Managing Severe Foetal Anaemia Due to Rh Alloimmunisation: A Report of Two Cases of Successful Intrauterine Blood Transfusion

Intrauterine Transfusion (IUT) remains a critical intervention in managing severe foetal anaemia, particularly due to Red Blood Cell (RBC) alloimmunisation. Without timely treatment, foetal anaemia can lead to hydrops foetalis, heart failure, or even intrauterine death. The decision to perform IUT is guided by key clinical indicators such as raised Middle Cerebral Artery Peak Systolic Velocity (MCA-PSV), decreased foetal haemoglobin, and high maternal antibody titres. Although IUT has significantly improved foetal and neonatal outcomes, it requires precise timing, well-coordinated teamwork, and careful preparation of compatible donor blood to minimise complications. In the present report, both cases involved Rh-negative women with known alloimmunisation who presented in the third trimester with rising antibody levels and ultrasound findings suggestive of foetal anaemia. The transfusions were performed under ultrasound guidance via umbilical vein puncture. Blood prepared for Intrauterine Transfusion (IUT) was group O RhD-negative, leukocyte-depleted, irradiated, and crossmatch-compatible with the maternal sample. Foetal haemoglobin and haematocrit levels were assessed before, during, and after the transfusion, with close monitoring maintained until delivery and throughout the neonatal period. In the first case, two well-timed transfusions improved foetal haemoglobin and normalised MCAPSV, resulting in the birth of a stable neonate who later required exchange transfusion and phototherapy but recovered fully. The second mother received one IUT but declined further treatment despite worsening MCA-PSV. Due to foetal distress, an emergency caesarean section was performed. The preterm infant responded well to a double-volume exchange transfusion and phototherapy. Both babies remained stable during follow-up, with one requiring a top-up transfusion for delayed haemolysis.