Download PDF
AJP Rep 2013; 03(02): 075-078
DOI: 10.1055/s-0033-1341576
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Serial Intrauterine Transfusions for a Hydropic Fetus with Severe Anemia and Thrombocytopenia Caused by Parvovirus: Lessons Learned

Pedro S. Argoti
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, University of Texas School of Medicine at Houston, The Texas Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas
,
Michael Bebbington
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, University of Texas School of Medicine at Houston, The Texas Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas
,
Michael Adler
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, University of Texas School of Medicine at Houston, The Texas Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas
,
Anthony Johnson
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, University of Texas School of Medicine at Houston, The Texas Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas
,
Kenneth J. Moise Jr.
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, University of Texas School of Medicine at Houston, The Texas Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas
› Author Affiliations
Further Information

Publication History

31 January 2013

06 February 2013

Publication Date:
19 March 2013 (online)

Also available at
   Permissions and Reprints

Abstract

Introduction Fetal exsanguination is a rare complication of cordocentesis. Successful correction of fetal thrombocytopenia is essential for the reduction of risks.

Case Report A 25-year-old, gravida 3, P2-0-0-0-2, was referred at 27 weeks of gestation for evaluation of newly diagnosed nonimmune hydrops secondary to parvovirus infection. Despite the use of ancillary platelet transfusions to correct the severe fetal thrombocytopenia, prolonged bleeding from the cord puncture site still occurred, necessitating five intrauterine transfusions to ultimately correct the fetal anemia.

Conclusions The use of a smaller-diameter procedure needle, correction of the fetal thrombocytopenia early in the procedure, and external cord compression with the ultrasound transducer were ultimately successful measures in allowing for minimal loss of transfused red cells from the intravascular compartment.

Keywords

parvovirus - intrauterine transfusion - fetal thrombocytopenia - platelet count
 

  • References

  • 1 Valeur-Jensen AK, Pedersen CB, Westergaard T , et al. Risk factors for parvovirus B19 infection in pregnancy. JAMA 1999; 281: 1099-1105
    CrossrefPubMedSearch in Google Scholar
  • 2 Rodis JF, Borgida AF, Wilson M , et al. Management of parvovirus infection in pregnancy and outcomes of hydrops: a survey of members of the Society of Perinatal Obstetricians. Am J Obstet Gynecol 1998; 179: 985-988
    CrossrefPubMedSearch in Google Scholar
  • 3 de Haan TR, van den Akker ES, Porcelijn L, Oepkes D, Kroes AC, Walther FJ. Thrombocytopenia in hydropic fetuses with parvovirus B19 infection: incidence, treatment and correlation with fetal B19 viral load. BJOG 2008; 115: 76-81
    PubMedSearch in Google Scholar
  • 4 Paidas MJ, Berkowitz RL, Lynch L , et al. Alloimmune thrombocytopenia: fetal and neonatal losses related to cordocentesis. Am J Obstet Gynecol 1995; 172 (2 Pt 1) 475-479
    CrossrefPubMedSearch in Google Scholar
  • 5 Segata M, Chaoui R, Khalek N, Bahado-Singh R, Paidas MJ, Mari G. Fetal thrombocytopenia secondary to parvovirus infection. Am J Obstet Gynecol 2007; 196: e1-e4
    PubMedSearch in Google Scholar
  • 6 Kenneth J, Moise J. Intrauterine fetal transfusion of platelets. Uptodate. April 18, 2012 . Available at: http://www.uptodate.com ; Accessed November 13, 2012.
    PubMedSearch in Google Scholar
  • 7 Berkowitz RL, Kolb EA, McFarland JG , et al. Parallel randomized trials of risk-based therapy for fetal alloimmune thrombocytopenia. Obstet Gynecol 2006; 107: 91-96
    CrossrefPubMedSearch in Google Scholar
  • 8 Nicolini U, Nicolaidis P, Fisk NM, Tannirandorn Y, Rodeck CH. Fetal blood sampling from the intrahepatic vein: analysis of safety and clinical experience with 214 procedures. Obstet Gynecol 1990; 76: 47-53
    PubMedSearch in Google Scholar
  • 9 Hashimoto B, Filly RA, Callen PW, Parer JT. Absorption of fetal intraperitoneal blood after intrauterine transfusion. J Ultrasound Med 1987; 6: 421-423
    PubMedSearch in Google Scholar