Managing the difficult case of fetal anemia

Abstract

Objectives. To describe a series of complex fetal anemia cases, detail the appropriate investigations and management, and review the literature.

Methods. Four cases of non-red cell alloimmunization or infective cases of fetal anemia are presented.

Results. Of the four cases presented, one was a neonatal death, one pregnancy was terminated, one case was diagnosed with Diamond Blackfan anemia, and one case was due to recurrent feto-maternal hemorrhages despite negative Kleihauer tests.

Conclusions. Non-alloimmune causes of fetal anemia can be difficult to manage. Some cases require repeated and frequent intrauterine transfusions. The perinatal mortality and preterm delivery rates are increased, and some cases require considerable long-term treatment including regular transfusions. We present our experience of a series of non-immune fetal anemia managed in a tertiary unit, review the literature, and suggest appropriate management.

Keywords:

• Fetal anemia
• fetal blood sampling
• non-immune hydrops
• red cell abnormalities
• feto-maternal hemorrhage

Acknowledgements

The authors wish to thank Mrs. Sheila Jacques and Ms. Marcia Wilson for their help in obtaining case notes and help with patient follow-up.

Declaration of interest:

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.