Prenatal ABO/RHD Genotyping: A New Paradigm to Allow for Fresh Whole Blood for Cardiopulmonary Bypass in the Immediate Newborn Period.
Prenatal ABO/RHD Genotyping: A New Paradigm to Allow for Fresh Whole Blood for Cardiopulmonary Bypass in the Immediate Newborn Period.
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产前 ABO/RHD 基因分型：一种新范式，允许在新生儿早期进行心肺搭桥术时使用新鲜全血。
DOI：
10.1159/000487592
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发表时间：
2018
影响因子：
2.2
通讯作者：
McMillan,KristenNelson
中科院分区：
文献类型：
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作者：
Bishop,JulietChhay;Blakemore,Karin;Vricella,Luca;Sekar,Priya;Sagaser,Katelynn;Crino,Jude;Ness,Paul;Kogutt,BenjaminK;Boyd,Joan;Aucott,Susan;Jelin,AngieC;Chiu,Joanne;Gehrie,Eric;McMillan,KristenNelson
与标准成分疗法相比，新鲜全血 (FWB) 为在心脏直视手术中接受体外循环 (CPB) 的新生儿提供了潜在的益处：减少失血和随后的容量超负荷风险、改善凝血状态、体外循环期间和之后更高的血小板计数、规避有限的血管通路以及显着减少供体暴露。然而，获得 FWB 需要 2-5 天的准备时间，这通常妨碍了在新生儿期需要 CPB 的新生儿的可用性。使用多学科方法和羊水分子 ABO/RHD 基因分型，我们制定了一项方案，允许采购 FWB 用于定时分娩，然后进行心脏直视手术。符合条件的受试者包括在诊断出胎儿心脏异常后接受遗传性羊膜穿刺术的患者，可能需要在出生后最初几天进行开放式手术修复。该协议已在严重胎儿心脏异常的产前诊断后成功实施。利用产前时间段和使用分子基因分型在产前进行胎儿血型的能力，为 CPB 提供 FWB 的新范例成为可能，以改善由一些将接受 CPB 的最小和病情最严重的患者组成的人群的围手术期、短期和长期结果。
Compared to standard component therapy, fresh whole blood (FWB) offers potential benefits to neonates undergoing cardiopulmonary bypass (CPB) in the context of open cardiac surgery: decreased blood loss and subsequent risk of volume overload, improved coagulation status, higher platelet counts during and following CPB, circumvention of limited vascular access, and significantly reduced donor exposures. Obtaining FWB, however, entails 2–5 days of preparation, which often precludes its availability for neonates requiring CPB in the immediate newborn period. Using a multidisciplinary approach and molecular ABO/RHD genotyping on amniotic fluid, we developed a protocol to allow procurement of FWB for timed delivery followed by open cardiac surgery. Eligible subjects include patients undergoing genetic amniocentesis following the diagnosis of a fetal cardiac anomaly likely to require open surgical repair in the initial days after birth. This protocol has been successfully implemented following prenatal diagnosis of severe fetal cardiac anomalies. Taking advantage of the prenatal time period and the ability to perform fetal blood typing prenatally using molecular genotyping makes possible a new paradigm for the availability of FWB for CPB to improve perioperative, short-term, and long-term outcomes in a population comprised of some of the smallest and sickest patients who will undergo CPB.