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Aryabhatta Sadhu: Intrauterine Red-Cell and Platelet Transfusion in Fetal Medicine

Aryabhatta Sadhu/LinkedIn

Oct 26, 2026, 15:37

Aryabhatta Sadhu: Intrauterine Red-Cell and Platelet Transfusion in Fetal Medicine

Aryabhatta Sadhu, Attending Consultant and Head of Transfusion Medicine at Fortis Hospital Shalimar Bagh, New Delhi, Member of AABB, Member International Society of Blood Transfusion (ISBT), shared a post on LinkedIn:

”Fetal transfusion medicine: same vessel, same needle — not the same clinical role.

Intrauterine red-cell transfusion (IUT) and intrauterine platelet transfusion (IUPT) both reach the fetus through the umbilical vein, at the placental cord insertion or its intrahepatic segment. Their places in contemporary practice are very different.

IUT for fetal anaemia

Serial middle cerebral artery peak systolic velocity (MCA-PSV) is the primary non-invasive test. A value above 1.5 multiples of the median (MoM), or hydrops, prompts referral and fetal blood sampling with blood ready — a referral threshold, not a transfusion trigger.
Red cells: compatible with fetal and maternal blood (usually RhD-negative), negative for all antigens corresponding to maternal antibodies, no more than 10 days old, leukocyte-depleted, irradiated and used within 24 hours, with a haematocrit of 75 to 85 percent.
In a large single-centre series involving 937 IUT procedures in 334 fetuses between 2001 and 2015, procedure-related perinatal loss was 0.6 percent per procedure. The risk is higher before 20 weeks of gestation.

IUPT in fetal and neonatal alloimmune thrombocytopenia (FNAIT)

FNAIT-related intracranial haemorrhage (ICH) often begins before 28 weeks of gestation and frequently affects first pregnancies.
Weekly maternal intravenous immunoglobulin (IVIG), started earlier when there has been a previous pregnancy affected by intracranial haemorrhage, is first-line treatment. Fetal blood sampling followed by platelet transfusion is no longer first-line and is reserved for exceptional cases, if used at all.
In a systematic review, invasive strategies were associated with procedure-related complications in 11 percent of treated pregnancies.

Take-home: both procedures require a fetal therapy centre and a prepared transfusion service, but IUT is an established treatment for significant fetal anaemia, whereas IUPT is reserved for exceptional circumstances within IVIG-based FNAIT care.”

Aryabhatta Sadhu: Intrauterine Red-Cell and Platelet Transfusion in Fetal Medicine