Maternal ABO-mismatched blood for intrauterine transfusion of severe hemolytic disease of the newborn due to anti-Rh17

• Published in: Transfusion (Philadelphia, Pa.) Vol. 44; no. 9; pp. 1357 - 1360
• Main Authors: Denomme, G.A., Ryan, G., Seaward, P.G.R., Kelly, E.N., Fernandes, B.J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK and Malden, USA Blackwell Science Inc 01.09.2004; Blackwell Publishing
• Subjects: ABO Blood-Group System - immunology; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Group Incompatibility; Blood Transfusion, Intrauterine; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Cesarean Section; Erythroblastosis, Fetal - embryology; Erythroblastosis, Fetal - genetics; Erythroblastosis, Fetal - immunology; Erythroblastosis, Fetal - therapy; Female; Fetal Distress - etiology; Genotype; Humans; Hydrops Fetalis - diagnostic imaging; Hydrops Fetalis - embryology; Hydrops Fetalis - etiology; Hydrops Fetalis - therapy; Infant, Newborn; Jaundice, Neonatal - etiology; Jaundice, Neonatal - therapy; Male; Medical sciences; Parity; Phenotype; Phototherapy; Pregnancy; Rh Isoimmunization - immunology; Rh-Hr Blood-Group System - immunology; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Ultrasonography; Newborn diseases; Transfusion
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/j.1537-2995.2004.04082.x

BACKGROUND:  Clinically significant antibodies to high‐incident antigens present a challenge in hemolytic disease of the newborn. Antigen‐negative blood may be difficult to obtain for intrauterine transfusion (IUT). In these instances, maternal blood is de facto compatible regardless of an ABO mismatch. CASE REPORT:  A group B/D‐‐ woman with a history of hemolytic disease of the newborn due to anti‐Rh17 (titer 256) presented to the obstetrical clinic at 12 weeks gestation for management of her third pregnancy. She consented to donate blood for possible IUT. STUDY DESIGN AND METHODS:  Washed maternal packed cells were suspended in saline to 75 percent Hct and irradiated before transfusion. The fetus was transfused via the intrahepatic vein. RESULTS:  Ultrasound examination at 19 weeks indicated a hydropic fetus. The fetal blood group was O Rh+, direct antiglobulin test 4+, and hemoglobin 22 g per L. A total of 368 mL of maternal blood was transfused during seven procedures. Labor was induced at 38 weeks, and a 2560‐g male infant was delivered by Caesarian‐section due to fetal distress. The infant grouped as B Rh+, direct antiglobulin test negative. No group O red blood cells were detected. The hemoglobin level was 143 g per L rising to 209 g per L at discharge 3 days later. The indirect bilirubin was 55 µmol/L and remained stable during the hospital stay. Phototherapy was discontinued after 1 day, and the infant was discharged without an exchange or top‐up transfusion. CONCLUSIONS:  Maternal ABO‐mismatched blood is an alternate source for IUT in instances when antigen‐compatible allogenic blood is unavailable.