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Erythroblastosis and reticulocytosis in anemic fetuses

  • K.H. Nicolaides
    Correspondence
    Reprint requests: K. H. Nicolaides, MD, Harris Birthright Center for Fetal Medicine, Department of Obstetrics and Gynaecology, King's College School of Medicine, Denmark Hill, London, England SE5 8RX.
    Affiliations
    Harris Birthright Research Centre for Fetal Medicine, Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry London, England

    Lions Mountbatten Haematology Unit, King's College School of Medicine and Dentistry London, England
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  • B. Thilaganathan
    Affiliations
    Harris Birthright Research Centre for Fetal Medicine, Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry London, England

    Lions Mountbatten Haematology Unit, King's College School of Medicine and Dentistry London, England
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  • C.H. Rodeck
    Affiliations
    Harris Birthright Research Centre for Fetal Medicine, Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry London, England

    Lions Mountbatten Haematology Unit, King's College School of Medicine and Dentistry London, England
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  • R.S. Mibashan
    Affiliations
    Harris Birthright Research Centre for Fetal Medicine, Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry London, England

    Lions Mountbatten Haematology Unit, King's College School of Medicine and Dentistry London, England
    Search for articles by this author
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      Abstract

      The fetal blood erythroblast and reticulocyte counts were determined in umbilical cord samples obtained at 17 to 36 weeks' gestation from 127 pregnancies complicated by red blood cell isoimmunization. The reticulocyte count increased linearly with fetal anemia, and the erythroblast count increased exponentially. Significant erythroblastosis was observed only when the hemoglobin concentration deficit was >7 gm/dl. Of the 52 fetuses with a hemoglobin concentration deficit >7 gm/dl, 35 had ultrasonographic evidence of hydrops. These data suggest that medullary hematopoiesis is stimulated by mild anemia and that recruitment of extramedullary sites occurs when anemia is severe. Extensive hepatic erythropoiesis may be the cause of fetal hydrops in red blood cell isoimmunization.

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      References

      1. Nicolaides KH, Soothill PW, Clewell WH, Rodeck CH. Fetal haemoglobin measurement in the assessment of red cell isoimmunization. Lancet [in press].

      2. Nicolaides KH, Thilaganathan B, Mibashan RS. Cordocentesis in the investigation of fetal erythropoiesis. [Submitted for publication].

        • Rodeck CH
        • Nicolaides KH
        • Warsof SL
        • Fysh WJ
        • Gamsu HR
        • Kemp JR
        The management of severe rhesus isoimmunization by fetoscopic intravascular blood transfusion.
        Am J Obstet Gynecol. 1984; 150: 769-774
        • Nicolaides KH
        • Soothill PW
        • Rodeck CH
        • Campbell S
        Ultrasound-guided sampling of umbilical cord and placental blood to assess fetal wellbeing.
        Lancet. 1986; 1: 1065-1067
        • Rightmire DA
        • Nicolaides KH
        • Rodeck CH
        • et al.
        Midtrimester fetal blood flow velocities in rhesus isoimmunization.
        Obstet Gynecol. 1986; 68: 233-236
        • Jandl JH
        • Jones AR
        • Castle WB
        The destruction of red cells by antibodies in man. I. Observations on the sequestration and lysis of red cells altered by immune mechanisms.
        J Clin Invest. 1957; 36: 1428-1459
      3. Erslev AJ. Production of erythrocytes. In: Williams JW, Beutter E, Erslev AJ, Tichman MA, eds. Hematology. 3rd ed. New York: McGraw-Hill, 365–376.

        • Soothill PW
        • Nicolaides KH
        • Rodeck CH
        • Clewell WH
        • Lindridge J
        Relationship of fetal hemoglobin and oxygen content to lactate concentration in Rh isoimmunized pregnancies.
        Obstet Gynecol. 1987; 69: 268-270
        • Finne PH
        Erythropoietin production in fetal hypoxia and in anemic uremic patients.
        Ann NY Acad Sci. 1968; 149: 497-503
        • Nicolaides KH
        • Rodeck CH
        • Millar DS
        • Mibashan RS
        Fetal haematology in rhesus isoimmunisation.
        Br Med J. 1985; 290: 661-663
        • Nicolaides KH
        • Warenski JC
        • Rodeck CH
        The relationship of fetal plasma protein concentration and hemoglobin level to the development of hydrops in rhesus isoimmunization.
        Am J Obstet Gynecol. 1985; 152: 341-344
        • Bowman JM
        The management of Rh isoimmunization.
        Obstet Gynecol. 1978; 52: 1