Evaluation of Gasometric Behavior of Transfused Fetuses in Alloimmunized Pregnant Women According to the Concentration of Circulating Adult Hemoglobin
Journal Title: Interventions in Gynaecology and Women’s Healthcare - Year 2018, Vol 1, Issue 4
Abstract
Introduction: Perinatal hemolytic disease occurs due to the passage of antibodies from maternal to fetal circulation through the placenta; this leads to fetal erythrocytes hemolysis and death (in extreme cases). Regarding the treatment by intrauterine transfusion, little is known about the effect of the concentration of transfused adult red blood cells on the hemodynamics and gas exchanges in the fetal blood. Objective: to compare the gasometric values between fetuses with gradual elevation of adult hemoglobin (HbA) concentration after intrauterine transfusion and anemic fetuses with only fetal hemoglobin (HbF). Methods: a longitudinal observational study was carried out from 1998 to 2015 with 365 transfusions performed on 143 fetuses. The HbF concentration was determined by the Kleihauer-Betke test and pH, pCO2, pO2, SatO2, HCO3 and BE values were obtained from umbilical cord venous blood. The cases were ordered according to the deficit of Hb concentration in comparison with normality curve given for each gestational age. Results: the gradual substitution of fetal by adult red blood cells did not significantly influenced the gasometric parameters for both Hb deficit lower than 5 g/dL [pH (p=0.958), pCO2 (p=0.400), pO2 (p=0.493), SatO2 (p=0.698), HCO3 (p=0.495) and BE (p=0.522)] and higher than 5 g/dL [pH (p=0.601), pCO2 (p=0.065), pO2 (p=0.770), SatO2 (p=0.096), HCO3 (p=0.096) and BE (p=0.525)]. Conclusions: Due to the existence of a hematological system with great capacity of metabolic balance, no associations between gasometric parameters and the percentage of HbF replacement were observed; this, regardless the degree of anemia resulted from Hb deficit. The incidence of Rhesus (Rh) alloimmunization has decreased following the implementation of prophylaxis programmes with anti-D immunoglobulin (Ig); however, it continues to be a cause of perinatal morbidity and mortality due to lack and/or failure of prophylaxis. In addition, some fetuses are affected by this hemolytic disease due to maternal sensitization by other atypical antigens [1]. A fetus with anemia becomes able to withstand extremely low levels of hemoglobin (Hb) due to the maintance of blood circulation through the placenta; however, the severity of this condition results in depletion of the depurative capacity of the placenta [2]. Among invasive procedures for treatment of anemia, intrauterine transfusion by cordocentesis allows the replacement of large quantities of adult red blood cells (RBC) [3]. The volume of transfused blood leads to an expansion of fetoplacental circulation, increases the concentration of adult RBC; thus, there is a consequential reduction of venous return and changes in the physical characteristics of fetal blood that is replaced by adult RBC. In comparison with fetal erythrocytes, adult RBC present lower volume, higher rigidity, decreased oxygenation capacity and increased propensity to aggregate when present in the fetal circulation [4].
Authors and Affiliations
Naeme José de Sá Filho, Alamanda Kfoury Pereira
Keywords
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- EP ID EP570041
- DOI 10.32474/IGWHC.2018.01.000116
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