Báo cáo ca bệnh: Thiếu máu nặng ở trẻ sơ sinh đủ tháng do truyền máu mẹ con

Fetal maternal hemorrhage (FMH), where fetal blood enters maternal circulation, is a common occurrence in pregnancies, yet significant blood loss leading to severe neonatal anemia is a rare but critical condition with potentially devastating consequences, including stillbirth and hydrops fetalis. Severe anemia in newborns remains a major contributor to infant mortality and long-term developmental impairments. Despite its rarity, FMH-induced neonatal anemia poses diagnostic challenges, as clinical manifestations can be non-specific, often leading to delayed intervention. This case report aims to highlight the importance of considering FMH as a differential diagnosis for severe neonatal anemia, emphasizing the role of diagnostic tools like the Kleihauer-Betke test and illustrating the efficacy of targeted therapeutic approaches such as exchange transfusion, particularly in cases without hypovolemia.

Medical professionals, including pediatricians, neonatologists, obstetricians, and general practitioners interested in neonatal care and blood disorders.

This academic case report details a critical instance of severe neonatal anemia in a full-term newborn, specifically attributed to significant fetal maternal hemorrhage (FMH). While FMH is broadly common in pregnancies, substantial fetal blood loss into the maternal circulation leading to severe anemia in the neonate is rare and often insidious, making accurate diagnosis challenging. The presented case involved a neonate with profound anemia but without signs of hypovolemia, a crucial distinction for guiding therapy. The diagnostic process involved considering FMH as the underlying cause and confirming it through a Kleihauer-Betke test, which revealed significant fetal cells in the maternal blood. The core therapeutic approach adopted was exchange transfusion. This intervention was chosen strategically to address the severe anemia by increasing oxygen-carrying capacity without inducing circulatory overload, a risk associated with simple blood transfusions in normovolemic anemic infants, which could lead to heart failure. The report emphasizes that neonatal anemia due to FMH, though uncommon, warrants prompt consideration. It highlights the efficacy of exchange transfusion as a safe and effective treatment, particularly when the infant does not exhibit hypovolemic shock. The implications extend to improving clinical practice by urging healthcare professionals, particularly pediatricians and neonatologists, to maintain a high index of suspicion for FMH in cases of unexplained severe neonatal anemia, ensuring timely diagnosis and appropriate management to prevent adverse outcomes and improve patient prognosis. The discussion also contextualizes FMH within broader causes of neonatal anemia and its neurological sequelae, reinforcing the value of this specific intervention.