Sonographic findings in severe fetomaternal transfusion.

Fetomaternal hemorrhage (FMH) or fetomaternal transfusion syndrome is the leakage of fetal red blood cells into the maternal circulation. Massive FMH can cause substantial fetal morbidity and mortality. Sonographic evidence of severe FMH syndrome includes fetal hydrops and other fetal anemia-related findings. The peak systolic velocity in the middle cerebral artery has extensively been used for the prediction of fetal anemia and for the timing of the first intrauterine intravascular transfusion (IIVT). We present a case of severe FMH syndrome that was diagnosed during the 24th week of pregnancy. A total of eight IIVT were performed. The actual increase in the fetal Hb after each transfusion was much lower than the expected. At 27 weeks of gestation, sonographic evaluation revealed areas of echogenicity around the posterior horns of the lateral ventricles suggesting ischemic damage. Due to these findings, no further IIVTs were offered and the fetus died a week later. The management of fetal anemia caused by severe FMH is difficult, and the anemic fetuses do not respond well to serial IIVTs as the transfer of blood to the maternal circulation continues.

Blood component therapy.

The blood component support in pediatric patients is more challenging as compared to adult patients, as such, a thorough understanding of various blood components and indications for each is critical when making the decision for transfusion. Transfusion needs in pediatric group parallel the changes that accompany the transitions from fetus to neonate, neonate to infant, and throughout childhood. Modified or unmodified blood components viz. red blood cells, platelets, granulocytes, fresh frozen plasma and cryoprecipitate are required for transfusion support in pediatric population. In general, fetuses and infants younger than 4 months of age have specialized transfusion requirements whereas transfusion of infants older than 4 months and children parallels those for adults. Transfusion practices differ widely among pediatric care units depending upon individual preferences, hospital transfusion policy and resource availability. There is a need to implement best transfusion practices and despite the lack of firm evidences, existing pediatric transfusion guidelines can help pediatric care providers in their decisions related to component transfusion.

Prenatal evaluation and in utero platelet transfusion for thrombocytopenia absent radii syndrome.

A fetus with absent radii in both forearms was discovered on routine ultrasound examination performed at 18 weeks of pregnancy. No other significant abnormalities were found, and no signs of haemorrhage were detected. Serial ultrasound examinations revealed no evidence of fetal internal bleeding. At 37 weeks of pregnancy, a CBC obtained by cordocentesis under ultrasound guidance confirmed the diagnosis of thrombocytopenia absent radii (TAR) syndrome. Apheresis platelets were transfused into the umbilical vein to correct the thrombocytopenia and was followed by an uncomplicated delivery. No bleeding was encountered during the remainder of the baby's neonatal course. We conclude that TAR syndrome can be readily identified prenatally on sonogram, and if severe thrombocytopenia is confirmed by cordocentesis, platelets should be transfused to diminish the risk of serious internal bleeding during and immediately after delivery.