A study reporting changes in survival statistics, complication rates and other relevant statistics regarding hemolytic disease of the fetus and newborn (HDFN) over the last 20 years was recently published in The Journal of Obstetrics and Gynecology of India.
“The aim of the study is to report the outcomes in women undergoing intrauterine transfusions (IUTIntrauterine transfusion A procedure that delivers donor red blood cells to the fetus through the umbilical vein to treat severe anemia caused by HDFN.) for fetal anemiaAnemia A condition that occurs when the body doesn’t have enough healthy red blood cells to carry oxygen to its tissues. In HDFN, anemia occurs when maternal antibodies destroy fetal red blood cells. due to rhesus alloimmunizationAlloimmunization When a person’s immune system develops antibodies against foreign antigens from the same species—such as when an Rh-negative mother’s body forms antibodies against her baby’s Rh-positive red blood cells. over the last two decades, over [three] time periods from 2002 to 2021 and to report the prevalence of minor antibodiesAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. at our center and their effect on perinatal and neonatal outcomes,” the authors wrote.
Researchers gathered data from the Department of Obstetrics and Gynecology from a specialized center in New Delhi, India. The data was divided into three periods: 2002-2007, 2011-2014, and 2015-2021.
Evolution in survival and complication rates
Results showed that the survival rate has remained over 95% since 2001. The authors observed a 24% in hydrops referrals since the first period. Hydrops is a life-threatening delta liquid overload frequently observed in HDFN.
The number of intrauterine transfusions (IUTs) remained stable throughout the three periods. However, the rate of complications associated with IUTs, such as premature membrane rupture, preterm labor and fetal bradycardia, has significantly decreased since 2001.
Increases in antibodyAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. testing
Most HDFN cases are produced by RhD or ABO alloimmunization. Because HDFN due to minor antigensAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. such as K, M and E were not as frequent, testing for minor antigens wasn’t the standard 20 years back.
Researchers reported a significant increase in testing for minor antibodies since 2018. Testing revealed that almost half of the alloimmunized mothers had minor antibodies, alone or in conjunction with RhD antibodies. Pregnancies with double alloimmunization tended to require more IUTs than the rest.
“HDFN still remains a significant problem requiring early surveillance and timely intervention,” the authors wrote. “Although the survival following intervention is quite favorable, it requires intensive management with a robust support from the blood bank.”
