1
|
Christensen RD, Bahr TM, Ohls RK, Moise KJ. Neonatal/perinatal diagnosis of hemolysis using ETCOc. Semin Fetal Neonatal Med 2025; 30:101547. [PMID: 39455373 DOI: 10.1016/j.siny.2024.101547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2024]
Abstract
Hemolysis is a pathological shortening of the red blood cell lifespan. When hemolysis occurs in a neonate, hazardous hyperbilirubinemia and severe anemia could result. Hemolysis can be diagnosed, and its severity quantified, by the non-invasive measurement of carbon monoxide (CO) in exhaled breath. The point-of-care measurement is called "End-tidal CO corrected for ambient CO" (ETCOc). Herein we explain how ETCOc measurements can be used to diagnose and manage various perinatal/neonatal hemolytic disorders. We provide information regarding five clinical situations; 1) facilitating a precise diagnosis among neonates presenting with anemia or jaundice of unknown etiology, 2) monitoring fetal hemolysis with serial measurements of mothers during pregnancy, 3) measuring the duration of hemolysis in neonates with hemolytic disease, 4) measuring neonates who require phototherapy, to determine whether they have hemolytic vs. non-hemolytic jaundice, and 5) measuring all neonates in the birth hospital as part of a jaundice-detection and management program.
Collapse
Affiliation(s)
- Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA; Women and Newborns Research, Intermountain Health, Murray, UT, USA.
| | - Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA; Women and Newborns Research, Intermountain Health, Murray, UT, USA
| | - Robin K Ohls
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Kenneth J Moise
- Comprehensive Fetal Care Center at Dell Children's Medical Center and Department of Women's Health, Dell Medical School, Austin, TX, USA
| |
Collapse
|
2
|
Mesarič VA, Bricl I, Hrastar E, Kornhauser Cerar L, Lozar Krivec J, Rus M, de Winter DP, Premru Sršen T. Fetal treatment and long-term neonatal outcomes in severe maternal red cell alloimmunization - a single-centre experience. CASE REPORTS IN PERINATAL MEDICINE 2025; 14:20240040. [PMID: 40491564 PMCID: PMC12147441 DOI: 10.1515/crpm-2024-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 05/23/2025] [Indexed: 06/11/2025]
Abstract
Objectives Haemolytic disease of the fetus and newborn (HDFN) occurs due to maternal IgG alloantibodies that actively cross the placenta and bind to paternally derived fetal antigens on the erythrocytes. The aims of this study were to describe the Slovenian cohort of patients with severe HDFN, who required fetal treatment, to review the fetal treatment strategies, and to describe pregnancy and neurodevelopmental outcomes. Case series presentation Data on patients who developed severe HDFN between 2006 and 2021 and were treated at our institution were collected retrospectively. Primary care pediatricians were contacted regarding neurodevelopmental outcomes of surviving infants. There were 19 pregnancies affected with severe HDFN. The most commonly implicated antigen was RhD. Seventeen children were liveborn. Sixteen fetuses were treated with intrauterine transfusion (IUT). Two children had developmental delay at the corrected age of 2 years. Conclusions In this study, the Slovenian national cohort of severe cases of HDFN is described for the first time. Prevalence of RhD alloimmunization was higher in comparison to the literature. A combined treatment with therapeutic plasmapheresis, immunoglobulins and IUT was successful. Three quarters of newborns were born in the late preterm period. Overall survival rate and long-term neonatal adverse outcomes in our cohort were in line with the literature.
Collapse
Affiliation(s)
- Vita Andreja Mesarič
- Department of Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Irena Bricl
- Blood Transfusion Centre of Slovenija, Ljubljana, Slovenia
| | - Erika Hrastar
- Blood Transfusion Centre of Slovenija, Ljubljana, Slovenia
| | - Lilijana Kornhauser Cerar
- Neonatology Section, Department of Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jana Lozar Krivec
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Neonatology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Miha Rus
- Neonatology Section, Department of Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Derek P. de Winter
- Department of Pediatrics, Division of Neonatology, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
- Department of Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Tanja Premru Sršen
- Department of Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
3
|
Geta T, Atinafu B, Kassa T. Knowledge about Rh-incompatibility and its associated factors among antenatal care recipients in public hospitals of Wolaita zone, 2022: facility-based cross-sectional study. BMJ PUBLIC HEALTH 2024; 2:e000422. [PMID: 40018202 PMCID: PMC11812781 DOI: 10.1136/bmjph-2023-000422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/28/2024] [Indexed: 03/01/2025]
Abstract
Background Lack of awareness about the Rh-incompatibility problem is one of the factors hindering early prevention in Ethiopia. Thus, the objective of this study is to determine what was known about Rh-incompatibility disorders and their associated factors among pregnant women participating in prenatal care in southern Ethiopia. Design setting and participants A facility-based cross-sectional study was employed in four selected hospitals during 1-30 August 2022. The systematic random sampling method was used as a technique of selecting the study participants. The study was performed using a structured questionnaire. The data were coded and entered into EPI DATA V.4.6, and then the analysis was done using SPSS V.23 software program. Adjusted OR with 95% CI was the measurement unit of association between independent variables and outcome variables. The significance level was established as p<0.05. Result 414 women took the survey, which corresponds to a response rate of 98.1%. Of those who responded, only 48% knew their blood group. The study found that 35.3% (95% CI: 31% to 40%) of women had a good knowledge of Rh-incompatibility. Maternal educational level above secondary school, multigravida women, blood type screening in the maternity ward, early counselling on Rh status and Rh-incompatibility and a positive attitude among women were significantly associated with pregnant women's knowledge of Rh-incompatibility. Conclusion The majority of pregnant women had poor knowledge regarding Rh-incompatibility. Therefore, all responsible organisations should focus on expanding pregnant women's knowledge of Rh-incompatibility and the factors significantly associated with knowledge of Rh-incompatibility.
Collapse
Affiliation(s)
- Temesgen Geta
- School of Nursing, Wolaita Sodo University, Wolaita, Ethiopia
| | | | - Tsiyon Kassa
- School of Nursing, Wachemo University, Hossana, Ethiopia
| |
Collapse
|
4
|
Liang Y, Wang T, Zhu W, Wang X, Zhang X, Zheng Z, Lei Y. Case report: Double filtration plasmapheresis (DFPP) for severe rhesus-D alloimmunization in two pregnant patients. Front Pediatr 2023; 11:1147675. [PMID: 37114005 PMCID: PMC10127454 DOI: 10.3389/fped.2023.1147675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
Maternal erythrocyte alloimmunization is one of the most important causes of fetal anemia. The standard treatment for anemic fetuses is intrauterine blood transfusion (IUT). However, IUT may have adverse effects, particularly before 20 weeks of gestation. In this report, two women who had previously had severely affected alloimmunized pregnancy developed high titers of anti-D antibodies before 20 weeks of gestation. Ultrasound Doppler showed severe fetal anemia, and intrauterine transfusion was expected to be unavoidable. To prolong pregnancy to a gestation in which intravascular IUT was possible, we used repeated double filtration plasmapheresis (DFPP) as a rescue therapy. The titers of IgG-D, IgG-A, and IgG-B decreased after DFPP treatment. One woman successfully prolonged pregnancy until 20 weeks of gestation. Subsequently, she underwent four cycles of IUTs and delivered at 30 weeks of gestation by emergency cesarean section due to fetal bradycardia during the fifth intrauterine transfusion. The other woman successfully delayed intrauterine transfusion until 26 weeks of gestation. The favorable results of the two patients indicate that DFPP may be an effective and safe treatment modality for RhD immunity in pregnant women. Moreover, DFPP is potentially helpful for reducing the occurrence of ABO hemolytic disease in neonates due to the clearance of IgG-A and IgG-B antibodies (e.g., O pregnant women harbored A/B/AB neonates). However, more clinical trials are needed to verify the results.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Yan Lei
- Correspondence: Zhihua Zheng Yan Lei
| |
Collapse
|
5
|
Baumgarten J, Happel C, Groener D, Staudt J, Bockisch B, Sabet A, Grünwald F, Rink T. Retrospective Analysis of the Development of Human Thyroglobulin during Pregnancy in Patients with Treated Non-Recurrent Differentiated Thyroid Cancer. Curr Oncol 2022; 29:4012-4019. [PMID: 35735429 PMCID: PMC9221990 DOI: 10.3390/curroncol29060320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 12/04/2022] Open
Abstract
Aim: Therapy success in patients with differentiated thyroid cancer (DTC) after thyroidectomy and radioiodine therapy (RIT) is proven by permanent decrease in human thyroglobulin (hTg) to <1 ng/mL. In this retrospective analysis hTg development before, during and after pregnancy were analyzed. Material and methods: A descriptive analysis of hTg courses in 47 women with 57 pregnancies under levothyroxine substitution was performed after treatment of DTC without evidence of residual or recurrent disease. We compared hTg levels before, during and after pregnancies. A median of four measurements were performed during pregnancy. Results: In five out of the 47 patients at least one hTg increase to ≥1.0 ng/mL occurred during pregnancy (P1: 1.1; P2: 1.75; P3: 1.0; P4: 1.1; P5: 1.07 ng/mL). In another three cases an increase to ≥0.5 ng/mL occurred. After delivery, all patients returned to undetectable hTg levels. Human Tg maxima during pregnancy were significantly elevated according to Friedman´s Chi2 and p Holm−Bonferroni. Conclusion: In women with ablative thyroid therapy after DTC, a temporary elevation in hTg levels during pregnancy may occur. The reason therefore remains unclear and requires further investigation.
Collapse
Affiliation(s)
- Justus Baumgarten
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590 Frankfurt, Germany; (J.B.); (D.G.); (B.B.); (A.S.); (F.G.); (T.R.)
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590 Frankfurt, Germany; (J.B.); (D.G.); (B.B.); (A.S.); (F.G.); (T.R.)
- Correspondence:
| | - Daniel Groener
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590 Frankfurt, Germany; (J.B.); (D.G.); (B.B.); (A.S.); (F.G.); (T.R.)
| | - Jennifer Staudt
- Department of Nuclear Medicine, Medizinisches Versorgungszentrum (MVZ), D-63739 Aschaffenburg, Germany;
| | - Benjamin Bockisch
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590 Frankfurt, Germany; (J.B.); (D.G.); (B.B.); (A.S.); (F.G.); (T.R.)
| | - Amir Sabet
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590 Frankfurt, Germany; (J.B.); (D.G.); (B.B.); (A.S.); (F.G.); (T.R.)
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590 Frankfurt, Germany; (J.B.); (D.G.); (B.B.); (A.S.); (F.G.); (T.R.)
| | - Thomas Rink
- Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, D-60590 Frankfurt, Germany; (J.B.); (D.G.); (B.B.); (A.S.); (F.G.); (T.R.)
- Institute for Nuclear Medicine, Nussallee 7, D-63450 Hanau, Germany
| |
Collapse
|
6
|
Ohto H. Extension of Homo Sapiens Adapting to Every Environment with Divertgent Phenotypes: Blood Type Incompatible in Pregnancy as an Abaxial Phenomenon. Transfus Apher Sci 2020; 59:102943. [PMID: 33059996 PMCID: PMC7521375 DOI: 10.1016/j.transci.2020.102943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hitoshi Ohto
- Fukushima Medical University, Fukushima City, Fukushima 960-1295, Japan.
| |
Collapse
|