Prediction of the intensity of postnatal hemolysis in newborns with hemolytic disease by the Rh-factor, who received intrauterine transfusion of donor erythrocytes

• Evgenia V. Uretskaya
• Anna A. Lenyushkina
• Polina A. Uvarenkova
• Olga A. Krogh-Jensen

Abstract

Currently, intrauterine transfusion (IUT) is the standard of treatment for severe forms of fetal hemolytic disease (HDF). Owing to this method, in recent years, there has been a significant decrease in the incidence of severe forms of Rh-mediated hemolytic disease of the newborn (HDN). It changes the HDF pathogenesis, allowing the continuation of the pregnancy, and besides this significantly affects the postnatal picture of the disease. In this connection it's necessary to determine the most informative predictors of the intensive postnatal hemolysis which would allow to predict the severity of HDN and choose the optimal neonatal treatment after IUTs. Literature analysis has shown that there are several criteria: antenatal (assessment of antibody cytotoxicity, amount of IUTs, bilirubin level at the last IUTs) and postnatal criteria (fetal hemoglobin fraction, reticulocytes level in peripheral blood, and direct Coombs' test after birth). The most informative and clinically available predictors are the fetal hemoglobin fraction of more than 40-50%, determined by Kleinhower-Betke test or an automatic blood analyzer; the reticulocyte count of >100x10⁹ and a positive direct Coombs' test after birth.

Keywords:alloimmunization, red blood cell antibodies, Hemolytic disease of the fetus and newborn, fetal anemia, intrauterine transfusion, predictors of intensive hemolysis, fetal hemoglobin fraction, reticulocytes, direct Coombs' test, exchange transfusion

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