Intrauterine transfusions (IUTs) are a fundamental part of the treatment of hemolytic disease of the fetus and newborn (HDFN); however, in a recently published study in Vox Sanguinis, researchers stated there is great variability among centers in the preparation and selection of red blood cells for transfusion, thus creating a need for a more standardized approach.
IUTs are usually performed in specialized centers to treat fetal anemia induced by causes such as HDFN, fetal-maternal hemorrhage or thalassemia. Although it is a widely used procedure, the practices surrounding the material selection and preparation can vary significantly among centers, as guidelines are based on personal experience and expert opinion rather than on specialized studies.
“The goal of the present study is to better understand the scope and variation of IUT transfusion practice in Canada related to the selection and preparation of red cells for the procedure, fetal pretransfusion testing and processes for post-transfusion traceability,” the authors wrote.
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Researchers performed a survey in nine specialized centers in Canada; the surveys were followed by a meeting with the directors of the transfusion services to clarify responses. Results showed that each center averaged 100 IUTs per year. In most cases, red blood cell concentrates are less than seven days old, are O negative and have been tested for viruses such as cytomegalovirus.
However, the processes involved in the preparation of red blood cell concentrates and fetal blood sampling and administration are variable. Furthermore, prophylactic antigen matching to prevent maternal alloimmunization has yet to be widely adopted, posing challenges in post-IUT traceability.
Limitations of the study include topic constraints and missing data on specific IUT indications. The researchers called for standardization and national guidelines for IUT practices in Canada.
“This survey reviews current practice and highlights the need for standardized national guidelines regarding the selection and preparation of RBCs for IUT,” the authors concluded.
