Blood transfusion plays a key role in the effective treatment and management of hemolytic disease of the fetus and newborn (HDFN) after a patient is diagnosed.
HDFN is a rare red blood cell disorder that causes your baby’s red blood cells to rapidly break down. It occurs when the blood types of a mother and her baby are incompatible.
HDFN may be detected during your pregnancy or following the birth of your baby. Prompt treatment is critical to prevent serious outcomes in your baby, including severe anemia, hydrops fetalis (swelling of the liver, spleen or heart) and even death.
Prenatal treatment
Improved prenatal screening means HDFN is most often identified during pregnancy. If your baby is diagnosed with HDFN during pregnancy, fetal blood sampling will determine the next steps. If your baby shows moderate to severe anemia or signs of hydrops fetalis, an intrauterine blood transfusion (IUT) will urgently be performed.
New red blood cells collected from donors are injected into your baby’s umbilical cord to prevent or treat anemia. Carried out in aseptic conditions by a multidisciplinary team of experts, the IUT is guided into the umbilical vein by Doppler ultrasound. It may need to be repeated multiple times during pregnancy.
Early delivery of your baby may be recommended or required to pursue further treatment. In many cases, this is by cesarean section.
How safe is IUT?
Intrauterine transfusions are the cornerstone of prenatal management of HDFN. The procedure is considered safe and effective, and its use has significantly increased perinatal outcomes. In recent years, perinatal survival rates of over 90% have been reported.
As with most surgical interventions, there are some inherent risks to be aware of. Risks associated with IUT may include fetal distress, fetal infection, fetal bradycardia (low heart rate), hemorrhaging at the puncture site, uterine infection, amniotic fluid leakage, preterm labor, preterm birth and, more rarely, fetal death.
These risks have been shown to increase when IUT is performed before 20-22 weeks gestation. Less invasive alternatives are being trialed to replace the early use of IUT.
What happens after birth?
Once your baby is born, he or she will be kept in intensive care to monitor any remaining symptoms. If large amounts of bilirubin are present, these may include anemia, jaundice, or an enlarged spleen and/or liver or swelling of the body (due to hydrops fetalis).
Newborns with ongoing symptoms will usually receive phytotherapy and intravenous fluids. Other treatments for severe anemia include blood transfusion, intravenous immunoglobulin and exchange transfusion.
Intravenous immunoglobulin refers to a fluid made from blood plasma containing antibodies from blood donors that is injected into your baby. It helps lower your baby’s bilirubin levels, which increase as red cells break down.
Less frequently used is an exchange transfusion, which is required in severe cases of HDFN in newborns. This procedure involves removing your baby’s blood and replacing it with a donor’s blood. It is required to rapidly decrease bilirubin levels and remove antigen-positive red blood cells.
Postnatal treatment
In some cases, HDFN is not identified until after your baby is born. Here, treatment will also most likely include blood transfusion, depending on severity.
If your baby is born with anemia, jaundice or hydrops fetalis, blood tests will be done to assess your baby’s condition. Treatment options are the same as for newborns who have been treated in utero—phytotherapy, intravenous fluids, blood transfusion, intravenous immunoglobulin and exchange transfusion.
Once your baby has been discharged, a top-up transfusion may be required at 3-4 weeks of age.
