A case study published recently in Transfusion highlights the need for a multidisciplinary strategy that may include a mother donating blood for her infant when planning delivery and surgery delivery for infants at risk for hemolytic disease of the fetus and newborn (HDFN).
The study describes a 36-year-old pregnant woman with a rare blood type who is at elevated risk for HDFN. The patient and her partner carry a known sickle cell trait (SCT), and this was the patient’s third pregnancy.
Results of blood tests revealed that the patient has a rare blood type: group O RhD-positive. She is homozygous for the RN haplotype, with anti-Sec, anti-c and ante-e antibodies detected and has not received any prior transfusions.
Read more about the prognosis of HDFN
In her second pregnancy, complications developed that were associated with alloimmunization and slowed intrauterine growth. Routine antibody testing revealed the presence of alloantibodies. Her alloantibody titers were low. Results of middle cerebral artery (MCA) Doppler imaging were normal.
Her second pregnancy resulted in an unremarkable delivery by cesarean section. Because of her rare blood type, the woman donated two frozen red blood cell (RBC) units postpartum.
Mother donates blood for infant’s heart surgery
During her current, third pregnancy, the patient presented to the center at 28 weeks’ gestational age (GA) for assessment of her rare blood type and alloantibodies.
Although findings from MCA Doppler imaging were normal, the use of morphological ultrasound identified the presence of dextro-transposition of a critical cyanotic heart defect that necessitates the performance of neonatal cardiac surgery.
An elective cesarean section was scheduled at 39 weeks’ GA, followed by neonatal cardiac surgery with cardiopulmonary bypass support shortly thereafter. Crossmatched RBC units needed to be compatible because of the probability of passive transfer of maternal alloantibodies to the fetus.
Because of the rarity of the mother’s genotype, no compatible blood donor was identified in the provincial and national donor-registry. Thus, three blood donations were collected from the mother in her third trimester. The first maternal donation was obtained at 30 weeks’ GA, followed by additional donations at 37 weeks’ and 38 weeks’ GA. An additional unit of blood was obtained postpartum.
The baby experienced some issues with hemolytic anemia. He was rehospitalized and received several transfusions. His hemoglobin level increased appropriately.
The value of a multidisciplinary approach
Many obstacles needed to be overcome in this case, including the rarity of Sec-donors, organizing directed donations throughout the pregnancy, processing units from donors with SCT, scheduling the inventory and managing the expiration dates of the blood units needed for the newborn’s surgery.
These efforts require the mobilization of numerous resources by the supplier of the donated blood, as well as a close partnership with both the hospital and the mother.
“[A] multidisciplinary approach and effective collaboration between the blood supplier and the blood banks are essential for the successful care of these patients,” the authors stated. “[D]onations during pregnancy despite hemoglobin levels below . . . [the] usual donor cutoff are feasible and relatively safe when planned in advance.”
