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Br J Haematol. 2019 May 29. doi: 10.1111/bjh.15962. [Epub ahead of print]

Predicting anaemia and transfusion dependency in severe alloimmune haemolytic disease of the fetus and newborn in the first 3 months after birth.

Author information

1
Centre for Clinical Transfusion Research, Sanquin, Leiden, the Netherlands.
2
Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, Leiden, the Netherlands.
3
Department of Immunohaematology and Blood Transfusion, Leiden University Medical Centre, Leiden, the Netherlands.
4
Department of Immunohaematology Diagnostics, Sanquin, Amsterdam, the Netherlands.
5
Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands.
6
Department of Obstetrics, Division of Fetal Medicine, Leiden University Medical Centre, Leiden, the Netherlands.

Abstract

Infants with haemolytic disease of the fetus and newborn (HDFN) often require erythrocyte transfusions in the first 3 months of life. We aimed to evaluate the incidence, timing and potential predictors of transfusion-dependent anaemia. An observational cohort of 298 term and near-term infants with severe HDFN treated with or without intrauterine transfusion (IUT) was evaluated. Transfusions were administered to 88% (169/193) of infants with IUT and 60% (63/105) without IUT. The following potential predictors were associated with less anaemia: K compared to D immunisation [odds ratio (OR) 0·13, 95% confidence interval (CI): 0·03-0·55], higher reticulocyte count at birth [per 10 parts per thousand (‰) higher, OR 0·99, CI: 0·97-1·00] and exchange transfusion (OR 0·11, 95% CI: 0·03-0·50). Without IUT, these variables were: lower reticulocyte count at birth (per 10‰ lower, OR 1·02, 95% CI: 1·00-1·03), lower maximum bilirubin after birth (per 10 μmol/l lower, OR 1·01, 95% CI: 1·01-1·02) and exchange transfusion (OR 0·07, 95% CI: 0·01-0·20). In conclusion, potential predictors for anaemia in infants with severe HDFN varied between infants treated with and without IUT and are useful for selecting subgroups of infants at increased risk of anaemia.

KEYWORDS:

HDFN ; alloimmunisation; anaemia; newborn; transfusion

PMID:
31140599
DOI:
10.1111/bjh.15962

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