Craparo F J, Bonati F, Gementi P, Nicolini U
1st Department of Obstetrics and Gynecology, University of Milano, Ospedale Buzzi, Milano, Italy.
Ultrasound Obstet Gynecol. 2005 Feb;25(2):144-8. doi: 10.1002/uog.1833.
To evaluate the effects of serial intravascular transfusions on RhD-alloimmunized fetuses with ascites/hydrops at the time of the first transfusion by measuring multiple hematological/biochemical blood variables.
Thirty-one singleton pregnancies were referred for management of RhD alloimmunization. Seven fetuses had hydrops on presentation and were transfused immediately. The remainder underwent weekly ultrasound examinations, and fetal blood sampling and transfusion were performed on development of ascites. In the 104 samples collected overall from the 31 fetuses, glucose, uric acid, urea, creatinine, total protein, total and direct bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltransferase, alkaline phosphatase, lactic dehydrogenase, amylase, pseudocholinesterase (PCHE), creatine kinase, triglycerides and cholesterol were measured and compared with a reference range for non-anemic fetuses.
The median gestational age at first transfusion was 26 (range, 18-34) weeks. There were three fetal losses after the first transfusion, two of which were due to procedure-related complications; one further loss occurred. At the first transfusion fetal hematocrit, pO2, total protein, PCHE, creatinine and urea concentrations were significantly decreased compared to reference data, while total and direct bilirubin, AST, ALT, amylase, triglyceride and uric acid concentrations were increased. In all surviving fetuses ascites/hydrops had disappeared by the second transfusion. Fetal pO2, total protein, AST, ALT and PCHE concentrations had normalized by the third transfusion. Correction of fetal anemia did not affect the other variables.
RhD-alloimmunized fetuses with ascites/hydrops at the time of the first transfusion had a survival rate of 87%. Alterations of several biochemical fetal blood indices are present at the first sampling/transfusion, but most variables normalize with intravascular transfusions.
通过测量多项血液学/生化血液指标，评估首次输血时系列血管内输血对患有腹水/水肿的RhD同种免疫胎儿的影响。
31例单胎妊娠因RhD同种免疫而接受治疗。7例胎儿在就诊时出现水肿并立即接受输血。其余胎儿每周进行超声检查，出现腹水时进行胎儿采血和输血。从31例胎儿中总共采集了104份样本，测量了葡萄糖、尿酸、尿素、肌酐、总蛋白、总胆红素和直接胆红素、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、γ-谷氨酰转移酶、碱性磷酸酶、乳酸脱氢酶、淀粉酶、假性胆碱酯酶（PCHE）、肌酸激酶、甘油三酯和胆固醇，并与非贫血胎儿的参考范围进行比较。
首次输血时的中位胎龄为26（范围18 - 34）周。首次输血后有3例胎儿死亡，其中2例死于与操作相关的并发症；又有1例死亡。首次输血时，胎儿血细胞比容、pO2、总蛋白、PCHE、肌酐和尿素浓度与参考数据相比显著降低，而总胆红素和直接胆红素、AST、ALT、淀粉酶、甘油三酯和尿酸浓度升高。在所有存活胎儿中，第二次输血时腹水/水肿已消失。第三次输血时胎儿pO2、总蛋白、AST、ALT和PCHE浓度已恢复正常。纠正胎儿贫血并未影响其他指标。
首次输血时患有腹水/水肿的RhD同种免疫胎儿的存活率为87%。首次采样/输血时存在几种生化胎儿血液指标的改变，但大多数指标通过血管内输血恢复正常。
