Transfusión fetal intrauterina por hdrops fetal no inmune secundario a anemia por citomegalovirus / Intrauterine Fetal Transfusion non-immune Hydrops Fetales Secondary to Anemia b y Cytomegalovirus

La infección por citomegalovirus (CMV) es la infección congénita más común, con una incidencia de 0.2 a 2.2 % en los recién nacidos vivos. Del 10 al 15% del los recién nacidos infectados son sintomáticos. Los signos clínicos comunes son ictericia, petequias y hepatoesplenomegalia, además de prematuridad, trombocitopenia y anemia. Él diagnóstico fetal se sospecha por ultra - sonografía y se conirma mediante detección de Ig G en muestra tomadas atreves de cordocentesis o amniocentesis. Descripción del caso: Se presenta caso de una embarazada de 35 años de edad, a quien se le realizo a las 34.3 semanas de gestación cordo - centesis diagnostica, por presentar Hidrops fetal NO INMUNE mas anemia fetal severa diagnósticada por velocidad de pico sistólico de la arteria cerebral media, presentando características ultrasonografías, se realizó transfusión intrautero sin ninguna complicación además se llevó el embarazo al término, la evaluación oftalmológica reporto secuelas maculares características de citomegalovirus...(AU)

[Anti-D isoimmunization severe in a twin pregnancy. Case report]. / Isoinmunización grave anti-D en una gestación gemelar. Caso clínico.

Perinatal hemolytic disease occurs secondary to a hemolytic phenomenon of immune origin resulting in fetal or neonatal anemia. A 38-year-old pregnant woman was referred to the Department of high risk Obstetrics, Hospital Universitario La Paz Madrid because of presenting a dichorionic diamniotic twin pregnancy spontaneously, pre-pregnancy diabetes poorly controlled and severe alloinmunization anti-D. Her first pregnancy ended in a normal delivery at term; in the period of 4 years, she has three newborn with 36, 34 and 40 weeks respectively, who die with a week of life. After that, two intrauterine fetal death occur at 26 weeks of gestation. The patient who is RhD negative, suffers anti-D inmunization with a antibody titration of 1/1024 with 14 weeks of gestation. Twelve plasmapheresis, eight doses of anti-D inmunoglobulins and intrauterine transfusions has been the treatment received. A severe anemia is found during the ultrasound control of the middLe cerebral artery peak systolic velocity in both twins since the 16th week. It remains stable thanks to the treatment. Finally at the 28th week of gestation, pregnancy is terminated with a cesarean section. The twins are born alive and premature, but with good general state. The measurement of the middle cerebral artery peak systolic velocity predicts moderate-severe fetal anemia cases, which are the most important in the clinical management because of the need of active treatment or finish the pregnancy.

Hemoglobin concentration is inversely associated with erythrocyte folate concentrations in Colombian school-age children, especially among children with low vitamin B12 status.

BACKGROUND: While the majority of cases of nutritional anemia in developing countries are caused by iron deficiency, other micronutrient deficiencies may also be involved. In Colombia, it was recently reported that 38% of school children were anemic; yet, the rate of iron deficiency was only 3.6%. OBJECTIVE: To determine if micronutrients other than iron were responsible for low hemoglobin concentrations in Colombian school children. METHODS: We examined hemoglobin concentrations in relation to plasma ferritin, vitamin A, vitamin B12, and erythrocyte folate levels in a representative sample of 2812 low- and middle-income children (5-12 years) from Bogotá, Colombia. RESULTS: In multivariate analysis, hemoglobin concentration was positively associated with child's age, mother's age, household's socioeconomic stratum, and family income. Low ferritin was related to 3.6 g/l lower hemoglobin concentration (95% confidence interval=-6.0, -1.3). Unexpectedly, we found an inverse trend in hemoglobin concentration by quartiles of erythrocyte folate; the adjusted hemoglobin concentration difference between the highest and lowest folate quartiles was -6.0 g/l (95% confidence interval=-7.2, -4.9; P for trend <0.0001). This difference was greatest among children with vitamin B12 concentration <148 pmol/l (-11.5 g/l), followed by children with vitamin B12 concentration 148-221 pmol/l (-7.7 g/l), and smallest in children with vitamin B12 concentration >221 pmol/l (-5.7 g/l); P for interaction=0.04. CONCLUSIONS: Hemoglobin concentration is inversely related to erythrocyte folate concentrations in a setting where folate fortification was adopted more than a decade ago. The impact of improving vitamin B12 status on this inverse relationship should be examined.

Influence of fetal anemia on fetal splenic artery Doppler in Rh-alloimmunized pregnancies.

OBJECTIVE: To verify the correlation between fetal splenic artery Doppler velocimetry and fetal hemoglobin (Hb) levels in Rh alloimmunization. METHODS: Splenic artery Doppler peak systolic velocity (PSV) and pulsatility index (PI) were obtained before cordocentesis in rhesus-alloimmunized fetuses. Doppler was performed before 80 cordocentesis in 36 patients between 20 and 35 weeks of gestation. Mild, moderate and severe anemia were defined as a Hb deficit of >or=2, >or=5 and >or=7 g/dl respectively. RESULTS: Anemia was noted in 64% of the fetuses and moderate and severe anemia in 18 and 21%. Splenic artery PSV was higher in groups with moderate (p = 0.001) and severe (p < 0.000) anemia but not in the group with mild anemia (p = 0.189) when compared to non-anemic fetuses. Splenic artery PI was higher only in the severely anemic group (p = 0.001). CONCLUSIONS: The splenic artery PI and PSV are higher in fetuses with severe anemia.

[Doppler ultrasound to detect Rh: a systematic review]. / Ultrasonido doppler para detección rh: una revisión sistemática.

BACKGROUND: Red cell alloimmunization is an important cause of perinatal morbidlity and mortality. Invasive procedures used to diagnose fetal anemia are associated with serious fetal and maternal complications. The development of noninvasive techniques as Doppler ultrasound can help us in the fetal anemia diagnosis. OBJECTIVES: To evaluate the effect of the Doppler ultrasound in prediction of fetal anemia caused by red cell alloimmunization. Strategy search: Relevant studies were identified by reviewing the registry of COCHRANE, and OVID, PROQUEST, MEDLINE and EMBASE data bases from 1966 to 2004. SELECTION CRITERIA: All prospective studies with clinically relevant results with comparison of Doppler ultrasound in fetal umbilical artery, fetal descendent aorta, middle cerebral fetal artery or esplecnic fetal artery with hemoglobin or fetal hematocrit. DATA COLLECTION AND ANALYSIS: Data were extracted from each report. The quality revision of the studies and the data compilation were made by the reviewers. MAIN RESULTS: Eighteen articles were included. Two studies reached the level of evidence 1 for diagnostic tests. The diagnostic tests had variations depending on the different cut-off of each study. Studies with level 1 of evidence reported detection of 100% for moderate to severe fetal anemia. CONCLUSIONS: Implementation of Doppler ultrasound for prediction of fetal anemia in complicated pregnancies with alloimmunization could reduce the number of invasive procedures and therefore its complications. The level of present evidence reveals to us that the studies do not fulfill the criteria of methodological quality.

Tail short variable: characterization of a new mouse mutant, and its possible analogy to certain human vascular disruption defects.

A new mouse mutant, tail short variable (Tsv) produces a reduction deformity of the tail, growth retardation, and, in adults, a mild anemia. Genetic and embryological studies show that on all genetic backgrounds there is variable viability of Tsv/Tsv and Tsv/+ and phenotypic overlap within these and with +/+. A modifier is located to a short segment of chromosome 7, which alters the tail length of Tsv/+ mice up to 15%. The modifier, Tsv, and a coat texture mutant come from the same wild Peru mouse. The tail deformity is associated with, and may be caused by, a vascular disruption of the caudal aorta starting on day 11 of gestation. Thus Tsv appears to be different from each of the thirty known mouse mutants involving the tail. It is suggested that Tsv could be a mouse model for human conditions involving transverse terminal limb defects such as Moebius and de Lange syndromes.