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Once a woman has antibodies, she is at high risk for a transfusion reaction. [10] For this reason, she must carry a medical alert card at all times and inform all doctors of her antibody status. [citation needed] "Acute hemolytic transfusion reactions may be either immune-mediated or nonimmune-mediated.
Intraperitoneal transfusion—blood transfused into fetal abdomen; Intravascular transfusion—blood transfused into fetal umbilical vein—This is the method of choice since the late 1980s, and more effective than intraperitoneal transfusion. A sample of fetal blood can be taken from the umbilical vein prior to the transfusion.
Up to 30ml of foetal-maternal transfusion may take place with no significant signs or symptoms seen in either mother or foetus. [3] Loss in excess of this may result in significant morbidity and mortality to the fetus. Fetal-maternal haemorrhage is one cause of intrauterine death (IUD).
The anti-RhE antibody can be naturally occurring, or arise following immune sensitization after a blood transfusion or pregnancy. The anti-RhE antibody is quite common especially in the Rh genotype CDe/CDe; it usually only causes a mild hemolytic disease, but can cause a severe condition in the newborn.
The red blood cells are removed by macrophages from the blood circulation into liver and spleen to be destroyed, which leads to extravascular haemolysis. This process usually mediated by anti-Rh and anti-Kidd antibodies. However, this type of transfusion reaction is less severe when compared to acute haemolytic transfusion reaction. [36]
Mothers who are negative for the Kell 1 antigen develop antibodies after being exposed to red blood cells that are positive for Kell 1.Over half of the cases of hemolytic disease of the newborn owing the anti-Kell antibodies are caused by multiple blood transfusions, with the remainder due to a previous pregnancy with a Kell 1 positive baby.
An Intrauterine transfusion (IUT) is a procedure that provides blood to a fetus, most commonly through the umbilical cord. [1] [2] It is used in cases of severe fetal anemia, such as when fetal red blood cells are being destroyed by maternal antibodies, or parvovirus B19 infection, homozygous alpha-thalassemia, or twin-to-twin transfusion syndrome. [3]
Hemolytic disease of the fetus and newborn is similar to a transfusion reaction in that the mother's antibodies cannot tolerate the fetus's antigens, which happens when the immune tolerance of pregnancy is impaired. In many instances the maternal immune system attacks the fetal blood cells, resulting in fetal anemia.