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Prescott B, Jackson DE. Effective management of foetal anaemia in Rh(D) alloimmunised pregnant women with intrauterine transfusion: a Systematic Review. Hematol Transfus Cell Ther 2024; 46:289-299. [PMID: 38278670 PMCID: PMC11221247 DOI: 10.1016/j.htct.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/27/2023] [Accepted: 07/24/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Foetal anaemia is caused by a severe pregnancy complication, haemolytic disease of the foetus and newborn. Intrauterine transfusions (IUTs) are performed to treat foetal anaemia in alloimmunised pregnant women. If left untreated hydrops can develop thereby reducing the chance of survival. Survival rates have improved but the procedure is not without complications. Procedure-related complications can be associated with early gestational age, hence delaying IUT could improve outcomes. This review aims to determine the effectiveness and safety of IUTs by examining survival and mortality rates, procedure-related complications with associated foetal mortality and the influence of hydrops. STUDY DESIGN AND METHOD A systematic review was conducted by searching keywords in four scientific databases from January 2000 to April 2022. A meta-analysis was performed with the OpenMeta-Analyst software using an arcsine transformed proportion with the binary random-effects model and maximum likelihood method. RESULTS Fifteen studies were identified as eligible and used in the meta-analysis. The forest plots all showed statistically significant outcomes with heterogeneity of data. Results indicated a greater foetal survival rate with IUT to treat anaemic foetuses, a low foetal mortality rate, and low risk of procedure-related complications associated with foetal loss but a higher risk of foetal mortality when hydrops is present. CONCLUSION The findings of this systematic review and meta-analysis provide evidence that IUT is a safe and effective treatment for foetal anaemia in the absence of hydrops when experienced personnel perform the procedure to minimise the risk of procedure-related complications.
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Affiliation(s)
- Brittany Prescott
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Denise E Jackson
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia.
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Kebamo TE, Kombe AT, Eticha T, Arkew M, Nigussie Bolado G, Ayalew TL, Haile K, Walano GA. Magnitude of Red Blood Cell Alloimmunization Among Pregnant Women Attending Antenatal Care at Wolaita Sodo University Comprehensive Specialized Hospital, Southwest Ethiopia. J Blood Med 2023; 14:663-669. [PMID: 38152294 PMCID: PMC10752022 DOI: 10.2147/jbm.s440952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/21/2023] [Indexed: 12/29/2023] Open
Abstract
Background Maternal red cell alloimmunization occurs when a woman's immune system becomes sensitive to unfamiliar red blood cell antigens. This leads to the production of alloantibodies, which can have serious implications for the fetus and newborn. However, there is a lack of comprehensive information about the extent of red cell alloimmunization in underdeveloped countries like Ethiopia. Therefore, this study aimed to determine the magnitude of red cell alloimmunization among pregnant women attending antenatal care at Wolaita Sodo University Comprehensive Specialized Hospital from September 01 to November 30, 2022. Methods In this institutional-based cross-sectional study, 422 pregnant women were participated and recruited using a systematic random sampling technique. Data on sociodemographic characteristics, obstetric history, and other clinical information were collected using structured questionnaires through face-to-face interview. Blood grouping and indirect antihuman globulin tests were performed. The relationship between red cell alloimmunization and the independent variables was determined using the chi-square test. P-value <0.05 was considered statistical significance. Results In this study, the blood group distributions among the participants were as follows: O, 177 (41.9%); A, 124 (29.4%); B, 76 (18%); and AB, 45 (3.86%). Among the pregnant women included in the study, a total of 51 (12.08%) were identified as RhD-negative. Out of these RhD-negative women, 5 (9.8%) were found to have developed alloimmunization with red blood cell antigens. Miscarriage and post-partum hemorrhage were found to be important factors associated with the occurrence of red cell alloimmunization in these women. Conclusion This study showed that one out of ten pregnant women was alloimmunized. Therefore, antenatal blood grouping and indirect antihuman globulin screening should be performed routinely to manage and minimize the undesirable outcomes of alloimmunization during pregnancy.
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Affiliation(s)
- Tamirat Ersino Kebamo
- School of Medical Laboratory Sciences, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Abinet Tantu Kombe
- School of Medical Laboratory Sciences, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Temesgen Eticha
- School of Medical Laboratory Sciences, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Mesay Arkew
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Getachew Nigussie Bolado
- School of Nursing, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tadele Lankrew Ayalew
- School of Nursing, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kassahun Haile
- School of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Getachew Alemu Walano
- School of Medical Laboratory Sciences, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Al Lawati M, Al Balushi B. RHD Positive Haplotype in D Negative Omani Blood Donor. Oman Med J 2023; 38:e488. [PMID: 37122416 PMCID: PMC10130977 DOI: 10.5001/omj.2023.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/09/2021] [Indexed: 11/03/2022] Open
Abstract
The frequency of Rhesus D negative blood group in Omanis is 8.35% but the molecular background of this phenotype is unknown in the Omani population. The Rhesus D negative phenotype has a high molecular diversity. We report a rare case of serological D negative with existence of complete RHD gene in a 43-year-old Omani male blood donor. Molecular analysis of RHD exons showed duplication across the boundary of intron 3 and exon 4. This is a 37 bp insert in RHD exon 4 along with c.609 G>A mutation. We are uncertain if the presence of RHDΨ is homozygous (RHDΨ/RHDΨ) or hemizygous (RHDΨ/del). Therefore, molecular basis of D zygosity determination would be a good approach to further explore the case.
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Affiliation(s)
- Mujtaba Al Lawati
- Department of Medical Lab Sciences, Oman College of Health Sciences, Muscat, Oman
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de Winter DP, Kaminski A, Tjoa ML, Oepkes D. Hemolytic disease of the fetus and newborn: systematic literature review of the antenatal landscape. BMC Pregnancy Childbirth 2023; 23:12. [PMID: 36611144 PMCID: PMC9824959 DOI: 10.1186/s12884-022-05329-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/21/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Prevention of pregnancy-related alloimmunization and the management of hemolytic disease of the fetus and newborn (HDFN) has significantly improved over the past decades. Considering improvements in HDFN care, the objectives of this systematic literature review were to assess the prenatal treatment landscape and outcomes of Rh(D)- and K-mediated HDFN in mothers and fetuses, to identify the burden of disease, to identify evidence gaps in the literature, and to provide recommendations for future research. METHODS We performed a systematic search on MEDLINE, EMBASE and clinicaltrials.gov. Observational studies, trials, modelling studies, systematic reviews of cohort studies, and case reports and series of women and/or their fetus with HDFN caused by Rhesus (Rh)D or Kell alloimmunization. Extracted data included prevalence; treatment patterns; clinical outcomes; treatment efficacy; and mortality. RESULTS We identified 2,541 articles. After excluding 2,482 articles and adding 1 article from screening systematic reviews, 60 articles were selected. Most abstracted data were from case reports and case series. Prevalence was 0.047% and 0.006% for Rh(D)- and K-mediated HDFN, respectively. Most commonly reported antenatal treatment was intrauterine transfusion (IUT; median frequency [interquartile range]: 13.0% [7.2-66.0]). Average gestational age at first IUT ranged between 25 and 27 weeks. weeks. This timing is early and carries risks, which were observed in outcomes associated with IUTs. The rate of hydrops fetalis among pregnancies with Rh(D)-mediated HDFN treated with IUT was 14.8% (range, 0-50%) and 39.2% in K-mediated HDFN. Overall mean ± SD fetal mortality rate that was found to be 19.8%±29.4% across 19 studies. Mean gestational age at birth ranged between 34 and 36 weeks. CONCLUSION These findings corroborate the rareness of HDFN and frequently needed intrauterine transfusion with inherent risks, and most births occur at a late preterm gestational age. We identified several evidence gaps providing opportunities for future studies.
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Affiliation(s)
- Derek P. de Winter
- grid.508552.fDepartment of Pediatrics, Division of Neonatology, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands ,grid.417732.40000 0001 2234 6887Department of Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Allysen Kaminski
- OPEN Health, Bethesda, MD USA ,grid.253615.60000 0004 1936 9510Present address: The George Washington University, Washington, DC, USA
| | - May Lee Tjoa
- grid.497530.c0000 0004 0389 4927Janssen Pharmaceuticals, Raritan, NJ USA
| | - Dick Oepkes
- grid.10419.3d0000000089452978Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, K-06-35, PO Box 9600, Leiden, 2300 RC The Netherlands
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Mbalibulha Y, Natukunda B, Livex OA, Ononge S, Kalyango JN, Kajja I. ABO and Rh Antigen Distribution Among Pregnant Women in South Western Uganda. J Blood Med 2022; 13:351-355. [PMID: 35769868 PMCID: PMC9234189 DOI: 10.2147/jbm.s360769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/14/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction ABO and Rh are the major blood group systems in Transfusion Medicine, the ABO system based on two red cell antigens (A, B) while the Rh has about 50 antigens of which five are highly clinically significant (D, C, c, E, e). These vary among races and ethnic groups. Blood type phenotype incompatibility between mother and fetus may result in antigen mismatch, triggering alloimmunization, and thus causing hemolytic transfusion reaction (HTR), which results in hemolytic disease of fetus and newborn (HDFN). This study aimed to determine the frequencies of ABO and rhesus blood group antigen in the pregnant women in South Western Uganda. Methods A cross-sectional study was carried out on 1369 pregnant women who were recruited and provided consent to participate during their regular antenatal visits between August 2020 and July 2021. Four milliliters (4mL) of EDTA-anti-coagulated blood samples were collected and ABO and Rh-blood grouping including Rh antigen screening was done using the agglutination technology comprised of glass beads and reagent contained in a column of the Ortho Biovue ID Micro Typing System (Ortho Clinical Diagnostics, New Jersey, USA). The Rh antigen phenotypes and frequencies were then determined. Results There was percentage distribution of 99.8%, c 99.3%, D 94.3%, C 19.2% and E 15.9%, with Rh cDe/cDe (65.1%) being the most common phenotype followed by cDe/CDe (15%), cDe/cDE (10.8%) and cDE/cDE 0.1% least common. The ABO grouping frequency was obtained as O 49.4%, A 29.5%, B 17.0% and AB 4.1%, with D positivity at 94.3%. Discussion Population genetic variations result in varied expressions of red cell antigens that may have clinical complications. Knowledge of the presence of these Rh antigen distributions and phenotype frequencies during pregnancy help in rational management of the pregnancy, alloimmunization and better approach to safe blood transfusion.
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Affiliation(s)
- Yona Mbalibulha
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bernard Natukunda
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Okwi Andrew Livex
- Department of Pathology, College of Health Science, Makerere University, Kampala, Uganda
| | - Sam Ononge
- Department of Obstetrics & Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joan N Kalyango
- Director Clinical and Epidemiology Unit, School of Medicine, College of Health Science, Makerere University, Kampala, Uganda
| | - Isaac Kajja
- Deputy Principal College of Health Sciences, Makerere University, Kampala, Uganda
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Red blood cell alloimmunization in pregnancy: A 10-year single-center study. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp201124016b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. Pregnancy-induced red blood cell (RBC) alloimmunization is important not only because of the possible negative effects on subsequent pregnancy outcomes in case the fetus carries the antigen but also because of the optimal trans-fusion management in cases of obstetric hemorrhage. Timely detection of RBC antibodies is part of testing, prevention, and treatment strategy, aimed at achieving better outcomes for alloimmunized mothers with an affected fetus. The aim of the study was to determine the frequency and specificity of alloantibodies among pregnant women from the South Backa District, Serbia, with special attention to the incidence of anti-D alloantibodies. Methods. A retrospective study was conducted in the Blood Transfusion Institute of Vojvodina and covered the period from January 1, 2010, to December 31, 2019. Screening and antibody identification were performed by an indirect antiglobulin test in gel-microcards (ID-Card Liss/Coombs) with two test RBC (ID-DiaCell I-II screening cells, Bio-Rad, Cressier, Switzerland) on an automated system (IH-500, Bio-Rad). Results. Among 25,694 tested pregnant women, 1.38% were actively immunized, while 1.12% of women acquired antibodies in the current pregnancy. Among 3,622 (14.09%) RhD-negative women, 1.77% produced anti-D antibodies during the ongoing pregnancy. Distribution of anti-body specificity was: anti-D 23.34%, anti-M 11.85%, anti-E 9.41%, anti-K 9.41%, anti-C 5.92%, anti-Fyb 5.92%, anti-c 3.13%, anti-S 3.13%, anti-Lea 3.13%, anti-Leb 3.13%, anti-Cw 1.75%, anti-Jka 1.40%, anti-P 1.05%, anti-Lub 0.70%, anti-Fya 0.35%, autoantibody of undetermined specificity 0.70%, and irregular antibodies of undetermined specificity 15.68%. Conclusion. Immunoglobulin prophylaxis has led to a significant reduction in the frequency of D-alloimmunization among pregnant women in the South Backa District over the last ten years. However, the incidence of anti-D antibodies is still significantly higher than in published data for developed countries. We also identified the other, less commonly present, clinically significant antibodies. There is a need to introduce uniform recommendations for immunohematological testing in pregnancy on the territory of the Republic of Serbia in accordance with modern requirements.
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Yahia A, Miskeen E, Sohail SK, Algak T, Aljadran S. Blood Group Rhesus D-negativity and Awareness Toward Importance of Anti-D Immunoglobulin Among Pregnant Women in Bisha, Saudi Arabia. Cureus 2020; 12:e7044. [PMID: 32128293 PMCID: PMC7032607 DOI: 10.7759/cureus.7044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Rhesus D (RhD) antigen alloimmunization has been a focus of concern for hematologists and obstetricians. It contributes to perinatal morbidity and mortality. The objectives of this study were to assess the awareness of pregnant women toward the clinical importance of blood group Rh(D)-negativity and anti-D immunoglobulin and to determine the prevalence of blood group Rh(D)-negativity among them. Methods and materials This cross-sectional study was conducted in a routine antenatal care clinic of King Abdullah Hospital in Bisha, Saudi Arabia from September 2018 to January 2019. The awareness of pregnant women toward the clinical importance of blood group Rh(D)-negativity and prophylaxis with anti-D immunoglobulin was assessed through a self-administered questionnaire. Samples were analyzed for ABO and Rh (D) blood groups using the microplate grouping method. The presence of anti-D alloantibodies was detected by the indirect antiglobulin test. Data were analyzed by IBM SPSS Statistics for Windows, Version 25.0 (Armonk, NY: IBM Corp.). A p-value ≤0.05 was considered statistically significant. Results A total of 108 respondents fulfilled the inclusion criteria and completed the survey. Forty-five pregnant women (41.7%) were observed to be aware of the blood group Rh(D)-negativity and anti-D immunoglobulin issue. The prevalence of the negative blood group was 11.1% (12/108). Awareness was found to be significantly associated with age, education, vaginal bleeding, blood groups, and previous administration of anti-D immunoglobulin (p-value ≤0.05). Conclusion The prevalence of blood group Rh(D)-negativity among respondents was found to be comparative with other populations, although the overall awareness was found to be suboptimal (41.7%). Structured health education programs by hematologists and obstetricians are needed to increase awareness and to address women at reproductive age.
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Affiliation(s)
- Amar Yahia
- Basic Medical Sciences, College of Medicine, University of Bisha, Bisha, SAU
| | - Elhadi Miskeen
- Obstetrics and Gynecology, College of Medicine, University of Bisha, Bisha, SAU
| | - Shahzada K Sohail
- Basic Medical Sciences, College of Medicine, University of Bisha, Bisha, SAU
| | - Tarig Algak
- Basic Medical Sciences, College of Medicine, University of Bisha, Bisha, SAU
| | - Saad Aljadran
- Laboratory Medicine, King Abdullah Hospital, Bisha, SAU
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Al-Riyami AZ, Daar S. Red cell alloimmunization in transfusion-dependent and transfusion-independent beta thalassemia: A review from the Eastern Mediterranean Region (EMRO). Transfus Apher Sci 2019; 58:102678. [DOI: 10.1016/j.transci.2019.102678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 01/19/2023]
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Al-Riyami AZ, Al-Muqbali A, Al-Sudiri S, Murthi Panchatcharam S, Zacharia M, Al-Mahrooqi S, Al-Hosni S, Al-Marhoobi A, Daar S. Risks of red blood cell alloimmunization in transfusion-dependent β-thalassemia in Oman: a 25-year experience of a university tertiary care reference center and a literature review. Transfusion 2018; 58:871-878. [DOI: 10.1111/trf.14508] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/04/2017] [Accepted: 12/18/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Arwa Z. Al-Riyami
- Department of Hematology; Sultan Qaboos University Hospital; Muscat Oman
| | - Ayman Al-Muqbali
- College of Medicine and Health Sciences; Sultan Qaboos University; Muscat Oman
| | - Saif Al-Sudiri
- College of Medicine and Health Sciences; Sultan Qaboos University; Muscat Oman
| | | | - Mathew Zacharia
- Department of Child Health; Sultan Qaboos University Hospital; Muscat Oman
| | - Sabah Al-Mahrooqi
- Department of Hematology; Sultan Qaboos University Hospital; Muscat Oman
| | - Saif Al-Hosni
- Department of Hematology; Sultan Qaboos University Hospital; Muscat Oman
| | - Ali Al-Marhoobi
- Department of Hematology; Sultan Qaboos University Hospital; Muscat Oman
| | - Shahina Daar
- Department of Hematology, College of Medicine and Health Sciences; Sultan Qaboos University; Muscat Oman
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Al-Riyami AZ, Al-Salmani M, Al-Hashami SN, Al-Mahrooqi S, Al-Marhoobi A, Al-Hinai S, Al-Hosni S, Panchatcharam SM, Al-Arimi ZA. Intrauterine Fetal Blood Transfusion: Descriptive study of the first four years' experience in Oman. Sultan Qaboos Univ Med J 2018; 18:e34-e42. [PMID: 29666679 PMCID: PMC5892811 DOI: 10.18295/squmj.2018.18.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/21/2017] [Accepted: 12/21/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Haemolytic disease of the fetus and newborn (HDFN) causes hydrops fetalis. The successful treatment of HDFN has been reported with intrauterine blood transfusion (IUT). This study aimed to describe the initial experience with IUT procedures in Oman. METHODS This retrospective observational study took place at the Royal Hospital and Sultan Qaboos University Hospital Blood Bank, Muscat, Oman, and included all women who underwent IUT procedures in Oman between March 2012 and March 2016. Gestational and neonatal outcomes were assessed, including complications, morbidity, neurodevelopmental sequelae and mortality. RESULTS A total of 28 IUT procedures for 13 fetuses carried by 11 women were performed. Gestational age at the time of referral ranged from 13-30 weeks, while the median gestational age at first IUT procedure was 26 weeks (range: 19-30 weeks). Indications for the procedure included HDFN caused by anti-D (n = 6), a combination of anti-D and anti-C (n = 4), anti-K (n = 1) and anti-Jsb (n = 1) antibodies and nonimmune hydrops fetalis due to a congenital parvovirus infection (n = 1). Median fetal haemoglobin levels at the beginning and end of the procedure were 4.6 g/dL and 12.8 g/dL, respectively. Most procedures were transplacental intravascular transfusions through the placental umbilical cord root (71.4%), followed by transamniotic intravascular transfusions (14.3%). The overall survival rate was 61.5%, with five deaths; of these, four were intrauterine and one was an early neonatal death due to non-resolved hydrops and severe cardiac dysfunction. CONCLUSION As a relatively novel obstetric procedure in Oman, IUT seems to result in a favourable outcome for hydropic fetuses.
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Affiliation(s)
- Arwa Z. Al-Riyami
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mouza Al-Salmani
- Department of Obstetrics & Gynaecology, Royal Hospital, Muscat, Oman
| | | | - Sabah Al-Mahrooqi
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ali Al-Marhoobi
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sumaiya Al-Hinai
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Saif Al-Hosni
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
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戴 颖, 黄 志, 刘 新, 王 启. [Risk factors for recurrence of large atherosclerotic cerebral infarction]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1678-1682. [PMID: 29292265 PMCID: PMC6744025 DOI: 10.3969/j.issn.1673-4254.2017.12.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To explore the risk factors for recurrence of large atherosclerotic cerebral infarction in first?episode patients. METHODS The consecutive patients with acute cerebral infarction diagnosed in the Department of Neurology were screened for large atherosclerotic cerebral infarction by CTA/MRA examination, and all the confirmed patients were followed up for 1 year. The patients were divided into recurrent ischemic stroke group and non?recurrent group according to occurrence of cerebrovascular events during the follow?up. RESULTS A total of 256 eligible patients were included in this study, and all of them completed the follow?up. During the 1?year follow?up, 30 (11.7%) patients had ischemic cerebrovascular stroke events. Univariate analysis showed significant differences in alcohol drinking (P=0.028), smoking (P=0.007), high?density lipoprotein cholesterol (HDL; P=0.045), ischemic heart disease (P=0.002), antihypertensive agents (P=0.036) and statin use (P=0.016) between the recurrent group and non?recurrent group. Cox regression analysis showed that irregular use of statins (RR=0.410, P=0.043), smoking (RR=2.253, P=0.043), HDL (RR=0.327, P=0.029), and ischemic heart disease (RR=8.566, P<0.001) were correlated with recurrent ischemic stroke. CONCLUSION The first?episode patients with irregular use of statins, low HDL levels, smoking and ischemic heart disease are at higher risks for having ischemic stroke recurrence.
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Affiliation(s)
- 颖仪 戴
- 南方医科大学,广东 广州 510515Southern Medical University, Guangzhou 510515, China
- 广东省第二人民医院神经内科,广东 广州 510317Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - 志新 黄
- 广东省第二人民医院神经内科,广东 广州 510317Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - 新通 刘
- 南方医科大学,广东 广州 510515Southern Medical University, Guangzhou 510515, China
- 广东省第二人民医院神经内科,广东 广州 510317Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - 启章 王
- 广州医科大学附属深圳沙井医院,广东 深圳 518104Shenzhen Shajing Hospital Affiliated to Guangzhou Medical University, Shenzhen 518104, China
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