Abstract
Intravascular transfusion therapy (IVT) is the accepted treatment for severe rhesus iso-immunisation. The timing and frequency of IVT is controversial, and is currently based on change in fetal haematocrit (Hct). The aims of this study were to measure fetal erythropoietin concentration (EPO), haematocrit and red cell volume following serial (IVT) and to study their inter-relationship as anaemia is corrected.
Methods & Results: Twelve pregnancies were studied with serial data in 4 cases. Pre-transfusion fetal EPO correlated inversely with Hct (R2 31%; p = .004) and fell significantly between IVT 1 and IVT 2 (314 to 31 mU/ml:mean values). Hct fell between IVT1 and IVT 2 (35 to 25% : mean values n=4). Neither fetal, or donor red cell volumes fell during this time, though circulating fetoplacental blood volume increased (179 to 357 mis; mean values n=4).
Conclusions: Fetal EPO is inversely related to Hct, and is suppressed by IVT through increases in total red cell volume. The fall in Hct between IVT 1 and IVT 2 is due to the physiological increase in fetoplacental blood volume rather than destruction of transfused red cells.
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Stewart, G., Kingdom, J., Whittle, M. et al. FETAL HAEMOPOIETIC RESPONSES TO INTRAVASCULAR TRANSFUSION. Pediatr Res 32, 616 (1992). https://doi.org/10.1203/00006450-199211000-00067
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DOI: https://doi.org/10.1203/00006450-199211000-00067