gestation. Thyroid-stimulating hormone (TSH), and free and total thyroxine and triiodothyronine were significantly higher than in normal controls. Furthermore, there was a significant association between the increase in TSH and the degree of fetal anemia.

Anemia↗
PubMed1988

The development of immunological relationship between mother and fetus under physiological and pathological conditions.

On the basis of results of our research and review of literature, the complex of immuno logical influences, operating during the development of the human fetus, were evaluated. It is obvious that during the early stages of pregnancy the conceptus is protected by non-specific mechanisms, i.e. hormonally (HCG, progesterone) and by certain properties of the trophoblast (barrier function, immunologically inert surface). Specific immunological tolerance is formed by gradual penetration of trophoblast particles and later by penetration of fetal blood cells into maternal circulation. Thus a specific suppression of maternal T lymphocytes against fetal antigens develops, other immunological functions being intact. - Following a strong antigenic stimulus (e.g. Rh-D), isoimmunization of the mother and serious risk for the fetus occur. Immunological causes of abortion could not be unequivocally proved in recurrent abortions. The explanation of the origin of EPH-gestosis on the basis of toxic action of immunocomplexes is highly probable, however the laboratory and experimental proof is still lacking.

Abortion, Habitual↗
PubMed1985

Sonographic sign for the detection of early fetal ascites in the management of severe isoimmune disease without intrauterine transfusion.

Ultrasonography is an important adjunct to the delta optical density at 450 nm in the management of isoimmunized pregnancies. We describe a sonographic finding that we believe is the earliest sign of fetal ascites suggesting decompensation. In this patient, despite high measurements of delta optical density at 450 nm, intrauterine therapy or delivery was delayed for more than 7 weeks by careful sonographic monitoring.

Adult↗
PubMed2001

Management of isoimmunization in the presence of multiple maternal antibodies.

OBJECTIVE: Evaluation and management of patients with multiple maternal antibody isoimmunization is unclear. The presence of > or = 1 maternal antibody may suggest a worse scenario. The objective of this study was 2-fold: first, to determine whether the presence of multiple antibodies predicts a more severe course than single antibodies and second, to determine the utility of the Queenan curves/protocol in evaluating multiple-antibody isoimmunization. STUDY DESIGN: Amniotic fluid DeltaOD(450) measurements were obtained from the antenatal testing logbook and confirmed by chart review. Cases were categorized by antibody type and clinical outcomes obtained by chart review. RESULTS: Twenty-four pregnancies with isoimmunization and multiple maternal antibodies were identified; of these, 17 had 2 antibodies (anti-D and -C in 13; anti-D and -E in 1; anti-D and -Jka in 1; anti-c and -E in 1; and anti-c and -Jka in 1), and 7 had > 2 antibodies (anti-D, -C, and -E in 4; anti-D, -C, and -N in 1; anti-c, -E, and -FYA in 1; and anti-E, -K, -Fya, -S, and -C in 1). Eleven patients (46%) required at least 1 intrauterine fetal transfusion (mean initial fetal hematocrit, 15%; range, 4.9%-24%). In those not transfused, no DeltaOD(450) measurements occurred in the Queenan "fetal death risk" zone. Poorest outcomes (multiple transfusions/hydrops/fetal demise) were in patients with anti-D and anti-C, with or without anti-E. The absence of anti-D was associated with no need for fetal transfusions. The overall transfusion rate was significantly higher compared with a group of 57 isoimmunization patients with only anti-D (46% vs. 25%, P < or =.05). CONCLUSIONS: The presence of anti-D appears to be the most significant factor guiding the course of isoimmunization with multiple antibodies. The presence of another antibody with anti-D appears to significantly increase the need for intrauterine fetal transfusions. The Queenan protocol can successfully treat patients with multiple maternal red blood cell antibodies.

Amniotic Fluid↗
PubMed1989

Isoimmunization to Cromer antigen in pregnancy.

Pregnancy in a woman isoimmunized to Cromer antigen, a high-frequency antigen, is reported. Neither of her two Cromer antigen-positive infants was affected with hemolytic disease of the newborn. Autologous blood or that from a compatible Cromer antigen-negative relative may be frozen and stored for possible transfusion in a pregnant woman with anti-Cromer antigen antibodies.

Adult↗
PubMed1994

Aldosterone concentration in normal, growth-retarded, anemic, and hydropic fetuses.

OBJECTIVE: To establish a gestational age reference range for fetal plasma aldosterone concentration and to determine whether anemia, growth retardation, or hydrops are associated with abnormal levels. METHODS: Aldosterone concentration was measured in umbilical venous blood obtained by funipuncture from pregnancies complicated by red blood cell isoimmunization (n = 17), fetal growth retardation (n = 8), and nonimmune hydrops fetalis (n = 17). Values were compared to reference ranges constructed from the study of samples obtained by funipuncture or at elective cesarean delivery from 40 essentially normal fetuses and maternal blood from 33 uncomplicated pregnancies. RESULTS: In the control group, the fetal plasma aldosterone concentration increased linearly with gestation, reaching adult levels at term. In nonimmune hydrops and red blood cell isoimmunization, the aldosterone concentration was increased. In the growth-retarded fetuses, the levels were not significantly different from normals. CONCLUSION: The gestational age-related increase in fetal plasma aldosterone concentration presumably reflects maturation of adrenal function. In certain abnormal pregnancies, fetal aldosterone concentrations increase.

Aldosterone↗
PubMed1989

Fetal cardiac output in the isoimmunized pregnancy: a pulsed Doppler-echocardiographic study of patients undergoing intravascular intrauterine transfusion.

The mechanism of development of hydrops fetalis in severe isoimmunization has been subject to speculation. We performed pulsed Doppler assessment of cardiac output in 13 severely isoimmunized fetuses before and after intravascular transfusion and compared the results with 37 control fetuses between 20 and 34 weeks' gestation. The cardiac index of the anemic fetuses was significantly greater than that of the control group. A significant (right ventricle, p less than 0.01; left ventricle, p less than 0.02) increase in indexed output was noted from both ventricles and in the combined ventricular output (mean +/- SEM 644 +/- 35.3 ml/kg/min in control fetuses versus 879 +/- 86.0 ml/kg/min in anemic fetuses, p less than 0.006). An increase in cardiac output was also noted when anemic fetuses were compared with gestational age-specific norms. We conclude that severely anemic fetuses of isoimmunized pregnancies tend to have significantly higher cardiac output than do unaffected fetuses and that this high output state may play a part in the development of hydrops fetalis.

Blood Transfusion, Intrauterine↗
PubMed1990

Platelet count in normal, small, and anemic fetuses.

A reference range for fetal platelet count with gestation was established from the study of samples obtained by cordocentesis from 229 pregnancies that had prenatal diagnosis. The mean platelet count increased from 187 +/- 47 x 10(9)/L at 15 weeks to 274 +/- 47 x 10(9)/L at 40 weeks' gestation. In 113 red cell-isoimmunized pregnancies, the moderately anemic fetuses were significantly thrombocythenic, whereas the severely anemic fetuses were thrombocytopenic. In 136 small-for-gestational-age fetuses the platelet count was reduced and there were significant correlations between the magnitude of the thrombocytopenia and the degree of fetal smallness, hypoxemia, and acidemia.

Anemia↗
PubMed1988

Diagnostic fetal umbilical blood sampling in the management of isoimmunization.

Current management of isoimmunization in pregnancy is predicted on the assumption that all sensitized women carry antigen-positive fetuses. In addition, management is based on indirect predictors of the magnitude of the fetal hemolytic disease. We present a preliminary report using a new approach of direct fetal blood sampling for the diagnosis and treatment of these patients. This form of evaluation provides specific information about fetal red blood cell antigen status and the degree of fetal anemia at an earlier gestational age than that validated by the Liley curves and eliminates empiricism from both the diagnosis and treatment of the isoimmunized pregnancy. The use of such a management protocol reduces the need for multiple invasive procedures in fetuses at little risk for disease and provides specific information about the status of those fetuses truly at risk.

Blood Group Incompatibility↗
PubMed1989

Amniotic fluid prolactin levels in rhesus isoimmunized patients.

The concentration of prolactin in the amniotic fluid (AFPRL) was measured in 75 samples obtained in the third trimester of 14 isoimmunized women. There was a uniform decline in prolactin levels with advancing gestation in each pregnancy (r = -0.89 to -0.99). The decline in AFPRL was similar in uncomplicated pregnancies. AFPRL levels were not predictive of umbilical cord hemoglobin or bilirubin levels and amniotic fluid lecithin/sphingomyelin ratio.

Amniotic Fluid↗
PubMed1989

Improved fetal survival with small volume plasmapheresis in Rhesus disease.

Fifty pregnant multiparas with Rhesus isoimmunization were treated by small volume plasmapheresis initiated at the end of their first trimester. Forty mothers were successfully delivered at 31-38 weeks of babies that survived. There were ten fetal losses, six of these were stillborn, and there were three neonatal deaths, and one abortion. This fetal survival rate is acceptable, and plasmapheresis remains an alternative therapy in locations where immunoprophylaxis is not common.

Coombs Test↗
PubMed1997

Clinical biological features of Ballantyne syndrome and the role of placental hydrops.

Ballantyne syndrome was first described in association with severe hydrops fetalis caused by rhesus isoimmunization, and lately, in association with diverse etiologies of nonimmunological severe fetal hydrops. This report is a case of typical Ballantyne syndrome in association with lethal hydrops fetalis caused by Ebstein's anomaly. It is likely that any severe fetal hydrops with massive placental hydrops may produce Ballantyne syndrome. Hemodilution could be the main biological feature, differentiating Ballantyne syndrome from usual preeclamptic syndromes. Pathophysiological hypotheses are discussed.

Adult↗
PubMed1986

Intrauterine intravascular transfusions for severe red blood cell isoimmunization: ultrasound-guided percutaneous approach.

Eight pregnancies with severe red blood cell isoimmunization were managed with use of an intravascular approach for intrauterine transfusions. Fetoscopy was not employed, and the procedures were performed percutaneously under direct ultrasound visualization. A total of 16 of 18 attempted transfusions were successfully performed, with four fetuses requiring more than one transfusion. Technical aspects of the procedure as well as its indications, advantages, and drawbacks are discussed.

Adult↗
PubMed1994

Umbilical venous pressure in normal, growth-retarded, and anemic fetuses.

OBJECTIVE: Our purpose was to establish a reference range with gestation for umbilical venous blood pressure and to examine possible changes in intrauterine growth retardation and red blood cell isoimmunization. STUDY DESIGN: Umbilical venous pressure was measured at cordocentesis in pregnancies complicated by intrauterine growth retardation (n = 20) and red blood cell isoimmunization (n = 61) both before and after intravascular fetal blood transfusion. The values were compared with a reference range that was constructed from the study of 111 pregnancies undergoing prenatal diagnosis at 18 to 40 weeks' gestation. RESULTS: In the control group the mean umbilical venous pressure increased significantly with gestation. In the growth-retarded fetuses umbilical venous pressure was higher, normal, or decreased, and there was no significant association between umbilical venous pressure and either fetal size or degree of acidemia. In the pregnancies complicated by red blood cell isoimmunization umbilical venous pressure increased with anemia but decreased to normal in the most severely anemic and hydropic fetuses. After intravascular blood transfusion umbilical venous pressure in proportion to the improvement in fetal hemoglobin concentration. CONCLUSION: Umbilical venous pressure is not the equivalent of central venous pressure but reflects both left and right heart function and placental resistance.

Case-Control Studies↗