Intrauterine transfusions (IUTs) are a cornerstone of treatment for patients with severe hemolytic disease of the fetus and newborn (HDFN). The procedure, which provides red blood cells to the fetus during pregnancy, helps to prevent or treat anemia.
What is an IUT?
During an IUT, a needle is inserted through the pregnant mother’s abdomen to deliver donated red blood cells to the fetus. The donated cells are carefully selected and tested beforehand to ensure compatibility, which helps to avoid any immune reactions.
The most common type of IUT is an intravascular transfusion, where the blood cells are given to the fetus through a vein in the umbilical cord. From there, the cells can be directly absorbed into the fetal bloodstream.
Read more about HDFN treatment and care
IUTs can treat up to 80% of cases of severe HDFN. Additionally, the procedure reduces the risk of hydrops fetalis, a severe complication of HDFN in which fluid accumulates in the organs.
A brief history of IUTs for HDFN
The history of HDFN spans centuries and involves several major medical innovations.
The first documented case of HDFN was believed to be reported in a set of twins in 1609 by a midwife named Luoise Bourgeois. At the time, there were no treatment options available for babies born with HDFN, and the mortality rate was extremely high.
In 1963, Dr. Albert William Liley performed the world’s first successful IUT on a woman named Mrs. E. McLeod. Rather than performing an intravascular transfusion, Dr, Liley delivered the blood cells into the fetus’ abdomen. This technique, known as intraperitoneal transfusion, is still sometimes used today.
By this point, Liley had performed three failed IUTs on other patients. From these failed attempts, he learned that some patients may require multiple transfusions to have a sustained response. This is because even after a transfusion, the maternal antibodies can continue to destroy the newly transfused red blood cells.
The impact of Liley’s work
Following Liley’s success, he received worldwide recognition for his research, with both patients and physicians around the globe reaching out to him for his services.
The success rate of IUTs rose drastically over time, from 39.2% shortly after it was first introduced to 90% by 1990. Today, the success rate of IUTs remains high, with over 95% of patients experiencing a full recovery with no long-term complications.
IUTs are still routinely used today to treat severe cases of fetal anemia during pregnancy. With the advent of novel therapies, our reliance on IUTs to treat HDFN may decrease with time. For now, though, the procedure will continue to be a critical, life-saving option for patients impacted by HDFN.
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