The practices regarding intrauterine transfusions to treat fetal anemia vary greatly in different health centers, and a set of recommendations for standard practice was recently published in a paper on Transfusion.
An intrauterine transfusion is an invasive procedure in which donor blood or plasma is transferred through the uterus to the fetus during a pregnancy. The objective of the transfusion is to treat fetal anemia due to causes such as hemolytic disease of the fetus and newborn (HDFN) or viral infections.
The procedure is associated with improved survival of fetuses with anemia. However, complications such as hemorrhage, infection and early birth occur in up to 4% of intrauterine transfusions.
Learn more about HDFN treatment and care
“There is significant variability among centers in the United States and internationally with regard to policies and procedures for performing IUT and selecting and modifying blood components,” the authors wrote.
Therefore, after analysis of multicenter perspectives from experts, the authors formulated a list of general recommendations for intrauterine transfusion.
Researchers recommended using maternal medical history to detect pregnancies at risk of fetal anemia, as well as the importance of routine antibody screening for HDFN and the use of ultrasound surveillance for fetal anemia.
The recommendations highlighted the importance of timely and clear communication between all the personnel involved in the transfusion, including physicians, nurses and the blood bank.
Regarding the technical considerations for intrauterine transfusion, the authors recommend performing them after 18 months of gestation. The procedure should be performed in close proximity to an operating room in case an emergency C-section is required. Ultrasound guidance is recommended. The red blood cells selected for an intrauterine transfusion should be as fresh as possible, no more than 7 days after collection.
“The fetus is vulnerable to hemodynamic alterations and transfusion-related adverse events; therefore, special consideration must be given to blood component selection and modification,” the authors wrote.
