Repeated direct fetal intravascular high-dose immunoglobulin therapy for the treatment of Rh hemolytic disease

Abstract

Recently, administration of high-dose intravenous immunoglobulin (HDivIG) either to the mother or the neonate has been proposed in an effort to prevent progressive hemolysis in Rh(D) perinatal disease, but no cases have been published with direct fetal HDivIG administration. We report a case in which HDivIG was repeatedly administered by cordocentesis to a fetus affected by Rh(D) disease from 28 to 36 weeks gestation, at doses of approximately 450 mg/kg. The fetus required no transfusions, and the neonatal evolution was satisfactory. The treatment, performed at three weeks intervals, seemed to be useful in preventing fetal hemolysis. No fetal complications were present. Recurrent administration of HDivIG therapy to the fetus in cases of severe Rh(D) disease, appears to be feasible and free of serious complications to the fetus or the mother.

IVIG – Is it the answer? Maternal administration of immunoglobulin for severe fetal red blood cell alloimmunisation during pregnancy: A case series

“…Direct fetal infusion of IVIG has also been studied in conjunction with IUT, albeit with limited demonstrated benefit 23–25 . The route of delivery of IVIG in these studies is a limiting factor for efficacy as dosages are limited by fetal weight.…”

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

“…The effect of IVIG in HDFN may result from various mechanisms including (1) inhibition of Fc-mediated antibody passage across the placenta, (2) negative feedback on maternal antibody production and/or (3) reticuloendothelial Fc-receptor saturation/blockage, amongst others resulting in decreased uptake of opsonized fetal cells by macrophages [74,[79][80][81][82][83]. Although IVIG may prevent or reduce fetal hemolysis, it does not treat fetal anemia [84].…”

Therapeutic management of fetal anemia: review of standard practice and alternative treatment options

“…20 weeks of gestation) [75] . There are few reports in the literature, based on a small series of patients, that suggest the use of combination treatment with plasma exchange and IVIG in severe pregnancy alloimmunization in an attempt to prolong pregnancy to a gestational age at which IUT is technically possible [1,16] . This combined approach has fi rst been described in a variety of immune-mediated diseases such as systemic lupus erythematosus, Sjogren disease, and Guillain-Barr é syndrome [13] .…”