Fetal Intravenous Immunoglobulin Therapy in Rhesus Hemolytic Disease

Kriplani, Alka; Singh, Bhawna; Mandal, Kavita

doi:10.1159/000097661

Cited by 24 publications

(22 citation statements)

References 16 publications

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“…Another case series of 4 cases [16] found fetal IVIG therapy in Rh hemolytic disease beneficial. IVIG was transfused into cord blood at the time of IUT in severely hydropic fetuses <28 weeks' gestation.…”

Section: Discussionmentioning

confidence: 99%

Direct Fetal Intravenous Immunoglobulin Infusion as an Adjunct to Intrauterine Fetal Blood Transfusion in Rhesus-Allommunized Pregnancies: A Pilot Study

Deka

Sharma²,

Dadhwal³

et al. 2013

Fetal Diagn Ther

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Objectives: To study the usefulness of direct fetal intravenous immunoglobulin (IVIG) infusion along with intrauterine transfusion (IUT) in the management of severe fetal anemia in rhesus (Rh) alloimmunized pregnancies. Methods: Thirty-four consecutive Rh-isoimmunized pregnant women who required serial IUTs received either blood alone (control group, n = 16) or IVIG and blood (study group, n = 18). Pregnancies were followed up to delivery, and fetal outcome was recorded. The rate of fall of hematocrit was measured and compared between the two groups. Results: There was a slower rate of fall of hematocrit in the study group (IUT and IVIG) compared to the control group (only IUT). The mean rate of fall was 0.72 ± 0.54% per day in the study group while it was 1.29 ± 0.95% per day in the control group (p = 0.005). Conclusion: Fall of fetal hematocrit was reduced in the study group. The results of this pilot study can be used to time the next transfusion in patients receiving IVIG along with IUT (taking the rate of fall as 0.70%). This may eventually result in decreasing the number of transfusions per fetus.

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Section: Discussionmentioning

confidence: 99%

Direct Fetal Intravenous Immunoglobulin Infusion as an Adjunct to Intrauterine Fetal Blood Transfusion in Rhesus-Allommunized Pregnancies: A Pilot Study

Deka

Sharma²,

Dadhwal³

et al. 2013

Fetal Diagn Ther

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“…Bilirubin levels can rise quickly in the first hours of postnatal life, and interventions must be prompt to prevent side effects related to hyperbilirubinemia [29]. The reduction in the frequency of disease occurrence has followed the understanding of its pathophysiology, the development of reliable diagnostic tools, the widespread use of Rh-immune globulin prophylaxis [19,21], and, for those cases slipping through the prevention system, the availability of treatment by intrauterine blood transfusions, which together constitute one of the great advances in modern medicine [10,17,27].…”

Section: Discussionmentioning

confidence: 99%

Early intravenous immunoglobin (two-dose regimen) in the management of severe Rh hemolytic disease of newborn—a prospective randomized controlled trial

Elalfy

Elbarbary

Abaza³

2010

Eur J Pediatr

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Phototherapy is the standard treatment in moderately severe hemolytic disease of newborn (HDN), whereas exchange transfusion (ET) is the second line in progressive cases. Intravenous immunoglobin (IVIG) has been suggested to decrease the need for ET. We aimed at assessing the efficacy of early two-dose regimens of IVIG to avoid unnecessary ET in severe Rh HDN. The study included 90 full-term neonates with Rh incompatibility unmodified by antenatal treatment and not eligible for early ET and which were randomly assigned into one of three groups: group (I), treated by conventional method; groups IIa and IIb received IVIG once at 12 h postnatal age if PT was indicated, in a dose of 0.5 and 1 g/kg, respectively. Analysis revealed 11 neonates (22%) in the conventional group and 2 (5%) in the intervention group who administered low-dose IVIG at 12 h, while none in group IIb required exchange transfusion (p = 0.03). Mean bilirubin levels were significantly lower during the first 96 h in the intervention group compared to the conventional group (p < 0.0001). Shorter duration of phototherapy (52.8 ± 12.39 h) and hospital stay (3.25 ± 0.71 days) in the IVIG group compared to conventional group (84 ± 12.12 h and 4.72 ± 0.78 days, p < 0.0001, respectively) were observed. We conclude that IVIG administration at 12 h was effective in the treatment of severe Rh HDN; the low-dose IVIG (0.5 g/kg) was as effective as high dose (1 g/kg) in reducing the duration of phototherapy and hospital stay, but less effective in avoiding exchange transfusion.

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“…Several case reports have been published with favorable outcome following this combined approach [86,[92][93][94][95][96]. Reported side effects of IVIG are rare but may include: headache, fever, myalgia and low back pain, rush or chills, urticaria, nausea and vomiting, tachycardia, chest tightness, hypotension and shortness of breath [42,50,97,98]. These events usually occur 30-60 min after admission and especially the headache could be prevented by 1000 mg acetaminophen before infusion [42].…”

Section: Intravenous Immunoglobulins (Ivig)mentioning

confidence: 99%

“…These events usually occur 30-60 min after admission and especially the headache could be prevented by 1000 mg acetaminophen before infusion [42]. Although very rare, renal failure, aseptic meningitis, anaphylaxis (mainly in case of IgA deficiency), hemolytic anemia, thromboembolism and pulmonary edema are described [50,97,98].…”

Section: Intravenous Immunoglobulins (Ivig)mentioning

confidence: 99%

Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn – review on current management and outcome

Zwiers

Kamp

Oepkes

et al. 2017

Expert Review of Hematology

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Introduction: Hemolytic disease of the fetus and newborn (HDFN) remains a serious pregnancy complication which can lead to severe fetal anemia, hydrops and perinatal death. Areas covered: This review focusses on the current prenatal management, treatment with intrauterine transfusion (IUT) and promising non-invasive treatment options for HDFN. Expert commentary: IUTs are the cornerstone in prenatal management of HDFN and have significantly improved perinatal outcome in the past decades. IUT is now a relatively safe procedure, however the risk of complications is still high when performed early in the second trimester. Non-invasive management using intravenous immunoglobulin may be a safe alternative and requires further investigation. ARTICLE HISTORY

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Fetal Intravenous Immunoglobulin Therapy in Rhesus Hemolytic Disease

Cited by 24 publications

References 16 publications

Direct Fetal Intravenous Immunoglobulin Infusion as an Adjunct to Intrauterine Fetal Blood Transfusion in Rhesus-Allommunized Pregnancies: A Pilot Study

Direct Fetal Intravenous Immunoglobulin Infusion as an Adjunct to Intrauterine Fetal Blood Transfusion in Rhesus-Allommunized Pregnancies: A Pilot Study

Early intravenous immunoglobin (two-dose regimen) in the management of severe Rh hemolytic disease of newborn—a prospective randomized controlled trial

Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn – review on current management and outcome

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