Title Liječenje i dijagnostika neimunoloških anemija ploda Title (english) Treatment and diagnosis of non-immune fetal anemia Author Iva Markulin Mentor Berivoj Mišković (mentor)Committee member Snježana Škrablin-Kučić (predsjednik povjerenstva)Committee member Željko Duić (član povjerenstva)Committee member Berivoj Mišković (član povjerenstva)Granter University of Zagreb Defense date and country 2020-07-17, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Fetalne anemije (FA) rijetke su bolesti u trudnoći, a dijele se u dvije velike skupine: imunološke i neimunološke. Neimunološke fetalne anemije (NFA) izrazito su heterogena skupina FA s različitom etiopatogenezom. S obzirom na uvedenu Rh-profilaksu, poprimaju sve veći značaj u kliničkoj praksi iako im je učestalost ostala nepromijenjena. Zajedničko obilježje svih NFA je izostanak specifičnih protutijela majke na antigene fetalnih eritrocita. NFA mogu nastati stupnjevito kao posljedica kroničnih bolesti ili akutno, uslijed krvarenja u fetoplacentnoj cirkulaciji. Među najčešće uzroke kroničnih NFA ubrajaju se infekcije, anemije u blizanačkim trudnoćama, tumori posteljice ili tumori fetusa i nasljedne bolesti, poput nasljednih anemija i urođenih greški metabolizma. Fetomaternalno krvarenje (FMK) i prsnuće predležećih fetalnih krvnih žila, tzv. vasa previa, uzrokuju akutnu FA i dekompenzaciju kardiovaskularnog sustava. U nekim slučajevima etiologija NFA ostaje nepoznata unatoč detaljno provedenoj dijagnostici. Fetalni hidrops krajnji je stadij FA i najčešće označava zakašnjelu dijagnozu i lošiju prognozu. Dijagnostički postupci kod NFA su mnogobrojni i određuje ih sam uzročnik. „Zlatni standard“ u dijagnostičkoj obradi NFA je mjerenje vršnih sistoličkih brzina u središnjoj moždanoj arteriji (MCA-PSV) doplerom u boji, čime je potreba za invazivnim zahvatima smanjena za 70%. Kordocenteza je danas isključivo vezana uz postupak intrauterinih transfuzija (IUT). S obzirom na različitu etiopatogenezu, dostupni su i različite metode liječenja NFA. Akutne anemije zbrinjavaju se kirurški, odnosno hitnim carskim rezom, a u liječenju kroničnih NFA najčešće se primjenjuju IUT. One su zahtjevna, ali učinkovita i sigurna metoda liječenja većine NFA uz koju je fetalna smrtnost zbog FA pala ispod 10%. Uz IUT, za liječenje sindroma blizanačke anemije i policitemije (TAPS) primjenjuje se i laserska ablacija vaskularnih anastomozi, koja je ujedno i terapija međublizanačkog transfuzijskog sindroma (MBTS). Nedovoljan je broj studija koje su dugoročno pratile neurološki razvoj djece nakon NFA, međutim prema većini provedenih studija, samo malen postotak djece liječen IUT zbog fetalne anemije ima neki stupanj neuromotornog deficita.
Abstract (english) Fetal anemias (FA) are rare diseases in pregnancy and are divided into two major categories: immune and non-immune. Non-immune fetal anemias (NFA) are a extremely heterogeneous group of FAs with different etiopathogenesis. Due to the introduced Rh-prophylaxis, they are becoming important in clinical practice, although their frequency has remained unchanged. A common feature of all NFAs is the absence of specific maternal antibodies to fetal erythrocyte antigens. NFAs can occur gradually as a consequence of chronic diseases or acutely, due to bleeding in the fetoplacental circulation. The most common causes of chronic NFA include infections, anemia in twin pregnancies, placental or fetal tumors, and inherited diseases, such as hereditary anemias and congenital metabolic errors. Fetomaternal hemorrhage (FMH) and rupture of the previa fetal blood vessels, the so-called vasa previa, cause acute FA and decompensation of the cardiovascular system. In some cases, the etiology of NFA remains unknown despite detailed diagnostics. Fetal hydrops is the final stage of FA and most commonly indicates delayed diagnosis and worse prognosis. Diagnostic procedures in NFA are numerous and are determined by the causative agent. The "gold standard" in NFA diagnostic processing is the measurement of peak systolic velocities in the middle cerebral artery (MCA-PSV) by color Doppler, thus reducing the need for invasive procedures by 70%. Cordocentesis today is exclusively related to the intrauterine transfusion (IUT) procedure. Due to different etiopathogenesis, different methods of NFA treatment are also available. Acute anemias are treated surgically or by emergency cesarean section, and IUTs are most often used in the treatment of chronic NFA. They are a demanding but effective and safe method of treating most NFA with which fetal mortality due to FA has fallen below 10%. Laser ablation of vascular anastomoses is the method of choice in the treatment of NFA arising as a complication of monochorionic (MC) twin pregnancies, e.g., twin-to-twin transfusion syndrome (TTTS) or twin anemia and polycythemia (TAPS). In addition to IUT, laser ablation of vascular anastomoses is also used to treat the twin anemia polycythemia sequence (TAPS) (TAPS). Nevertheless, it is the treatment of twin-to-twin transfusion syndrome. There are insufficient studies that have long-term followed the neurological development of children after NFA, however according to most studies conducted, only a small percentage of children treated with IUT due to fetal anemia have some degree of neuromotor deficit.
Keywords
neimunološke fetalne anemije
etiologija neimunoloških fetalnih anemija
dijagnostika fetalnih anemija
intrauterina transfuzija
komplikacije intrauterinih transfuzija
ishodi trudnoća
Keywords (english)
non-immune fetal anemias
etiology of non-immune fetal anemias
diagnosis of fetal anemias
intrauterine transfusion
complications of intrauterine transfusions
pregnancy outcomes
Language croatian URN:NBN urn:nbn:hr:105:436168 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2021-08-24 11:08:37
