Erythropoietin in human fetuses with immune hemolytic anemia and hydrops fetalis.

Abstract

OBJECTIVE:

To determine whether plasma erythropoietin is increased in fetuses with anemia due to Rh isoimmunization.

METHODS:

Hemoglobin and erythropoietin were measured in samples obtained by funipuncture from 15 fetuses with Rh isoimmunization (gestational age 26.2 +/- 5.0 weeks, mean +/- standard deviation) and from 13 control fetuses (23.1 +/- 6.7 weeks). Hemoglobin and erythropoietin also were determined in umbilical cord blood collected at birth from 20 term fetuses delivered by elective cesarean.

RESULTS:

Fetuses with Rh isoimmunization had lower hemoglobin and higher plasma erythropoietin measurements than mid-gestation controls (6.1 +/- 3.9 versus 10.7 +/- 1.5 g/dL and 105.5 +/- 168.1 versus 12.5 +/- 3.1 mU/mL, P < .05, respectively). Hemoglobin and plasma erythropoietin increased with gestational age in control fetuses. There was an inverse association between hemoglobin and plasma erythropoietin in control and Rh-isoimmunized fetuses (r = -0.56, P < .005). Using multiple linear regression, hemoglobin and gestational age were associated independently with plasma erythropoietin (overall F2,25 = 12.3, multiple r2 = 0.49, P < .001). Despite marked decreases in hemoglobin, fetuses below 24 weeks' gestation had minimal increases in plasma erythropoietin compared to fetuses above that gestational age. Mildly anemic Rh-isoimmunized fetuses (hemoglobin 11.6 +/- 2.0 g/dL) delivered vaginally had significantly higher erythropoietin levels in umbilical cord plasma than Rh-isoimmunized fetuses with comparable hemoglobin (10.9 +/- 3.5 g/dL) delivered by elective cesarean without labor (1246 +/- 856 versus 106 +/- 66 mU/mL, respectively, P < .05).

CONCLUSION:

Fetuses with anemia at mid to late gestation respond with increases in plasma erythropoietin, but these changes are substantially attenuated before 24 weeks' gestation.

• Authors: F R Moya, P A Grannum, J A Widness, G K Clemons, J A Copel, J C Hobbins
• Journal: Obstetrics and gynecology (Obstet Gynecol) Vol. 82 Issue 3 Pg. 353-8 (Sep 1993) ISSN: 0029-7844 [Print] United States
• PMID: 8355933 (Publication Type: Journal Article)

Chemical References

• Hemoglobins
• Erythropoietin

Topics

• Anemia, Hemolytic, Autoimmune (blood, complications, therapy)
• Blood Transfusion, Intrauterine
• Erythropoietin (blood)
• Fetal Blood
• Fetal Diseases (blood, therapy)
• Gestational Age
• Hemoglobins (analysis)
• Humans
• Hydrops Fetalis (blood, complications, therapy)
• Regression Analysis
• Rh Isoimmunization (blood, complications, therapy)