Nonimmune Fetal Anemia: Exploring the Unfathomed! Case Series and Review of Literature

Background: To discuss a series of complex non-immune fetal anemia cases, including etiology, investigations, workup, diagnosis, and management. Materials and methods: Five complex non-immune cases of fetal anemia seen in our department are presented. Results: Of the five cases presented, all are live births with follow-up least up to 1.5 years of age. They are cases of hereditary spherocytosis, congenital dyserythropoietic anemia, MCDA twins—twin-twin transfusion syndrome (TTTS) post-laser co-twin demise-fetal anemia, placental chorioangioma, and massive fetomaternal hemorrhage. Conclusion: Non-immune causes of fetal anemia can be difficult to diagnose its etiology and hence complex to manage. Repeated intrauterine transfusions may be the only perinatal management. The perinatal morbidity/mortality and preterm delivery rates are increased, and some cases require long-term treatment including regular transfusions. We present our experience of a series of complex non-immune fetal anemia managed in a tertiary unit, review the literature, and suggest appropriate management. Detailed fetal structural evaluation and placental ultrasound, MCA-PSV Doppler, fetal echocardiogram if hydrops, FBS, blood type, Hb, hematocrit, platelet count, direct Coombs, reticulocyte count and total bilirubin, PCR for CMV and PB 19 with or without syphilis and toxoplasmosis, peripheral smear, nonstress test for sinusoidal fetal heart rate pattern. 2