title: Prediction of the rate of decline in fetal hemoglobin levels between first and second transfusions in red cell alloimmune disease.
abstract: OBJECTIVE
  To determine variables that predict the rate of decline in fetal hemoglobin levels in alloimmune disease.
  
  
  METHODS
  Retrospective review of singleton pregnancies that underwent first and second intrauterine transfusions for treatment of fetal anemia because of maternal Rh alloimmunization in a tertiary referral center.
  
  
  RESULTS
  Forty-one first intrauterine transfusions were performed at 26.1 weeks (standard deviation, SD, 4.6), mean volume of blood transfused was 44.4 mL (SD 23.5) and estimated feto-placental volume expansion was 51.3% (SD 14.5%). Between first and second transfusion, hemoglobin levels reduced on average 0.40 g/dl/day (SD 0.25). Stepwise multiple regression analysis demonstrated that this rate significantly correlated with hemoglobin levels after the first transfusion, the interval between both procedures, and middle cerebral artery systolic velocity before the second transfusion.
  
  
  CONCLUSIONS
  The rate of decline in fetal hemoglobin levels between first and second transfusions in alloimmune disease can be predicted by a combination of hemoglobin levels after the first transfusion, interval between both procedures, and middle cerebral artery systolic velocity before the second transfusion.
authors.affiliation: Department of Obstetrics and Gynecology, São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Estela Naomi
authors.initials: EN
authors.lastname: Nishie
authors.forename: Adolfo Wenjaw
authors.initials: AW
authors.lastname: Liao
authors.forename: Maria de Loudes
authors.initials: Mde L
authors.lastname: Brizot
authors.forename: Renata A
authors.initials: RA
authors.lastname: Assunção
authors.forename: Marcelo
authors.initials: M
authors.lastname: Zugaib
mesh_terms: D000328:Adult; D001805:Blood Transfusion, Intrauterine / Q000706:statistics & numerical data; D001810:Blood Volume / Q000502:physiology; D015536:Down-Regulation; D004899:Erythroblastosis, Fetal / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D004912:Erythrocytes / Q000276:immunology; D005260:Female; D005319:Fetal Hemoglobin / Q000032:analysis / Q000378:metabolism*; D006801:Humans; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D012203:Rh Isoimmunization / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*
chemical_list: D005319:Fetal Hemoglobin