Several features of newborns following intrauterine intravascular blood transfusion for fetal hemolytic disease caused by anti-D alloimmunization

Abstract

Background: Early detection and intervention for fetal hemolytic disease are essential to prevent severe complications. This study evaluates the antenatal and postnatal clinical and laboratory characteristics of newborns who underwent intrauterine intravascular transfusion due to anti-D-induced hemolytic disease. Study Design and Methods: Twenty newborns who received intrauterine transfusions between 18 and 35 weeks of gestation were included. Data on maternal history, transfusion frequency, birth anthropometrics, ABO blood group, D typing, laboratory findings, morbidities, and hospitalization duration were analyzed. Results: Thirteen cases (65%) had anti-D antibody titers ≥1:1024. Intrauterine transfusions were administered once in 55% of cases, twice in 15%, and three or more times in 30%, with a mean gestational age of 29.6 ± 2.3 weeks. The mean birth weight and gestational age were 2478.7 ± 222.03 g and 35.6 ± 2.08 weeks, respectively. Severe hyperbilirubinemia requiring treatment was present in 50% of newborns, while 50% exhibited anemia-related complications. Hypoxic–ischemic encephalopathy and intracranial hemorrhage were observed in 55% and 45% of cases, respectively. Exchange transfusions were required in 65% (once) and 10% (twice) of cases. All newborns received standard hemolytic disease treatments, including high-intensity phototherapy (94.3 ± 22.4 h), infusion therapy (packed red cell transfusions, 10 mL/kg, 8 ± 2 times), and intravenous immunoglobulin (0.5–1 g/kg, 6 ± 1 times). Conclusion: Newborns with anti-D-alloimmunization-induced hemolytic disease requiring intrauterine transfusion demand intensive neonatal care to manage anemia, hyperbilirubinemia, hypoxic–ischemic encephalopathy, and intracranial hemorrhage.