Hemolytic Disease of the Fetus and New-born and Intrauterine Blood Transfusion among Palestinian Pregnant Women

Abstract

Background: Intrauterine transfusion (IUT) is considered to be the most successful relief of fetal anemia resulting from Hemolytic Disease of Fetus and New-born (HDFN). This study aims to determine the frequencies of RBC alloantibodies that might cause fetal hemolysis and evaluate the perinatal outcome of IUTs in Palestine. Materials and Methods: We conducted a retrospective-cohort study of pregnant women who requited IUT procedure at Al-Makassed Hospital in East Jerusalem. We reviewed Blood-Bank records between 2003 and 2013. Data were collected on all RBC-alloimmunized pregnancies requiring IUTs including the age of pregnant women, blood typing, antibody identification, and antibody titers. Also, we collected clinical data from the patients' files about the obstetric history and current pregnancy. Results: A total of 222 IUTs were performed during the study period in 65 alloimmunized pregnancies. Of all cases, 95.4% were associated with anti-D, 36.9 % with anti-C, and 10.8% with anti-E. Other non-Rh antibodies included mainly Kell, Kidd (10.8%), Luth and Lewis. The median number of transfusions needed per pregnancy was 3. The survival rate in the study was 90% and 27.3% of cases were hydropic; survival rate was significantly higher for fetuses without hydropic fetalis. Conclusions: IUT can improve perinatal outcome in alloimmunized pregnancies. In Palestine, policies should be drawn to introduce this procedure to more Palestinian Hospitals to increase its accessibility to the patients. In addition, secondary prevention of anti-D associated sensitization by rhesus immune globulin to reduce the incidence of HDFN should be more efficaciously implemented.