Cases reported "Erythroblastosis, Fetal"

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1/83. Severe hemolytic disease from rhesus anti-C antibodies in a surrogate pregnancy after oocyte donation. A case report.

    BACKGROUND: Maternal sensitization with rhesus anti-C antibodies is comparatively rare and usually benign. In pregnancies conceived using donor oocytes, the mother's blood group may differ from that of both the father and the oocyte donor, making blood group incompatibility more likely. CASE: twins, the result of a surrogate pregnancy using donor oocytes, were born with severe hemolytic disease due to rhesus anti-C antibodies. Both infants required exchange transfusion for profound anemia at birth. Isoimmunization in the surrogate mother was not detected antenatally. The twins were delivered by emergency cesarean section due to fetal compromise, detected fortuitously when the mother attended for routine fetal assessment at 35 weeks' gestation. CONCLUSION: Isoimmunization with anti-C antibodies is not always benign and may cause significant hemolytic disease. With the success of in vitro fertilization and oocyte donation, more infertile couples may use these methods to conceive, with or without surrogacy arrangements. In such cases, the provision of antenatal care may become a complex matter, involving several parties, and good communication between everyone involved is vital. In pregnancies conceived with donor oocytes, there may be a higher risk of blood group incompatibility, and special vigilance is warranted.
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2/83. Anti-G in a pregnant patient.

    BACKGROUND: Anti-G is a red cell (RBC) antibody of the Rh system. It has been described in pregnant women only in association with anti-D or anti-C; therefore, the ability of this antibody alone to cause hemolytic disease of the newborn is uncertain. One case in which this antibody caused no clinical sequelae is reported. CASE REPORT: The patient was a 35-year-old primigravida with type O, D-, C-, E-, c RBCs who was given 4 units of type O, D- allogeneic RBCs and 2 units of autologous RBCs 2 years antepartum. She was found to have anti-D and anti-C by an outside laboratory as part of a routine prenatal work-up. Further evaluation by our laboratory revealed the presence of anti-G and possible anti-C without anti-D. Titers at 22 weeks' gestation were 64 against r'r RBCs and 16 against R2R2 RBCs; these remained unchanged throughout the pregnancy. amniocentesis performed at Weeks 28 and 32 showed no evidence of hemolytic disease of the newborn. A healthy 3.3-kg infant was delivered at 36 weeks' gestation. Prophylactic Rh immune globulin was administered antepartum and postpartum. The infant's RBCs were type O, D , c C-, E-, and the direct antiglobulin test was positive. An acid eluate prepared from the baby's RBCs revealed anti-G. The total bilirubin was 5.5 mg per dL at birth, and the hematocrit was 66 percent. Total bilirubin peaked on Day 5 at 11.9 mg per dL, and no therapeutic intervention was required. CONCLUSIONS: Anti-G alone caused little if any fetal or neonatal hemolysis in this case. Although further study is needed, invasive fetal monitoring may be unnecessary if anti-G is the sole cause of fetomaternal RBC incompatibility.
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ranking = 0.54232494827272
keywords = gestation, pregnancy
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3/83. Use of recombinant human erythropoietin (EPO-alfa) in a mother alloimmunized to the Js(b) antigen.

    erythropoietin (EPO) is a glycoprotein hormone and the principal regulator of erythropoiesis in the fetus, newborn, and adult. EPO-alfa is erythropoietin manufactured by recombinant human dna technology (rhEPO). After counseling, a pregnant woman with anti-Js(b) in her serum was started on rhEPO (600 U/Kg, biweekly) to prevent anemia secondary to serial donations of her blood for fetal transfusions. After a total of 25 rhEPO infusions and autologous donation of 8 units of whole blood, maternal hemoglobin prior to the elective cesarean section at 37 weeks was 11.3 gm/dL. serum EPO concentration was determined in paired maternal and fetal blood samples, before ultrasound guided intravascular transfusions, in this alloimmunized Js(b)-negative and another Rh(D) alloimmunized pregnancy to determine possible correlations between maternal and fetal serum EPO. rhEPO prevented anemia in a patient who donated 8 units of blood from 18-37 weeks of pregnancy without inducing adverse biological effects such as hypertension or thrombotic complications in the placenta. Data presented in this study suggest that EPO does not cross the human placenta.
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ranking = 0.32392778927273
keywords = pregnancy
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4/83. Use of a PCR-based assay for fetal Cw antigen genotyping in a patient with a history of moderately severe hemolytic disease of the newborn due to anti-Cw.

    Anti-Cw is an uncommon cause of clinically significant hemolytic disease of the newborn (HDN). We report an unusually severe case of HDN due to anti-Cw that required phototherapy and exchange transfusion. We also describe a novel PCR-RFLP method for Cw typing of fetal genomic dna that was used for prenatal diagnosis in a subsequent pregnancy. Following PCR amplification of a 163 bp segment of the RHCE gene containing the nucleotide 122 G to A substitution that corresponds to the Cw allele, Cw types were distinguished by TaqI digestion. PCR-RFLP analysis confirmed that the father and previously affected child were Cw-positive. The fetus was Cw-negative, thus excluding HDN in the current pregnancy and obviating the need for further invasive or noninvasive diagnostic procedures for the remainder of the pregnancy. This case illustrates the utility of PCR-based fetal genotype determination in pregnancies at risk of HDN due to uncommon red cell antibodies such as anti-Cw.
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ranking = 0.48589168390909
keywords = pregnancy
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5/83. Intra-uterine transfusion in the management of pregnant women with severe rhesus isoimmunization. II. Results and discussion.

    The results of 51 intra-uterine transfusions in 34 pregnant women with severe rhesus isoimmunization are presented. The survival rate is 56%. Factors influencing the fetal and neonatal mortality are considered, e.g. the gestational age at the initial intra-uterine transfusion, the presence of fetal hydrops, and the interval from the initial intra-uterine transfusion to delivery. The difficulties of the selection procedure are emphasized and it is stated that in some cases intra-uterine transfusion should perhaps not be performed because of a predictable poor fetal prognosis. The significance of accumulating experience is discussed.
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ranking = 0.19018052681818
keywords = gestation
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6/83. Umbilical artery regression: a rare complication of intravascular fetal transfusion.

    BACKGROUND: Intravascular fetal transfusion is an important therapeutic advance but is associated with several complications. Regression of an umbilical artery associated with transfusion is rare. CASE: A case of red blood cell alloimmunization managed by serial transfusions was complicated by functional loss of an umbilical artery during pregnancy. Refractory fetal bradycardia occurred during the last transfusion procedure, requiring emergency preterm cesarean delivery. Coagulative necrosis, thrombosis, and focal calcification of one umbilical artery was confirmed after delivery. CONCLUSION: Umbilical artery regression associated with transfusion therapy is rare and may complicate subsequent fetal transfusions.
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ranking = 0.16196389463636
keywords = pregnancy
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7/83. Benefits and risks of fetal red-cell transfusion after 32 weeks gestation.

    OBJECTIVE: To compare the outcome after intrauterine transfusion (IUT) between fetuses treated before and those treated after 32 weeks gestation. SETTING: National referral center for intrauterine treatment of red-cell alloimmunization in The netherlands. Study DESIGN: Retrospective evaluation of an 11 year period, during which 209 fetuses were treated for alloimmune hemolytic disease with 609 red-cell IUTs. We compared fetal and neonatal outcome in three groups: fetuses only treated before 32 weeks gestation (group A, n=46), those treated both before and after 32 weeks (group B, n=117), and those where IUT was started at or after 32 weeks (group C, n=46). RESULTS: survival rate was 48% in group A, 100% in group B, and 91% in group C. Moreover, fetuses in group A were hydropic significantly more often. Short-term perinatal loss rate after IUT was 3.4% in the 409 procedures performed before 32 weeks and 1.0% in the 200 procedures performed after 32 weeks gestation. CONCLUSION: Perinatal losses were much more common in fetuses only treated before 32 weeks gestation. Two procedure-related perinatal losses in 200 IUT after 32 weeks remain a matter of concern because of the good prospects of alternative extrauterine treatment.
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ranking = 1.5214442145454
keywords = gestation
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8/83. Massive fetomaternal transplacental hemorrhage as a perinatology problem, role of ABO fetomaternal compatibility--case studies.

    BACKGROUND: Massive fetomaternal transplacental hemorrhage is not simply a problem of possible alloimunization in Rh incompatibility but also endangers the fetus (newborn) by massive anemization. Bleeding from placental vessels can occur after small trauma to the gravid uterus with mild or no clinical signs (bleeding or spotting, pain, hypertonus). The rupture of anchoring villi related to early uterine contractions is also possible. In the case of slow blood loss, the fetus reacts by adequate or inadequate compensatory reactions (hydrops fetus). Rapid and massive blood loss is followed by perinatal hypoxic damage and finally death. Our goal was to map out the diagnostic and therapeutic possibilities in regard to specific neonatal care. CASE REPORT: We evaluated four cases of fetomaternal transfusion during a 2-year period with special regard to postpartum adaptation of the newborn and the perinatal outcome. The incidence of adverse outcomes following massive fetomaternal transplacental hemorrhage was 50% (2 of 4). There was one perinatal death and one infant was affected by spastic quadriplegia. CONCLUSIONS: For diagnosis, it is possible to use cardiotocography (decreased variability, sinusoid pattern), ultrasound (biophysical profile) and special hematological tests for quantitative determination of fetal erythrocytes in the maternal blood. For the treatment of such cases one should consider premature termination of pregnancy or intraumbilical transfusion.
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ranking = 0.16196389463636
keywords = pregnancy
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9/83. Treatment with plasmapheresis and intravenous immunoglobulin in pregnancies complicated with anti-PP1Pk or anti-K immunization: a report of two patients.

    BACKGROUND AND OBJECTIVES: In addition to anti-D alloantibody, other antibodies such as anti-K antibody and anti-PP1Pk antibody have been reported to cause severe haemolytic disease of the newborn (HDN). HDN caused by anti-K results not only from destruction of red cells but also from suppression of erythropoiesis. Anti-PP1Pk has been associated with abortion early in pregnancy. We report on two patients, one with anti-PP1Pk and the other with anti-K, who were treated with plasmapheresis and intravenous immunoglobulin (IVIG) during pregnancy in an attempt to reduce the plasma antibody levels. MATERIALS AND methods: The patient with anti-PP1Pk had lost all seven previous fetuses in the first trimester and therefore therapy in this patient was started at 8 weeks of gestation. The second patient had been sensitized to the K antigen through blood transfusion and had had two intrauterine fetal deaths at 26 weeks of gestation with signs of hydrops fetalis. Treatment in this patient was started during the 16th week of pregnancy. RESULTS: As a result of therapy, the antibody titre was reduced in both patients. In the first patient a healthy infant was delivered by Caesarean section at 37 weeks of gestation. The second patient gave birth at 36 weeks of gestation. Neither newborn required exchange transfusion. CONCLUSION: In our two patients, plasmapheresis combined with IVIG proved successful in the management of fetomaternal incompatibilities where the mechanism of fetal loss differs from the classical anti-D.
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ranking = 1.2466137911818
keywords = gestation, pregnancy
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10/83. Severe haemolytic disease of the newborn due to anti-Js(b).

    A case of anti-Js(b) in pregnancy was associated with unexpectedly severe haemolytic disease of the newborn, requiring urgent exchange transfusion. Clinical signs of fetal distress were evident at 35 weeks of gestation in a sixth pregnancy. A Js(b ) baby from a previous pregnancy had been unaffected. This case report illustrates the difficulties of predicting severity on the basis of anti-Js(b) titre, and highlights issues relating to the problems of using reconstituted frozen red cells from the rare red cell bank for exchange transfusion.
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ranking = 0.67607221072727
keywords = gestation, pregnancy
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