Tackling the challenge of in utero blood exchange transfusion for fetal anemia at 15 weeks' gestation.

Severe fetal anemia due to parvovirus infection and alpha-thalassemia major can occur during the first trimester of pregnancy. In utero transfusion before 16 weeks of gestation is beneficial but challenging because the umbilical vein is too narrow to be precisely punctured. In addition, the fetal circulating volume is small, and the heart of an affected fetus is compromised. To avoid vascular overload, exchange transfusion may be considered. The technical difficulties make in utero simple transfusions seldom performed before 16 weeks of gestation, and exchange transfusion before 16 weeks of gestation has not been reported. Hence, we reported our technique of successful in utero exchange transfusion in a fetus with alpha-thalassemia major at 15 weeks of gestation. The keys of success were as follows: Fetal blood was not withdrawn for diagnostic investigation before the first transfusion for the following pragmatic reasons.