Hemolytic Disease of the Fetus and Newborn/Selection of Red Cells for Intrauterine Transfusion

Abstract

Intrauterine transfusion (IUT) is generally used to treat severe fetal anemia and on rare occasions fetal thrombocytopenia. The major indication for IUT and cause of fetal anemia is hemolytic disease of the fetus and newborn (HDFN). HDFN is caused by destruction of fetal red blood cells (RBCs) by maternal alloantibodies directed against a paternally inherited red cell antigen. The identification and appropriate monitoring of maternal antibodies capable of causing HDFN is critical for directing the need for fetal monitoring and possible intervention with IUT. Blood products for IUT should be compatible with maternal plasma, CMV-safe, and irradiated. Generally, RBC units for IUT are also packed by centrifugation to hematocrit (HCT) 65–80%, less than 7 days old and negative for hemoglobin S (HbS). Given the special attributes of the blood product required for IUT, close communication with the transfusion service is needed.