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A new method to determine the feto-placental volume based on dilution of fetal haemoglobin and an estimation of plasma fluid loss after intrauterine intravascular transfusion

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(1) To calculate the feto-placental volume (FPV), using the haematocrit (Ht) values and the percentages of fetal haemoglobin (HbF), before and after red blood cell transfusion. (2) To estimate the transfusion-induced loss of plasma fluid. Design

Retrospective analysis of data of 42 anaemic fetuses at the first transfusion [gestational age (GA) 19–36 weeks]. Setting

Department of Obstetrics, Leiden University Medical Centre, The Netherlands. Sample

Fifteen hydropic and 27 non-hydropic fetuses. Methods

Donor blood volume ( Vdonor ) and Ht ( Htdonor ), fetal pre- and post-transfusion Ht values ( Htinitial, Htfinal ) and percentages of HbF ( HbFinitial and HbFfinal ) were used to calculate the FPV. The total red cell volume after transfusion ( RCVfinal ) and Htfinal were used to estimate the plasma fluid loss. Main outcome measures

Feto-placental blood volume and loss of plasma fluid. Results

The equations that use Htfinal over-estimate the FPV when the formula does not account for the difference between donor and post-transfusion Ht ( FPVHt= 21.36 * GA − 390; r= 0.89 ). FPV is under-estimated ( FPVHt= 9.90 * GA − 172; r= 0.84 ) when the blood volume increases with a volume less than the added donor blood volume. The calculation of FPV, using HbF percentages and the initial fetal RCV, is independent of volume changes ( FPVHbF= 15.10 * GA − 279; r= 0.85 ). Comparing RCVfinal and Htfinal values showed that 31.1 ± 14.5% of the transfused volume was lost. Results of the hydropic fetuses did not differ from those of the non-hydropic fetuses. Conclusions

FPV values based on Ht values are less reliable than those based on RCV and HbF findings. When, for practical reasons, Ht values have to be used, we propose an adapted equation for the calculation of the necessary volume of donor blood: Vdonor= FPVHbF * ( Htfinal− Htinitial ) / ( Htdonor− 0.70 * Htfinal ).

Document Type: Research Article


Publication date: 2002-10-01

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