A cohort study of 20 pregnancies complicated by hemolytic disease of the fetus and newborn (HDFN) recently published in Transfusion highlighted the correlation between early diagnosis and favorable outcomes.
“This study highlights the necessity of early diagnosis and timely intrauterine transfusions for managing fetal anemia caused by anti-D alloimmunization,” the authors wrote.
The study aimed to analyze the clinical characteristics and outcomes of 20 newborns who received intrauterine blood transfusions due to HDFN at Fethi Sekin Research and Education Hospital, Elazig, Turkey, between 2019 and 2020.
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All included pregnancies received standard obstetric care and were uneventful until the HDFN diagnosis. More than 50% of the mothers had a history of previous miscarriage.
Intrauterine blood transfusions were performed between gestational weeks 25 and 34. Eleven cases required only one transfusion, three cases required two transfusions, and six cases required three or more.
Regarding HDFN-related complications after birth, the authors observed that 50% of the newborns presented with anemia and elevated bilirubin levels at birth (hyperbilirubinemia). The average birth weight and gestational age were below normal limits. Notably, 45% experienced intracranial hemorrhage (ICH), and 55% presented with hypoxic-ischemic encephalopathy (HIE). Over 40% of the patients had low platelet counts (thrombocytopenia) and required frozen plasma treatment.
The authors noted that the results are consistent with previous research suggesting that severe anemia increases the risk of these complications in fetuses undergoing intrauterine transfusions.
All patients requiring treatment received standard care for hyperbilirubinemia and anemia. However, long-term outcomes and sequelae were beyond the scope of the study.
“Newborns with hemolytic disease of the fetus caused by anti-D alloimmunization who have received intrauterine transfusions must be closely monitored in at least a tertiary-level neonatal intensive care unit for complications such as anemia, jaundice, HIE, and ICH,” the authors concluded.
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