ABSTRACT
Objectives: Haemolytic disease of the fetus and newborn [HDFN] causes hydrops fetalis. The successful treatment of HDFN has been reported with intrauterine blood transfusion [IUT]. This study aimed to describe the initial experience with IUT procedures in Oman
Methods: This retrospective observational study took place at the Royal Hospital and Sultan Qaboos University Hospital Blood Bank, Muscat, Oman, and included all women who underwent IUT procedures in Oman between March 2012 and March 2016. Gestational and neonatal outcomes were assessed, including complications, morbidity, neurodevelopmental sequelae and mortality
Results: A total of 28 IUT procedures for 13 fetuses carried by 11 women were performed. Gestational age at the time of referral ranged from 13-30 weeks, while the median gestational age at first IUT procedure was 26 weeks [range: 19-30 weeks]. Indications for the procedure included HDFN caused by anti-D [n = 6], a combination of anti-D and anti-C [n = 4], anti-K [n = 1] and anti-Jsb [n = 1] antibodies and nonimmune hydrops fetalis due to a congenital parvovirus infection [n = 1]. Median fetal haemoglobin levels at the beginning and end of the procedure were 4.6 g/dL and 12.8 g/dL, respectively. Most procedures were transplacental intravascular transfusions through the placental umbilical cord root [71.4%], followed by transamniotic intravascular transfusions [14.3%]. The overall survival rate was 61.5%, with five deaths; of these, four were intrauterine and one was an early neonatal death due to non-resolved hydrops and severe cardiac dysfunction
Conclusion: As a relatively novel obstetric procedure in Oman, IUT seems to result in a favourable outcome for hydropic fetuses
ABSTRACT
The recognition and management of transfusion reactions [TRs] are critical to ensure patient safety during and after a blood transfusion. Transfusion reactions are classified into acute transfusion reactions [ATRs] or delayed transfusion reactions, and each category includes different subtypes. Different ATRs share common signs and symptoms which can make categorisation difficult at the beginning of the reaction. Moreover, TRs are often under-recognised and under-reported. To ensure uniform practice and safety, it is necessary to implement a national haemovigilance system and a set of national guidelines establishing policies for blood transfusion and for the detection and management of TRs. In Oman, there are currently no local TR guidelines to guide physicians and hospital blood banks. This paper summarises the available literature and provides consensus guidelines to be used in the recognition, management and reporting of ATRs