Le point sur le suivi des allo-immunisations érythrocytaires
| Autor: | Vanina Castaigne, A. Mailloux, Y. Brossard, Evelyne Cynober, Bruno Carbonne, R. Levy, M. Larsen, A. Cortey |
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| Rok vydání: | 2010 |
| Předmět: |
Pediatrics
medicine.medical_specialty Pregnancy Fetus Blood transfusion business.industry Anemia medicine.medical_treatment Obstetrics and Gynecology Gestational age General Medicine medicine.disease Reproductive Medicine In utero medicine.artery embryonic structures Middle cerebral artery medicine Gestation business |
| Zdroj: | Gynécologie Obstétrique & Fertilité. 38:205-213 |
| ISSN: | 1297-9589 |
| DOI: | 10.1016/j.gyobfe.2010.01.012 |
| Popis: | Anti-RhD allo-immunisation has become rare since anti-D prophylaxis was introduced in the seventies; however, it remains the first cause of fetal anemia. It may cause severe fetal complications such as fetal hydrops, cerebral anoxic lesions and fetal death. In the neonatal period, severe jaundices and anemias requiring transfusion or exsanguino-transfusion are still common in case of severe allo-immunisation. Neonatal death and sequellae due to bilirubin encephalopathy have not fully disappeared. Follow-up of pregnancies with maternal allo-immunisation requires identification of the antibody (anti-RhD, anti-Kell and anti-c are the most frequently responsible for fetal complications), dosage and titration. In RhD allo-immunization, feto-maternal incompatibility may be confirmed by non-invasive RHD genotyping of the fetus in maternal blood. In cases at risk for fetal anemia, weekly Doppler assessment of middle cerebral artery peak systolic velocity (MCA-PSV) allows identification of fetal anemia before the occurrence of fetal hydrops. The reference treatment of fetal anemia is in utero fetal transfusion. The risk of fetal loss due to in utero transfusion (IUT) is 3% per procedure. The cumulated risk of fetal loss can thus exceed 10% in case of early occurrence of fetal anemia requiring up to five or six IUTs in a single pregnancy. |
| Databáze: | OpenAIRE |
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