Donald L. Hutchinson

Persistence of donor cells in neonates after fetal and exchange transfusion

Abstract Cytogenetic analysis was performed on the peripheral blood of 14 male infants who had received fetal transfusions of maternal blood and on 48 infants who had received exchange transfusion with donor blood of the opposite sex. Similar observations were made on the 167 donor blood packs prior to transfusion. Maternal lymphocytes have persisted for longer than 2 years in the peripheral blood of 4 infants who received fetal transfusion. In contrast, no donor lymphocytes were identified beyond 6 to 8 weeks post transfusion in the infants who received exchange transfusion with donor blood of blood bank origin.

The syndrome of chronic abruptio placentae, hydrorrhea, and circumvallate placenta

Circumvallate placenta is caused by repeated marginal hemorrhages. Three such cases are presented. Hydrorrhea gravidarum was present in each instance. The interrelation of these three entities (chronic abruptio placentae, hydrorrhea, and circumvallate placenta) is discussed.

Advantages of use of maternal erythrocytes for fetal transfusion

Abstract Although many incompletely understood problems surround fetal transfusion, the desirability of maximum quality control of donor blood is evident. It is felt that the administration of washed maternal erythrocytes will minimize the risk of incompatibility, homologous serum jaundice, infection, and immunologic disorders in the fetus. The removal of extraneous, unnecessary, and potentially injurious components from whole blood is incomplete, for mitotically active lymphocytes are present in all donor blood tested at the time of transfusion. Studies on 6 male fetuses who were transfused revealed 2 instances of more than 5 per cent XX lymphocytes in short-term cultures from samples of peripheral blood obtained on the day of birth (23 days after fetal transfusion) and at 16 months of age. Lymphocytic chimerism may be an infrequent but important complication of fetal transfusion.

The pathogenesis of placental infarction: II. An experimental study in the rhesus monkey placenta

Abstract One to 4 uteroplacental arteries were surgically visualized and ligated in vivo in 34 pregnant rhesus monkeys, and pregnancy was allowed to continue. The placentas of 19 animals eventually became available for histologic and histochemical study after a variable but predetermined interval following ligation. Necrotic cotyledonary lesions showing the histologic and histochemical characteristics of infarction could be demonstrated in connection with ligated uteroplacental arteries. The earliest lesion was found after a 23 hour interval following ligation. It is concluded that occlusion of a uteroplacental artery leads to a lesion which is comparable with an infarct in the human placenta. In this experimental model, there appears to be no effective collateral maternal cotyledonary circulation.

Fetal and maternal risks associated with intrauterine transfusion procedures

Continuing follow-up observations and study of information as derived from a large cohort of fetal recipients of intrauterine transfusion (IUT) is utilized to provide estimates of maternal and fetal risks associated with the transfusion procedures, subsequent maternal complications of the pregnancy, and the health, intelligence, and behavior of the erythroblastotic recipient. The upper limit of risk of the procedure is estimated to be 7.2 per cent. Fourteen per cent of hydropic fetuses survived through the perinatal period as compared with 47 per cent of nonhydropic fetuses. One infant developed acute lymphocytic leukemia (ALL) at age 4 1/2 years. The IUT survivors showed a marked correlation among the frequencies of abnormalities in the three areas measured: physical, intellectual, and social maturity. Only about 50 per cent were considered normal in these parameters of health. Maternal complications were observed in only 2 per cent of the cases.

Effects of a beta-adrenergic agent (metaproterenol) on uteroplacental circulation. An angiographic study in the pregnant rhesus monkey.

Abstract Placental radioangiography was performed in 13 lightly anesthetized pregnant rhesus monkeys under standardized conditions. Amniotic, aortic, and central venous pressures as well as the maternal electrocardiogram (ECG) were continuously monitored. In six experiments intravenous infusion of a small amount of metaproterenol was shown to accelerate the angiographic appearance of intervillous spurts due to vasodilatation. This effect could be partially blocked by propranolol and thus would appear to be caused by stimulation of vascular beta-adrenergic receptors. Evidence is adduced that accelerated uteroplacental circulation in this experimental model means increased uteroplacental blood flow. In analogy, administration of small amounts of a beta-adrenergic agent in cases of impaired uteroplacental blood flow due to vasospasm in man might lead to vasodilatation and consequently might improve uteroplacental flow and fetal condition.

Experimental production of anemia in fetal lambs

An attempt has been made to produce an experimental model in the fetal lamb which would simulate the physicochemical and pathologic phenomena associated with the severe anemia and hydrops seen in severe human erythroblastosis. Profound anemia was obtained by repeated fetal phlebotomy. Hemolytic anemia was induced in the fetal lamb by direct administration of phenylhydrazine, without discernible effect on the health of the maternal ewe. Hydrops fetalis has not been observed after either chronic fetal bleeding or with phenylhydrazine-induced anemia.

Diagnostic use of amniotic fluid

Summary The amniotic fluid is now recognized as a continually changing body compartment which can yield valuable information regarding fetal maturity and health. Practical clinical applications of amniotic fluid analysis are found in the management of pregnancy in Rh-sensitized women, in the evaluation of fetal distress, in the determination of fetal maturity, and in the detection of familial chromosomal and metabolic disorders. Continuing investigations of the origin, the circulatory pathways, and the constituents of this vital fluid will undoubtedly uncover further diagnostic applications.

A radioangiographic study of the effects of catecholamines on uteroplacental blood flow in the rhesus monkey.

Two placental radioangiographies were performed with a 20-min interval in ten lightly anesthetized rhesus monkeys. Amniotic and aortic pressures, as well as the maternal ECG, were continuously monitored. Norepinephrine or metaproterenol was administered in a low dose which did not cause general cardiovascular effects, prior to the second angiography. Norepinephrine appeared to cause constriction and metaproterenol, dilatation of the uteroplacental vessels. These effects could be diminished or abolished by an alpha- or beta-adrenergic blocking agent, respectively, and thus would appear to be caused by stimulation of adrenergic receptors in the uteroplacental vasculature.

Cyclohexylamine mutagenicity: an in vivo evaluation utilizing fetal lambs.

Summary The in vivo effects of cyclohexylamine (CHA) upon the segregation apparatus and chromosome morphology of mitogenically capable lymphocytes obtained from the peripheral circulating blood tissue of living fetal lambs in utero were evaluated. CHA proved to be a clastogen in vivo . The mechanism(s) of chromosome effect was evidently expressed during both G 1 and S-G 2 phases of the cellular autosynthetic cycle. Increases in numerical aberrations were not observed but the chemical was found to produce in vivo toxicity in that a dose-related inhibition of growth was an observable concomitant of increasing levels of treatment.