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Fetal Anemia
Karen Y. Oh, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Abnormal or decreased fetal red blood cells
            • Most commonly due to Rhesus (Rh) or other minor red cell antigen/protein incompatibility
              • Maternal antibodies cross placenta and cause lysis of fetal red blood cells, leading to fetal anemia
              • Sensitization can be from prior pregnancy

          IMAGING

          • Ultrasonographic Findings

            DIFFERENTIAL DIAGNOSIS

              PATHOLOGY

              • General Features

                CLINICAL ISSUES

                • Presentation

                  • Demographics

                    • Natural History & Prognosis

                      • Treatment

                        DIAGNOSTIC CHECKLIST

                        • Image Interpretation Pearls

                          Selected References

                          1. Jain V et al: Guidelines for the management of a pregnant trauma patient. J Obstet Gynaecol Can. 37(6):553-74, 2015
                          2. Salvi S et al: Reliability of Doppler assessment of the middle cerebral artery in the near and far fields in healthy and anemic fetuses. J Ultrasound Med. 34(11):2037-42, 2015
                          3. Slaghekke F et al: Middle cerebral artery peak systolic velocity to predict fetal hemoglobin levels in twin anemia-polycythemia sequence. Ultrasound Obstet Gynecol. 46(4):432-6, 2015
                          4. Hermann M et al: Cerebral Doppler velocimetry to predict fetal anemia after more than three intravenous fetal exchange transfusions. Transfusion. 54(11):2968-73, 2014
                          5. Rossi AC et al: Perinatal outcomes of twin anemia-polycythemia sequence: a systematic review. J Obstet Gynaecol Can. 36(8):701-7, 2014
                          6. Slaghekke F et al: Twin anemia-polycythemia sequence: diagnostic criteria, classification, perinatal management and outcome. Fetal Diagn Ther. 27(4):181-90, 2010
                          7. Yang Y et al: Homozygous alpha-thalassemia-1 presenting in a fetus without anemia. Acta Haematol. 123(4):207-9, 2010
                          8. Yinon Y Md et al: Early intra-uterine transfusions in severe red blood cell alloimmunization. Ultrasound Obstet Gynecol. Epub ahead of print, 2010
                          9. Heyborne K: Elevated middle cerebral artery peak systolic velocity in a nonanemic fetus with alpha-thalassemia trait. Obstet Gynecol Int. 2009:819380, 2009
                          10. Langlois S et al: Carrier screening for thalassemia and hemoglobinopathies in Canada. J Obstet Gynaecol Can. 30(10):950-71, 2008
                          11. Hanif F et al: Variables that affect the middle cerebral artery peak systolic velocity in fetuses with anemia and intrauterine growth restriction. Am J Perinatol. 24(8):501-5, 2007
                          12. Mari G et al: Middle cerebral artery peak systolic velocity: a new Doppler parameter in the assessment of growth-restricted fetuses. Ultrasound Obstet Gynecol. 29(3):310-6, 2007
                          13. Oepkes D et al: Doppler ultrasonography versus amniocentesis to predict fetal anemia. N Engl J Med. 355(2):156-64, 2006
                          14. Bullock R et al: Prediction of fetal anemia in pregnancies with red-cell alloimmunization: comparison of middle cerebral artery peak systolic velocity and amniotic fluid OD450. Ultrasound Obstet Gynecol. 25(4):331-4, 2005
                          15. Van Kamp IL et al: Complications of intrauterine intravascular transfusion for fetal anemia due to maternal red-cell alloimmunization. Am J Obstet Gynecol. 192(1):171-7, 2005
                          16. Bowman J: Thirty-five years of Rh prophylaxis. Transfusion. 43(12):1661-6, 2003
                          17. Cosmi E et al: Noninvasive diagnosis by Doppler ultrasonography of fetal anemia resulting from parvovirus infection. Am J Obstet Gynecol. 187(5):1290-3, 2002
                          18. Zimmerman R et al: Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation: a prospective multicentre trial with intention-to-treat. BJOG. 109(7):746-52, 2002
                          19. Mari G et al: Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N Engl J Med. 342(1):9-14, 2000
                          20. Porter TF et al: Intravenous immune globulin in the management of severe Rh D hemolytic disease. Obstet Gynecol Surv. 52(3):193-7, 1997
                          Related Anatomy
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                          Related Differential Diagnoses
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Terminology

                            • Imaging

                              • Top Differential Diagnoses

                                • Clinical Issues

                                  TERMINOLOGY

                                  • Definitions

                                    • Abnormal or decreased fetal red blood cells
                                    • Most commonly due to Rhesus (Rh) or other minor red cell antigen/protein incompatibility
                                      • Maternal antibodies cross placenta and cause lysis of fetal red blood cells, leading to fetal anemia
                                      • Sensitization can be from prior pregnancy

                                  IMAGING

                                  • Ultrasonographic Findings

                                    DIFFERENTIAL DIAGNOSIS

                                      PATHOLOGY

                                      • General Features

                                        CLINICAL ISSUES

                                        • Presentation

                                          • Demographics

                                            • Natural History & Prognosis

                                              • Treatment

                                                DIAGNOSTIC CHECKLIST

                                                • Image Interpretation Pearls

                                                  Selected References

                                                  1. Jain V et al: Guidelines for the management of a pregnant trauma patient. J Obstet Gynaecol Can. 37(6):553-74, 2015
                                                  2. Salvi S et al: Reliability of Doppler assessment of the middle cerebral artery in the near and far fields in healthy and anemic fetuses. J Ultrasound Med. 34(11):2037-42, 2015
                                                  3. Slaghekke F et al: Middle cerebral artery peak systolic velocity to predict fetal hemoglobin levels in twin anemia-polycythemia sequence. Ultrasound Obstet Gynecol. 46(4):432-6, 2015
                                                  4. Hermann M et al: Cerebral Doppler velocimetry to predict fetal anemia after more than three intravenous fetal exchange transfusions. Transfusion. 54(11):2968-73, 2014
                                                  5. Rossi AC et al: Perinatal outcomes of twin anemia-polycythemia sequence: a systematic review. J Obstet Gynaecol Can. 36(8):701-7, 2014
                                                  6. Slaghekke F et al: Twin anemia-polycythemia sequence: diagnostic criteria, classification, perinatal management and outcome. Fetal Diagn Ther. 27(4):181-90, 2010
                                                  7. Yang Y et al: Homozygous alpha-thalassemia-1 presenting in a fetus without anemia. Acta Haematol. 123(4):207-9, 2010
                                                  8. Yinon Y Md et al: Early intra-uterine transfusions in severe red blood cell alloimmunization. Ultrasound Obstet Gynecol. Epub ahead of print, 2010
                                                  9. Heyborne K: Elevated middle cerebral artery peak systolic velocity in a nonanemic fetus with alpha-thalassemia trait. Obstet Gynecol Int. 2009:819380, 2009
                                                  10. Langlois S et al: Carrier screening for thalassemia and hemoglobinopathies in Canada. J Obstet Gynaecol Can. 30(10):950-71, 2008
                                                  11. Hanif F et al: Variables that affect the middle cerebral artery peak systolic velocity in fetuses with anemia and intrauterine growth restriction. Am J Perinatol. 24(8):501-5, 2007
                                                  12. Mari G et al: Middle cerebral artery peak systolic velocity: a new Doppler parameter in the assessment of growth-restricted fetuses. Ultrasound Obstet Gynecol. 29(3):310-6, 2007
                                                  13. Oepkes D et al: Doppler ultrasonography versus amniocentesis to predict fetal anemia. N Engl J Med. 355(2):156-64, 2006
                                                  14. Bullock R et al: Prediction of fetal anemia in pregnancies with red-cell alloimmunization: comparison of middle cerebral artery peak systolic velocity and amniotic fluid OD450. Ultrasound Obstet Gynecol. 25(4):331-4, 2005
                                                  15. Van Kamp IL et al: Complications of intrauterine intravascular transfusion for fetal anemia due to maternal red-cell alloimmunization. Am J Obstet Gynecol. 192(1):171-7, 2005
                                                  16. Bowman J: Thirty-five years of Rh prophylaxis. Transfusion. 43(12):1661-6, 2003
                                                  17. Cosmi E et al: Noninvasive diagnosis by Doppler ultrasonography of fetal anemia resulting from parvovirus infection. Am J Obstet Gynecol. 187(5):1290-3, 2002
                                                  18. Zimmerman R et al: Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation: a prospective multicentre trial with intention-to-treat. BJOG. 109(7):746-52, 2002
                                                  19. Mari G et al: Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N Engl J Med. 342(1):9-14, 2000
                                                  20. Porter TF et al: Intravenous immune globulin in the management of severe Rh D hemolytic disease. Obstet Gynecol Surv. 52(3):193-7, 1997