ADVANTAGES OF LARGER VOLUME, LESS FREQUENT INTRAUTERINE RED-BLOOD-CELL TRANSFUSIONS FOR MATERNAL RED-CELL ALLOIMMUNIZATION

Larger volume intravascular transfusions to manage severe maternal red cell alloimmunization in pregnancy may prolong the interval between p rocedures without increasing maternal, fetal, or neonatal complication s. A retrospective cohort study compared the management and outcome of 19 patients with severe red cell alloimmunization managed at two faci lities with different intravascular transfusion protocols. The volume of blood transfused, pre- and post-transfusion fetal hematocrit, and i nterval (days) between intravascular transfusions were compared. The r espective maternal, fetal, and neonatal results were compared. The red blood cell volume transfused per procedure and the post- but not pre- transfusion fetal hematocrits were higher at New York Hospital than at Westchester County Medical Center. The interval between transfusions at New York Hospital (25.2 +/- 8.65 days) was longer than at Westchest er County Medical Center (13.5 +/- 6.0 days, p <0.0001). Although larg er volume transfusion was occasionally associated with transient fetal bradycardia, all red blood cell transfusions were completed without c omplication. The adverse outcomes, complication rates, and neonatal ou tcomes were otherwise similar in both management protocols. It is poss ible to significantly increase the interval between intravascular tran sfusions with larger transfusion volumes for the management of severe maternal red cell alloimmunization without undue risk. The overall ris k for the fetus and mother may be reduced by performing fewer transfus ions and avoiding additional blood product exposures.