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Abstract

THE EFFECTIVENESS OF INTRAUTERINE BLOOD TRANSFUSION IN TREATING HDFN CAUSED BY RED BLOOD CELL ALLOIMMUNIZATION

Mohammed Abdullah Alshuhoumi*, Suleiman Salim Alghafri and Sumaiya Saif Almamari

ABSTRACT

Background: Hemolytic disease of fetus and newborn (HDFN) due to maternal red cell alloimmunization showed a wide propagation worldwide, causing the increase in rates of mortality and morbidity. Intrauterine transfusion (IUT) is one of several treatments used to treat fetuses with HDFN disease by providing the baby with compatible blood, therefore increases the chance of survival. This research aimed to measure the effectiveness of IUT in relation to the survival chance of affected fetuses and the presence of hydrops by systematically reviewing published articles. Literature review: The way of performing intrauterine transfusion evolved over the years. Initially, blood was transfused into the peritoneum space and currently the blood components are transfused inside the umbilical cord in which absorbed into the fetal circulation. During the past years, a diversity of indications has been qualified, the main indication was RBC alloimmunization. In a retrospective study performed between 1999 and 2013, 87% of all neonates were having hemolytic anemia due to maternal alloimmunization. Pregnancies with HDFN caused by red cell alloimmunization are yearly having an increase in the number of affected fetuses that trigger the involvement of intrauterine blood transfusion. Method: To ensure the validity and reliability of the research, a sound methodology has been established that involved usage of the following measures, authentic sites like PubMed, official journals and most recent articles. The search strategy was based on the usage of keywords and synonyms reflecting the PICO elements of the research topic. Result and discussion: A dramatic enhancement in prognosis of HDFN and neonatal outcomes was accomplished with availability and introduction of IUT. From the various studies included in this research, the Survival chance increased significantly and ranged between 81% and 100%. Currently in experienced hands, procedures related complications are as low as 1.2 % per procedure and loss rate of 0% reported in Pasman et al study. Nevertheless, prevention of fetal loss can be technically approached in cases that required early intravascular IUT, and for that systems need to be established for early referral diagnosis and antibodies detection to prevent or minimize the level of hydrops. Conclusion: Intrauterine blood transfusion is considered safe and effective technique in treating hemolytic disease of fetus and newborn caused by red cell alloimmunization, resulting in improved neonatal outcomes as it associates with lower rates of procedure related complications.

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