Clinical Characteristics and Outcomes of Intrauterine Blood Transfusion (IUT) for Infectious Etiologies

IF 2.7 2区医学 Q2 GENETICS & HEREDITY

Prenatal Diagnosis Pub Date : 2024-09-14 DOI:10.1002/pd.6671

Jessian L. Munoz, Leticia Benitez, Cara Buskmiller, Ahmed A. Nassr, Michael A. Belfort, Magdalena Sanz Cortes, Roopali V. Donepudi

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引用次数: 0

Abstract

ObjectiveCongenital viral infection may result in fetal anemia and thrombocytopenia. While intrauterine blood transfusions (IUTs) are more commonly performed for Rh alloimmunization, reports using IUT for infection have varying success. Our primary objective was to characterize the outcomes of patients undergoing IUT for infectious etiologies at our center compared with Rh disease.Study DesignThis was a case series of patients undergoing IUT from 2012–2023. Infectious etiologies were identified by maternal serologies and confirmed by amniotic fluid polymerase chain reactions (PCR). Clinical outcomes were obtained from electronic medical records.ResultsDuring the study period, 70 patients underwent IUT, 34% (24/70) for Rh alloimmunization and 17% (12/70) for infection. Those with infectious etiologies were more likely to be diagnosed at earlier gestational ages (22 vs. 25 weeks, p = 0.04), with hydrops (75 vs. 33%, p = 0.03), and thrombocytopenia (27 ± 33 × 103 vs. 163 ± 112 × 103, p < 0.01). Perinatal death was significantly greater in cases of CMV (4/5, 80%) compared to parvovirus (1/7, 14%) or Rh alloimmunization (5/24, 21%) (p = 0.02).ConclusionAnemias and thrombocytopenias related to fetal infection may be indications for IUT. Compared with Rh alloimmunization, IUT in fetal infections was performed significantly earlier, and hydrops were more common at the time of IUT. In the case of CMV, greater rates of IUFD (80%) were observed. Patients should be counseled on the various outcomes by indication.

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感染性病因宫内输血 (IUT) 的临床特征和结果

目的先天性病毒感染可能导致胎儿贫血和血小板减少。宫腔内输血（IUT）更常见于治疗 Rh 同种免疫，而治疗感染的 IUT 成功率却参差不齐。我们的主要目的是对本中心因感染性病因而接受宫内输血的患者的治疗效果进行分析，并与 Rh 病进行比较。感染性病因通过母体血清学鉴定，并通过羊水聚合酶链反应（PCR）确认。结果在研究期间，70 名患者接受了 IUT，34%（24/70）因 Rh 同种免疫，17%（12/70）因感染。感染性病因的患者更有可能在较早孕龄（22 周 vs. 25 周，p = 0.04）、水肿（75 vs. 33%，p = 0.03）和血小板减少（27 ± 33 × 103 vs. 163 ± 112 × 103，p <0.01）时确诊。与副病毒（1/7，14%）或Rh同种免疫（5/24，21%）相比，CMV（4/5，80%）病例的围产期死亡率明显更高（P = 0.02）。与 Rh 同种免疫相比，胎儿感染的 IUT 实施时间明显更早，且 IUT 时肾积水更为常见。在 CMV 感染的情况下，IUFD 的发生率更高（80%）。应就不同适应症的各种结果向患者提供咨询。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Prenatal Diagnosis 医学-妇产科学

CiteScore

5.80

自引率

13.30%

发文量

204

审稿时长

2 months

期刊介绍： Prenatal Diagnosis welcomes submissions in all aspects of prenatal diagnosis with a particular focus on areas in which molecular biology and genetics interface with prenatal care and therapy, encompassing: all aspects of fetal imaging, including sonography and magnetic resonance imaging; prenatal cytogenetics, including molecular studies and array CGH; prenatal screening studies; fetal cells and cell-free nucleic acids in maternal blood and other fluids; preimplantation genetic diagnosis (PGD); prenatal diagnosis of single gene disorders, including metabolic disorders; fetal therapy; fetal and placental development and pathology; development and evaluation of laboratory services for prenatal diagnosis; psychosocial, legal, ethical and economic aspects of prenatal diagnosis; prenatal genetic counseling