Management of pregnancy when maternal blood has a very high level of fetal haemoglobin.
Fetal blood normally has a higher oxygen affinity than maternal blood because of the predominance of haemoglobin (Hb) F in the former and of Hb A in the latter; this predominance facilitates the transfer of oxygen from maternal to fetal blood. We report two patients who had exclusively or predominantly Hb F in their blood and were managed differently. When patient 1 became pregnant she had regular exchange blood transfusions in order to reduce her Hb F from 80% to below 50%; patient 2, who had 100% Hb F, was not transfused before, during or after her pregnancy. Each patient delivered a normal healthy baby. We conclude that the differential oxygen affinity produced by the combination of Hb A in the maternal blood and Hb F in the fetal blood is not indispensable to ensure an oxygen supply adequate for normal fetal development and growth.
Kaeda
J S
JS
Department of Haematology, Royal Postgraduate Medical School, London.
Prasad
K
K
Howard
R J
RJ
Mehta
A
A
Vulliamy
T
T
Luzzatto
L
L
D000328:Adult; D001803:Blood Transfusion; D005260:Female; D005319:Fetal Hemoglobin / Q000032:analysis*; D005838:Genotype; D005914:Globins / Q000235:genetics; D006801:Humans; D009154:Mutation; D010100:Oxygen / Q000097:blood; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood* / Q000628:therapy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods*; D017086:beta-Thalassemia / Q000097:blood* / Q000235:genetics / Q000628:therapy
D005914:Globins; D005319:Fetal Hemoglobin; D010100:Oxygen