title: Serial sonographic findings of four fetuses with homozygous alpha-thalassemia-1 from 21 weeks onwards.
abstract: OBJECTIVE
  To evaluate the potential usefulness of noninvasive ultrasound assessment of fetal anemia in the diagnosis and management of fetuses with homozygous alpha-thalassemia-1.
  
  
  METHODS
  We describe four pregnancies complicated by fetal homozygous alpha-thalassemia-1. They presented with ultrasound abnormalities before the development of hydrops. As part of evaluating the fetal condition, we performed ultrasound and Doppler studies aimed at identifying fetal anemia. These studies included evaluation of intrahepatic umbilical venous maximum flow velocity, middle cerebral artery peak flow velocity, fetal liver length and spleen perimeter.
  
  
  RESULTS
  In all four fetuses, ultrasound and Doppler studies suggested the presence of fetal anemia. Homozygous alpha-thalassemia-1 was diagnosed in all cases, with fetal blood sampling confirming anemia in three fetuses. The majority of the intrahepatic umbilical venous maximum flow velocity and middle cerebral artery peak flow velocity measurements were above the 95th centile. Two fetuses underwent intrauterine transfusion and fetal blood flow velocities returned to normal after correction of the fetal anemia. The fetal liver length and spleen perimeter measurements showed a similar trend, although they were less consistent before 28 weeks.
  
  
  CONCLUSIONS
  Non-invasive ultrasound parameters, in particular quantification of intrahepatic umbilical venous maximum flow velocity and middle cerebral artery peak flow velocity, were found to be useful in the diagnosis and management of fetal anemia in pregnancies with fetal homozygous alpha-thalassemia-1.
authors.affiliation: Fetal Assessment and Treatment Unit, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Ontario, Canada. leungwc65@hotmail.com
authors.forename: W C
authors.initials: WC
authors.lastname: Leung
authors.forename: D
authors.initials: D
authors.lastname: Oepkes
authors.forename: G
authors.initials: G
authors.lastname: Seaward
authors.forename: G
authors.initials: G
authors.lastname: Ryan
mesh_terms: D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000502:physiology; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D012039:Regional Blood Flow; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000502:physiology; D017085:alpha-Thalassemia / Q000000981:diagnostic imaging*