Egberts J, van Kamp I L, Kanhai H H, Meerman R H, Giordano P C, Gravenhorst J B
Department of Obstetrics and Gynaecology, Leiden University Medical Centre, The Netherlands.
Br J Obstet Gynaecol. 1997 Jul;104(7):818-24. doi: 10.1111/j.1471-0528.1997.tb12026.x.
To determine the proportional reduction per day in the number of fetal and donor red blood cells from the fetal circulation after intrauterine intravascular transfusions.
A retrospective study of 302 transfusions in 101 fetuses.
The Department of Obstetrics and Gynaecology of the University Medical Centre Leiden, The Netherlands.
We measured the haematocrit in fetal samples both before and after repeated intravascular intrauterine transfusion in fetuses with alloimmune disease. The percentage of fetal erythrocytes was determined in Kleihauer-Betke stained smears. The decline of fetal, donor and mixed red blood cells was calculated by dividing the proportional decrease of the haematocrit values of the number of days between transfusions, also after correction for changes in fetoplacental volumes. Results (given as mean [SD]) are derived from the proportional changes of haematocrit per day.
The interval between the first and second transfusion (15.5 days [SD 5.2]) was shorter than between subsequent transfusions (means ranging from 21.4 to 21.9 days; P < or = 0.0001). The decline per day of mixed, and of donor red blood cells, calculated without corrections for volume changes did not differ from those corrected for volume changes resulting from the transfusion and from fetal growth (correction factor 1.1 [SD 0.4]). Since the coefficient of variance is smaller for the uncorrected decline values, this type of calculation is preferable for clinical purposes. The disappearance of fetal erythrocytes after the first transfusion (6.1%/day [SD 2.9]) was faster than that of mixed fetal and donor red blood cells (3.2%/day [SD 1.2]; P < 0.0001) and of donor cells alone (1.4%/day [SD 1.6]; P < 0.0001). The decline of the mixed red blood cell population became the same as that of the donor cells (2.2%/day [SD 0.8]) after the second transfusion. This decline of donor cells was higher than after the first transfusion (1.4%/day [SD 1.6]; P < 0.05). After the first transfusion the fetal erythrocytes disappeared faster after transplacental puncture of the umbilical cord (6.6%/day [SD 2.8]) than after transamniotic punctures (5.4%/day [SD 2.7]; P = 0.05). The mixed red blood cell also decreased faster (3.5%/day [SD 1.3] versus 2.8%/day [SD 0.9]; P < 0.01).
The fast disappearance of fetal erythrocytes, especially after transplacental punctures, shows that the interval between the first and second transfusion needs to be shorter than that for intervals between subsequent transfusions. The number of donor erythrocytes declines by approximately 2% per day.
确定宫内血管内输血后胎儿循环中胎儿和供体红细胞数量每天的比例减少情况。
对101例胎儿的302次输血进行回顾性研究。
荷兰莱顿大学医学中心妇产科。
我们在患有同种免疫疾病的胎儿进行反复宫内血管内输血前后，测量胎儿样本中的血细胞比容。在Kleihauer-Betke染色涂片上测定胎儿红细胞的百分比。通过将输血间隔天数的血细胞比容值的比例下降除以输血间隔天数，同时校正胎儿胎盘体积的变化，计算胎儿、供体和混合红细胞的下降情况。结果（以平均值[标准差]表示）来自血细胞比容每天的比例变化。
第一次和第二次输血之间的间隔（15.5天[标准差5.2]）短于后续输血之间的间隔（平均值在21.4至21.9天之间；P≤0.0001）。在未校正体积变化的情况下计算的混合红细胞和供体红细胞每天的下降与校正因输血和胎儿生长导致的体积变化后的下降没有差异（校正因子1.1[标准差0.4]）。由于未校正下降值的方差系数较小，这种计算类型更适合临床应用。第一次输血后胎儿红细胞的消失速度（6.1%/天[标准差2.9]）快于混合胎儿和供体红细胞（3.2%/天[标准差1.2]；P<0.0001）和单独供体红细胞（1.4%/天[标准差1.6]；P<0.0001）。第二次输血后混合红细胞群体的下降与供体红细胞相同（2.2%/天[标准差0.8]）。供体红细胞的这种下降高于第一次输血后（1.4%/天[标准差1.6]；P<0.05）。第一次输血后，经脐带动脉穿刺的胎儿红细胞消失速度（6.6%/天[标准差2.8]）快于经羊膜穿刺的胎儿红细胞（5.4%/天[标准差2.7]；P=0.05）。混合红细胞下降也更快（3.5%/天[标准差1.3]对2.8%/天[标准差0.9]；P<0.01）。
胎儿红细胞的快速消失，尤其是经脐带动脉穿刺后，表明第一次和第二次输血之间的间隔需要短于后续输血之间的间隔。供体红细胞数量每天下降约2%。
