A personalized approach to the treatment of newborns with Rh factor hemolytic disease who underwent intrauterine hemotransfusion

The widespread use of intrauterine blood transfusions to correct severe anemia associated with Rh-related hemolytic disease of the fetus and newborn significantly impacts the preand postnatal presentation of the disease, complicating the assessment of its severity and the selection of treatment methods. Objective . To define a personalized approach to treating newborns with Rh-related hemolytic disease who have undergone intrauterine blood transfusions, based on clinical and laboratory parameters and treatment outcomes. Materials and Methods . 92 newborns born between 28–38 weeks with Rh-related hemolytic disease (ICD-10: P55.0) were examined. They were divided into three groups based on the frequency of intrauterine blood transfusions. Group 1 consisted of 42 infants who had received one blood transfusion, Group 2 included 38 infants who had received two blood transfusions, and Group 3 included 12 infants who had received three or more blood transfusions. Results . Fetal hemoglobin levels and the incidence of a positive Coombs test significantly decreased with increasing frequency of intrauterine blood transfusions ( p <0.05). Reticulocyte levels were lower in Group 3 infants compared to Groups 1 and 2 ( p <0.05). The rate of exchange transfusions did not differ statistically between groups, ranging from 42.8% to 50%. Red blood cell replacement transfusions were administered to a third of the children in Group 3, 5.3% in Group 2, and 19.1% in Group 1, with statistically significant differences between Groups 2 and 3 ( p =0.023). Fatal outcomes occurred only in Group 3 and were due to the development of cardiovascular failure during the exchange transfusion. Conclusions . A personalized approach to treating newborns with Rh-specific hemolytic disease requires consideration of risk factors for postnatal immune hemolysis, including the direct Coombs test, fetal hemoglobin levels, and reticulocyte counts.

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