Anemia from anti-E sensibiliization

Fabienne Bigi, MD

A 25-year-old-woman with positive titer of 1:256 for anti-E antibodies was referred to our unit at 38 weeks. The ultrasound findings were:

  • high middle cerebral artery systolic velocity
  • normal umbilical Doppler
  • pericardia effusion
  • dilated¬†heart
  • the thickness of the¬†inter-ventricular septum¬†was in the high limits
  • pathological mitral Doppler with E>A
  • high Vmax¬†in the¬†ductus¬†venosus
  • there were no hepatomegaly and¬†splenomegaly
  • normal placental thickness

The ultrasonographics findings of fetal anemia were followed by a cardiotocography that showed a sinusoidal rhythm and a moderate tachycardia (150bpm). The fetus was also not very active during the scan.

The baby was delivered in good conditions by a cesarean section (3,200g). No other anomaly was noted only a moderate pallor. The hemoglobin was 7g and the bilirubin was 99 in the second hour of life.  The baby underwent a exsanguinotransfusion.

Normal umbilical Doppler

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The high middle cerebral artery systolic velocity

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Note the thickness of the interventricular septum (upper limit):

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Abnormal Mitral Doppler  with E>A

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Note the dilated heart with a pericardial effusion

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Ductus venosus  Doppler

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Note the sinusoidal rhythm and a moderate tachycardia (150bpm)

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Note the normal placental thickness. There was no splenomegaly.

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