If your baby is diagnosed with hemolytic disease of the fetus and newborn (HDFN) during pregnancy, your healthcare team will react quickly to ensure timely treatment. Depending on the gestational age of your baby at diagnosis, this intervention will be necessary to protect your baby from premature birth.
A common procedure in managing HDFN in utero is an intrauterine blood transfusion (IUT).
HDFN is a rare red cell blood disorder that can occur as a result of the incompatibility of the blood group (ABO) or blood factor (Rh positive or negative) between a mother and her baby. The potential risk of this mismatch will be identified in prenatal blood screening, leading to a protocol of close monitoring and more specialized care during pregnancy and delivery. If left untreated, HDFN can lead to severe fetal anemia, fetal hydrops (swelling of internal organs) and in some rare cases, fetal death.
Learn more about HDFN treatment and care
Potential risks and complications of IUT in HDFN
During pregnancy, your baby’s red blood cell count will be regularly measured to test for anemia. If it drops too low and your baby is at risk of severe anemia, an IUT may be recommended. This procedure injects red blood cells collected from a donor into the baby, via the umbilical cord. It is a delicate procedure that is carried out by a specialized team. During the blood transfusion, the fetus is given pain relief and is immobilized to prevent any movement.
While an IUT is considered a safe and effective treatment, and of benefit to perinatal outcomes in fetuses with HDFN, mild side effects may occur. Severe adverse events may also arise during or after the procedure, though these are uncommon.
Procedure-related complications of IUT include the risk of infection from the donor blood, membrane rupture, preterm delivery, chorioamnionitis (inflammation of the placenta), fetal distress and death. In fetuses younger than 20 weeks gestation, the risk of complications is much higher. At less than 20 weeks, the risk of fetal death due to procedure-related complications is 8.5%, whereas at 20 weeks and over, the risk is 0.9%.
Iron overload, or an excess of iron in the body, is a common side effect of red blood cell transfusions and occurs when the body cannot eliminate the extra iron. The iron builds up in the body and can damage the vital organs. This is common in newborns who undergo an IUT in utero, with 70% of babies with HDFN found to have iron overload at birth. Iron overload is treated with oral iron chelation drugs.
Blood transfusions in neonates with HDFN
Blood transfusions may also be performed in newborns with HDFN to treat severe anemia. This life-saving procedure poses few risks, but side effects from a neonatal blood transfusion may include an allergic reaction, fever and iron overload. More severe adverse events can also occur in rarer cases.
