September 14, 2022• PRESS RELEASE
The 2,500th intrauterine blood transfusion took place in the Netherlands on 8 September. Leiden University Medical Center (LUMC) is the only Dutch hospital that performs this treatment. For 35 years, this treatment in the womb has saved the lives of unborn babies with severe anemia. A good time to reflect on the value of this intervention.
Treatment of fetal anemia in the uterus. It looks like a new advanced treatment method, but it was first performed in 1965 in Leiden. The current technique was introduced in 1987 and now, 35 years later, the 2500th blood transfusion takes place in the uterus. This makes it the most commonly performed fetal treatment in the Netherlands.
Without a blood transfusion, fetuses with severe anemia often die or suffer from chronic disabilities. The most common cause of severe anemia in unborn babies is rhesus disease. The mother’s blood is therefore rhesus-negative and that of the baby is rhesus-positive. As a result, the mother produces antibodies against the baby’s red blood cells, which break them down and cause anemia.
Fewer interventions
Nurse Jennie Verdoes and Prenatal Medicine Doctor Katinka Teunissen have both been involved in this unique treatment for nearly 30 years. A lot has changed in that period. “Where we did more than 100 transfusions a year, now it’s about 50,” says Verdoes. This is partly due to better screening so that high-risk pregnant women are identified earlier and better treatments. “For example, we can now prevent many cases of the disease with the drug anti-RD immunoprophylaxis,” says Teunissen. As a result, severe anemia in the fetus has become a rare disease.
Waiting room
“We see pregnant women at high risk of rhesus disease every week during consultation hours,” says Teunissen. “We use an ultrasound and a blood test to see if a transfusion is already needed for the baby.” Women are therefore closely monitored during pregnancy. “We work together for their transfusion and this creates a bond between doctor and patient. But also among the patients themselves, who often begin to recognize each other in the waiting room ».
Magic
Blood transfusions in the uterus require good preparation and a careful approach. With a long, thin needle, the fetal surgeon, under the supervision of a prenatal medicine doctor and a nurse, pierces a blood vessel in the placenta or a blood vessel of the fetus through the mother’s abdomen. Survival after this procedure is high, around 97%. According to Verdoes and Teunissen, this is partly due to the well-oiled machine that makes up this team. “Surgeons, nurses and prenatal doctors have been working together for a long time,” says Verdoes. “This is where our strength lies”.
So together they’ve already performed 2,500 transfusions. But it will never be a chore, Verdoes and Teunissen point out. “I still think it’s magical. With a relatively simple procedure, for which we only need very small amounts of blood, we can save a life. A life you haven’t seen with your own eyes yet, ”says Teunissen. “Also, each procedure is different and we can still have an elated ‘yes’ with the team if all goes well the first time around,” adds Verdoes.
Fast action
Blood transfusions into the uterus are only performed in the LUMC in the Netherlands. This has the advantage that action can be taken quickly and that good research can be done on this rare disease. The LUMC fetal team aims to improve the screening, diagnosis and treatment of rhesus disease. It does this not only in the Netherlands, but also with a worldwide registration and research in Tanzania, for example, where this disease is still a major problem.
How does Rhesus disease develop?
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