Massive fetomaternal haemorrhage warranting novel use of tandem isovolumetric partial exchange transfusion and therapeutic hypothermia.
Connor J LiggettSidney E ZvenElizabeth V SchulzChristopher M StarkPublished in: BMJ case reports (2023)
A newborn male infant was pale, hypotonic, and had respiratory distress after delivery. Venous cord blood gas revealed a severe metabolic acidosis. His initial examination was consistent with moderate encephalopathy and laboratory testing uncovered severe congenital anaemia (haematocrit 0.127 L/L). He met the clinical criteria for therapeutic hypothermia (TH) and required red blood cell transfusions, but due to the severity of his anaemia, an exchange transfusion was favoured to prevent transfusion-associated circulatory overload. There are no previous reports of these procedures completed in tandem, but the benefits were perceived to outweigh the risks. During the 72 hours of TH, the infant received an isovolumetric partial exchange transfusion and tolerated both treatments without any adverse clinical events.Kleihauer-Betke testing detected a massive chronic fetomaternal haemorrhage with 475 mL (164 mL/kg) of blood. A brain MRI completed prior to discharge was normal. At 6 months of age, he is growing and developing normally.
Keyphrases
- cardiac surgery
- cord blood
- red blood cell
- sickle cell disease
- early onset
- cardiac arrest
- acute kidney injury
- brain injury
- depressive symptoms
- mental health
- drug induced
- physical activity
- white matter
- emergency department
- adverse drug
- resting state
- extracorporeal membrane oxygenation
- room temperature
- multiple sclerosis
- electronic health record
- climate change
- carbon dioxide