Early Treatment by Plasmapheresis in a Woman with Multiple Abortions and the Rare Blood Group p

Abstract

Women with the rare blood group p are known to have an increased rate of abortions. The case of a 36-year-old woman is presented who had had 7 spontaneous abortions in the first trimester and no live child. When treated by plasma exchange begun early in pregnancy and continued until the 29th week, she delivered a normal child. Time to begin, amount and length of time necessary to continue plasma exchange in these patients are considered. In addition, the question of which fraction of the anti-PP(1)P^k could be responsible for abortion is discussed. To our knowledge, this is the first case of a woman of p phenotype with no live children but with multiple abortions treated by this method, which should be seriously considered in similar cases.

Successful Treatment by Double Filtrate Plasmapheresis in a Pregnant Woman With the Rare P Blood Group and a History of Multiple Early Miscarriages

“…The types of anticoagulant were not described in any previous reports including those treated by DFPP (4), except for one report (19). In that report, sodium citrate was used in a centrifugal separating system that usually requires citrate as an anticoagulant.…”

“…We reviewed previous reports of habitual abortion cases of p blood type that were treated either successfully (4,7,(14)(15)(16)(17)(18)(19)(20) or unsuccessfully (15,21) with antibody removal therapy, as outlined in Table 2. The timing of the treatment initiation is particularly important because P, P k antigen expresses as early as 3 weeks of age on the trophoblast of the placenta (7).…”

“…Consequently, the antigen engenders early abortion (10)(11)(12)(13) in more than half of the affected pregnancies (5). Only a few cases (4,7, [14][15][16][17][18][19][20] have shown successful delivery of living children as a result of therapy for anti-PP 1 P k positive pregnancy.…”

Anti-TJa Alloimmunization (anti-PP1Pk)

“…In the 4 previous cases, plasmaphere sis was started between the 3rd and 4th weeks [15][16][17][18]. Shechter et al [17] report a failure concerning a patient placed under observa tion and transfused at 7 weeks. Plasmaphere sis aims at obtaining rates of antibodies rang ing between one sixteenth and one sixtyfourth until week 18 if possible.…”

“…The four children reported in the literature were born by cesar ean section. Two deliveries were scheduled, one at 33 weeks [18], the other at 34 weeks due to fetal malpresentation [17], The two others took place at 31 weeks due to fetal dis tress and IUGD [16,19].…”