Congenital anemia: a diagnostic algorithm
DOI: 10.32364/2618-8430-2022-5-4-358-365
A.L. Zaplatnikov1, M.N. Podzolkova1, M.A. Ponimanskaya2, Yu.V. Denisova1, A.V. Dmitriev3, A.A. Dement’ev1, Zh.L. Chabaidze1, D.N. Smirnov1
1Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
2F.I. Inozemtsev City Clinical Hospital, Moscow, Russian Federation
3Ryazan State Medical University, Ryazan, Russian Federation
Congenital anemia is one of the major interdisciplinary problems of modern medicine. The aim of this publication is to outline the current concepts of early diagnosis of congenital anemia for their introduction in obstetric care practices. As a result, it will be possible to improve the disease prognosis and, in general, to reduce perinatal losses. Congenital anemias include those developed in the ante- and/or intranatal period. The main causes of congenital anemia comprise fetal blood loss, severe forms of intrauterine infections and hemolytic disease of the fetus. It is specified that the most common cause of congenital anemia is fetal blood loss. Prenatal fetal blood loss can be categorized as transplacental (fetal-maternal), intraplacental, retroplacental, fetal-fetal (in case of multifetal monochorionic pregnancy) and iatrogenic (rare complications of the invasive methods of patient examination and treatment). Fetal blood loss during delivery may be caused by var ious damages and/or disorders of the umbilical cord (rupture, hematoma) and/or the placenta (placental presentation or abruption, chorioangioma, etc.), as well as hemorrhages and bleedings (intracranial, into internal organs, etc.) of the fetus in case of abnormal labor and/or severe hypoxia. The article highlights the current verification criteria of congenital anemia and an algorithm of its diagnosis.
Keywords: anemia, immune hydrops fetalis, intrauterine infections, congenital anemia, complete blood count, fetal blood loss, non-immune hydrops fetalis, newborn infant, posthemorrhagic anemia.
For citation: Zaplatnikov A.L., Podzolkova M.N., Ponimanskaya M.A. et al. Congenital anemia: a diagnostic algorithm. Russian Journal of Woman and Child Health. 2022;5(4):358–365 (in Russ.). DOI: 10.32364/2618-8430-2022-5-4-358-365.
About the authors:
Andrey L. Zaplatnikov — Dr. Sc. (Med.), Professor, Vice-Rector for Academic Affairs, Head of the Prof. V.V. Gavryushov Department of Neonatology, Professor of the Acad. G.N. Speransky Department of Pediatrics, Russian Medical Academy of Continuous Professional Education; 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation; ORCID iD 0000-0003-1303-8318.
Nataliya M. Podzolkova — Dr. Sc. (Med.), Professor, Head of the Department of Obstetrics and Gynecology, Russian Medical Academy of Continuous Professional Education; 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation; ORCID iD 0000-0001-9183-7030.
Maria A. Ponimanskaya — C. Sc. (Med.), Chief Specialist in Obstetrics and Gynecology of the Central Administrative County of Moscow City, Head of the Autonomous Subdivision — Maternity Hospital No. 2, F.I. Inozemtsev City Clinical Hospital; 57 Verkhnyaya Pervomaiskaya str., Moscow, 105264, Russian Federation; ORCID iD 0000-0001-9447-110Х.
Yuliya V. Denisova — resident of the Department of Obstetrics and Gynecology, Russian Medical Academy of Continuous Professional Education; 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation; ORCID iD 0000-0003-1753-0537.
Andrey V. Dmitriev — Dr. Sc. (Med.), Professor, Head of the department of Childhood Diseases with the course of hospital therapy, Ryazan State Medical University; 9, Vysokovol’tnaya str., Ryazan, 390026, Russian Federation; ORCID iD 0000-0002-8202-3876.
Aleksandr A. Dement’ev — C. Sc. (Med.), associate professor of the V.V. Gavryushov Department of Neonatology, Russian Medical Academy of Continuous Professional Education; 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation; ORCID iD 0000-0002-7640-1172.
Zhuzhuna L. Chabaidze — C. Sc. (Med.), associate professor of the V.V. Gavryushov Department of Neonatology, Russian Medical Academy of Continuous Professional Education; 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation; ORCID iD 0000-0002-2192-796X.
Dmitry N. Smirnov — C. Sc. (Med.), assistant of the V.V. Gavryushov Department of Neonatology, Russian Medical Academy of Continuous Professional Education; 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation; ORCID iD 0000-0002-7840-2881.
Contact information: Andrey L. Zaplatnikov, e-mail: zaplatnikov@mail.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 20.09.2022.
Revised 13.10.2022.
Accepted 08.11.2022.
2. Shabalov N.P. Anemia. In: Neonatology. Shabalov N.P., ed. Volume 2. SPb.: MEDpres-inform; 2004:171–186 (in Russ.).
3. Anemia of the newborn: diagnosis, prevention, treatment. Clinical guidelines. M.: RASPM; 2015 (in Russ.).
4. Congenital anemia due to blood loss in the fetus. Clinical guidelines. Rossiyskoye obshchestvo neonatologov. 2021 (in Russ.).
5. Vorob’yev A.A. Anemia. Definition. Concepts. In: Guide to hematology in 3 volumes. T. 3. Vorobiev A.A., ed. M.: N’yuDiamed; 2002:148 (in Russ.).
6. Anemia in children: diagnosis, differential diagnosis, treatment. Rumyantsev A.G., Tokarev Yu.N., ed. 2nd ed, rev. and add. M.: MAKS Press; 2004 (in Russ.).
7. Zaplatnikov A.L., Kuznetsova O.A., Vorobyeva A.S. et al. Verification algorithm of the anemia nature based on a correct interpretation of the clinical blood test parameters. RMJ. 2017;12:908–912 (in Russ.).
8. Dallman P.R. Anemia of prematurity. Annu Rev Med. 1981;32:143–60. DOI: 10.1146/annurev.me.32.020181.001043.
9. Girelli G., Antoncecchi S., Casadei A.M. et al. Recommendations for transfusion therapy in neonatology. Blood Transfus. 2015;13(3):484–497.
10. Rumyantsev A.G., Rumyantsev S.A. Posthemorrhagic anemia. In: Neonatology: National Guide. Volodin N.N., ed. M.: GEOTAR-Media; 2009:352–356 (in Russ.).
11. Degtyarev D.N., Zaplatnikov A.L. Intrauterine infections. In: Neonatology. National leadership. Volodin N.N., ed. M.: GEOTAR-Мedia; 2013:725–729 (in Russ.).
12. Kurtser M.A., Gnetetskaya V.A., Mal’mberg O.L. Obstetrics and gynecology. 2009;2:37–40 (in Russ.).
13. Bellini C., Donarini G., Paladini D. et al. Etiology of non-immune hydrops fetalis: An update. Am J Med Genet A. 2015;167A(5):1082–1088. DOI: 10.1002/ajmg.a.36988.
14. Laterre M., Bernard P., Vikkula M., Sznajer Y. Improved diagnosis in non-immune hydrops fetalis using a standardized algorithm. Prenat. Diagn. 2018;38(5):337–343. DOI: 10.1002 / pd.5243.
15. Kadyrberdiyeva F.Z., Shmakov R.G., Bokeriya Ye.L. Non-immune dropsy of the fetus: modern principles of diagnosis and treatment. Obstetrics and gynecology. 2019;10:28–34 (in Russ.). DOI: 10.18565/aig.2019.10.28-34.
16. Syridou G., Spanakis N., Konstantinidou A. et al. Detection of cytomegalovirus, parvovirus B19 and herpes simplex viruses in cases of intrauterine fetal death: association with pathological findings. J Med Virol. 2008;80(10):1776–1782. DOI: 10.1002/jmv.21293.
17. Rh sensitization. Hemolytic disease of the fetus. Clinical guidelines. ROAG. 2020 (in Russ.).
18. De Almeida V., Bowman J.M. Massive fetomaternal hemorrhage: Manitoba experience. Obstet Gynecol. 1994;83(3):323–328. PMID: 8127519.
19. Rubod C., Mubiayi N., Goueff F.L. et al. Macrotransfusion feto-maternelle spontanée révélée par une diminution de la perception des mouvements actifs fœtaux. (Electronic resource.) URL: https://www.em-consulte.com/article/114813/macrotransfusion-foeto-maternelle-spontanee-revele (access date: 17.09.2022).
20. Markham L.A., Charsha D.S., Perelmuter B. Case report of massive fetomaternal hemorrhage and a guideline for acute neonatal management. Adv Neonatal Care. 2006;6(4):197–205; quiz 206–7. DOI: 10.1016/j.adnc.2006.04.007.
21. Pelikan D.M., Mesker W.E., Scherjon S.A. et al. Improvement of the Kleihauer-Betke test by automated detection of fetal erythrocytes in maternal blood. Cytometry B Clin Cytom. 2003;54(1):1–9. DOI: 10.1002/cyto.b.10017.
22. Krywko D.M., Yarrarapu S.N., Shunkwiler S.M. Kleihauer Betke Test. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021.
23. Chen J.C., Davis B.H., Wood B., Warzynski M.J. Multicenter clinical experience with flow cytometric method for fetomaternal hemorrhage detection. Cytometry. 2002;50(6):285–290. DOI: 10.1002/cyto.10154.
24. Garabedian C., Vaast P., Behal H. et al. Management of severe fetal anemia by Doppler measurement of middle cerebral artery: are there other benefits than reducing invasive procedures? Eur J Obstet Gynecol Reprod Biol. 2015;192:27–30. DOI: 10.1016/j.ejogrb.2015.06.016.
25. Babović I., Plešinac S., Radojičić Z. et al. Middle cerebral artery Doppler in prediction degree of fetal anemia and the best timing for the second intrauterine intravascular transfusion in red cell alloimmune disease. Clin Exp Obstet Gynecol. 2015;42(6):792–796. PMID: 26753488.
26. López-Carpintero N., Rodríguez-González R., González-González A., Díez-Sánchez J. Papel del Doppler en la arteria cerebral media en la atención de pacientes con isoinmunización Rhesus. Ginecol Obstet Mex. 2010;78(8):410–417 (in Spanish). PMID: 20939249.
27. Scheier M., Hernandez-Andrade E., Carmo A. et al. Prediction of fetal anemia in rhesus disease by measurement of fetal middle cerebral artery peak systolic velocity. Ultrasound Obstet Gynecol. 2004;23(5):432–436. DOI: 10.1002/uog.1010.
28. De Jong E.P., Lindenburg I.T., van Klink J.M. et al. Intrauterine transfusion for parvovirus B19 infection: long-term neurodevelopmental outcome. Am J Obstet Gynecol. 2012;206(3):204.e1–204.e5. DOI: 10.1016/j.ajog.2011.12.035.
29. Parvovirus B19V infection is congenital. Clinical guidelines. M.: RASPM; 2016 (in Russ.).
30. Grineva A.A., Vasilev V.V., Kashtanova T.A., Kyanksep I.V. Antenatal diagnostic and treatment of congenital infection coused by parvovirus B19 (clinical case). Journal Infectology. 2020;12(4):109–113 (in Russ.). DOI: 10.22625/2072-6732-2020-12-4-109-113.
This work is licensed under a Creative Commons «Attribution» 4.0 License.
Распечатать