title: In utero treatment of severe fetal anemia resulting from fetomaternal red blood cell incompatibility: a comparison of simple transfusion and exchange transfusion.
abstract: OBJECTIVE
  To compare in utero exchange transfusions (IUET) and in utero simple transfusions (IUST) for the treatment of fetal anemia resulting from red blood cell fetomaternal incompatibility.
  
  
  METHODS
  Retrospective comparative study from January 2006 through December 2011. The two techniques were compared for effectiveness, complications, and neonatal outcomes.
  
  
  RESULTS
  36 patients had 87 IUETs and 85 patients 241 IUSTs. Gestational age at the first transfusion was similar in both groups (IUET: 27±3.8 weeks; IUST: 27±4.7 weeks; NS) as was the initial fetal hemoglobin level (IUET: 6.4±2.8g/dL; IUST: 6.0±2.5g/dL; NS). No significant differences were noted for postprocedure complications or efficacy. The daily drop in hemoglobin level was similar in both groups (IUET: 0.41±0.23g/dL/day; IUST: 0.44±0.17g/dL/day; NS) as were the time intervals between two procedures. Gestational age at birth was earlier in the IUET group (34.4±1.3 weeks vs 35.5±1.8 weeks; p<0.001), but the postnatal transfusions or exchange transfusions rates and the duration of intensive phototherapy did not differ. No significant differences were noted for the overall survival rates (IUET: 100%; IUST: 96.4%; p>0.99).
  
  
  CONCLUSIONS
  IUET does not appear to provide any benefits compared with IUST, neither to be associated with a higher complication rate. The choice of the technique depends on availability of packed blood cells with high hematocrit (70-80%).
authors.affiliation: Unité d'obstétrique et unité clinique du Centre National de Référence en Hémobiologie Périnatale (CNRHP), Pôle Périnatalité Hôpital Trousseau, Paris, France. Electronic address: lucie.guilbaud@gmail.com.
authors.forename: Lucie
authors.initials: L
authors.lastname: Guilbaud
authors.affiliation: Clinique d'obstétrique, Pôle Femme-Mère-Nouveau-né, CHRU Lille, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Garabedian
authors.affiliation: Unité d'obstétrique et unité clinique du Centre National de Référence en Hémobiologie Périnatale (CNRHP), Pôle Périnatalité Hôpital Trousseau, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Cortey
authors.affiliation: Clinique d'obstétrique, Pôle Femme-Mère-Nouveau-né, CHRU Lille, France.
authors.forename: Thameur
authors.initials: T
authors.lastname: Rakza
authors.affiliation: Unité d'obstétrique et unité clinique du Centre National de Référence en Hémobiologie Périnatale (CNRHP), Pôle Périnatalité Hôpital Trousseau, Paris, France; Université Pierre et Marie Curie, Paris 6, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Carbonne
authors.affiliation: Clinique d'obstétrique, Pôle Femme-Mère-Nouveau-né, CHRU Lille, France; Université Lille Nord, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Houfflin-Debarge
mesh_terms: D000328:Adult; D000740:Anemia / Q000209:etiology / Q000628:therapy*; D001787:Blood Group Incompatibility / Q000150:complications*; D001805:Blood Transfusion, Intrauterine / Q000379:methods* / Q000706:statistics & numerical data; D005078:Exchange Transfusion, Whole Blood / Q000706:statistics & numerical data*; D005260:Female; D005315:Fetal Diseases / Q000628:therapy*; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies
keywords: Fetal anemia; Fetomaternal red blood cell incompatibility; Intrauterine exchange transfusion; Intrauterine transfusion; Red-blood cell alloimmunization; Rhesus hemolytic disease