National survey of current intrauterine transfusion practices in India: Identifying gaps and actionable recommendations.

Objective: Intrauterine transfusion (IUT) is a critical intervention for managing severe foetal anaemia, yet significant variability exists in transfusion protocols across India. This study aimed to evaluate the selection, processing and infusion protocols used by Indian transfusion medicine laboratories and foetal medicine teams for IUT, comparing them with international guidelines to develop best practice recommendations.

Methods: A cross-sectional survey was conducted among transfusion medicine and foetal medicine centres across India that had performed at least one IUT in the past 6 months. A structured questionnaire covering demographic data, transfusion medicine practices and foetal medicine protocols was distributed, and responses were analysed using descriptive statistics. A scoring system (0-4) was employed to assess adherence to best practices.

Results: A total of 22 centres participated, with wide variability observed in transfusion practices. While 91% of centres used O RhD-negative blood, only 41% implemented extended phenotype matching. The targeted haematocrit (HCT) levels varied, with 75% preferred by most centres. Leucodepletion practices were inconsistent, and only 18% screened for cytomegalovirus (CMV). The majority of centres (59%) reported low complication rates, with foetal bradycardia being the most common adverse event. Success rates exceeded 80% in most centres; a gap analysis was done to derive the recommendations.

Conclusions: The findings highlight the need for national guidelines for IUT practices in India. Recommendations include the use of pre-leucodepleted O RhD-negative red blood cells (RBCs), extended phenotype matching, fresh RBCs with HCT adjusted to 75%-80%, and mandatory irradiation. Implementing these best practices will standardize IUT services across India.