Question

Case Study #5 A 33-year-old multigravid woman (gravida 3; para 1) presented in week 11 of her fourth pregnancy. Her first pregnancy had been uneventful and this child was now 13 years old. Her second and third pregnancies had ended with dead hydropic fetuses at 36 and 23 weeks respectively. A rising level of antibody to the D antigen of the Rhesus blood group had been noted in each pregnancy, but no treatment had been available. The patient's Rhesus blood group was D negative but her husband was heterozygous for the D antigen; the fetus had a 50% chance of being affected. The mother's level of anti-D antibody was high (30iu/ml); ultrasound-guided needling of the umbilical vessels was performed at 19 weeks' gestation and blood samples obtained. The fetus was found to be Rhesus D positive with a low haemoglobin (70g/I), indicating was performed the next week; the amount of blood transfused was titrated against the fetal packed cell volume (PCV) and continued until the PCV was 40%. This was repeated, following fetal blood sampling, at 2-weekly intervals through the rest of the pregnancy. A live female infant was delivered by Caesarean section at 34 weeks. Her haemoglobin and serum bilirubin levels were normal at birth but she gradually became jaundiced over the next 72h. An exchange transfusion was given to reduce the level of previously transferred maternal antibody. She responded well and was discharged home 1 week later. A further top-up transfusion was required at 6 weeks. ??? An intravascular intrauterine transfusion

Answer 1

Hemolytic anemia.

Foetus red blood cells are being destroyed by Rh-antibodies of mother's body. So intrauterine blood transfusion to Rh+ foetus must be provided several times until the delivery (birth).