Successful management of severe red blood cell alloimmunization in pregnancy with a combination of therapeutic plasma exchange, intravenous immune globulin, and intrauterine transfusion

Nwogu, Laura C.; Moise, Kenneth J.; Klein, Kimberly; Tint, Hlaing; Castillo, Brian; Bai, Yu

doi:10.1111/trf.14453

Cited by 31 publications

(20 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This research included exclusively pregnancies complicated by anti-D and anti-Kell alloimmunization. Therapeutic plasma exchange, alone or in combination with immunoglobulin, to prevent or alleviate alloantibodies or to postpone the first IUT has been reported as an option in such pregnancies [24].…”

Section: Discussionmentioning

confidence: 99%

The Outcome of Hemolytic Disease of the Fetus and Newborn Caused by Anti-Rh17 Antibody: Analysis of Three Cases and Review of the Literature

Dajak

Ipavec

Cuk

et al. 2019

Transfus Med Hemother

View full text Add to dashboard Cite

Background: Anti-Rh17 is a rare red blood cell (RBC) antibody to high-frequency antigens that may cause severe hemolytic disease of the fetus and newborn (HDFN). Despite the rarity of HDFN caused by Anti-Rh17, this antibody was reported in many different populations. Emergency transfusions, especially exchange transfusions, present a huge problem if no compatible RBCs of phenotype D-- are available. Methods: Here we report obstetrical histories of three women and describe their pregnancies complicated by anti-Rh17 antibodies. We summarized published cases of pregnancies complicated by anti-Rh17 and reviewed transfusion treatment and outcomes. Additionally, a simplified flowchart for the management of such pregnancies is proposed. Results: Four pregnancies were affected by severe HDFN, and three of them ended with perinatal death. In the fourth case, the baby was born hydropic and icteric and the condition was rapidly deteriorating. Emergency exchange transfusion was performed with incompatible O-negative RBC units in AB-negative plasma. The baby was discharged on the 14th day in good health. In the available literature, 15 women and 22 pregnancies were reported, 20 of them developed severe HDFN. According to the data, intrauterine transfusion for treatment of HDFN was the most common form of treatment with the donation of the mother’s blood. Different options for exchange transfusion were described, including incompatible RBCs. Conclusion: In more than 90% of described pregnancies of HDFN caused by anti-Rh17 antibody, transfusion treatment was required. Therefore, RBC from D-- phenotype has to be available. According to published data, in emergent circumstances when maternal and blood from donor with phenotype D-- is not available, incompatible exchange transfusion is a better choice than delaying transfusion when it is necessary. It is of essential importance that pregnancies with high risk of HDFN due to anti-Rh17 are managed by a multidisciplinary team (transfusion medicine specialist, obstetrician, neonatologist) in a highly specialized tertiary institution.

show abstract

Section: Discussionmentioning

confidence: 99%

The Outcome of Hemolytic Disease of the Fetus and Newborn Caused by Anti-Rh17 Antibody: Analysis of Three Cases and Review of the Literature

Dajak

Ipavec

Cuk

et al. 2019

Transfus Med Hemother

View full text Add to dashboard Cite

show abstract

“…Several case series and case reports indicate a beneficial role of IVIG, at least in delaying the development of significant anemia [36]. Admittedly, focusing on the reported cases in the literature, the administration of IVIG varied considerably and was inadequate due to low doses, delayed administration (after fetal anemia was already present), and/or inconsequent administration in a number of cases (table 2) [30,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57]. Only one study has shown that the administration of 1 g/kg/week in four women with anti-D did not appear to improve outcomes of affected fetuses [58].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Antenatal Intravenous Immunoglobulin Treatment in Pregnancies at High Risk due to Alloimmunization to Red Blood Cells

Mayer

Hinkson

Hillebrand

et al. 2018

Transfus Med Hemother

View full text Add to dashboard Cite

Background: Alloimmunization to red blood cells (RBCs) may result in fetal anemia prior to 20 weeks gestation. The question as to whether early commencement of antenatal treatment with high-dose intravenous immunoglobulins (IVIG) may prevent or at least delay the development of fetal anemia in the presence of alloantibodies to RBCs is highly relevant. Patients and Results: Here we describe a patient with high-titer anti-K and two other severely affected pregnant women with a history of recurrent pregnancy loss due to high-titer anti-D or anti-D plus anti-C. Early commencement of treatment with IVIG (1 g/kg/week) resulted in prevention of intrauterine transfusion (IUT) in the former two cases, and in a significant delay of development of fetal anemia in the remaining case (26 weeks gestation). Conclusion: Based on our findings and of previously published cases, early initiation of treatment of severely alloimmunized women with IVIG (1 g/kg/week) could potentially improve the outcome of fetuses at risk.

show abstract

“…In pregnancies over 35 weeks of gestation delivery is considered to be safer than IUT. The last IUT is advised to be performed at 30-32 weeks of gestation with subsequent delivery at 32-34 weeks of gestation, after steroid administration for fetal pulmonary maturation [19,20,21,22].…”

Section: Antenatal Diagnosis and Managementmentioning

confidence: 99%

Untitled

2022

Ro Med J.

View full text Add to dashboard Cite

Hemolytic disease of the fetus and newborn is a consequence of maternal immune response to fetal red blood cells antigens inherited from the father, that the mother does not possess, stimulated by antepartum or intrapartum fetomaternal hemorrhage. As a result, fetal erythrocytes are destroyed, leading to various degrees of anemia and hyperbilirubinemia, with high perinatal morbidity and mortality rates. This review's purpose is to reveal the importance of the alloantibodies beyond RhD and ABO system, the updated algorithms used in the diagnosis and management of the disease and the importance of RhD universal immune prophylaxis practice. For this purpose, the database from PubMed and UpToDate was searched for literature reviews, case studies, society guidelines and retrospective studies in English regarding hemolytic disease of the fetus and newborn from 2013 to March 2022. Anti D prophylaxis protocols, early diagnosis and proper intrauterine and postpartum treatment help significantly reduce the disease's burden.

show abstract

Successful management of severe red blood cell alloimmunization in pregnancy with a combination of therapeutic plasma exchange, intravenous immune globulin, and intrauterine transfusion

Abstract: A combined regimen of TPE and IVIG early in pregnancy and IUT later in pregnancy results in successful management of severe maternal RBC alloimmunization and HDFN. IUT with fully phenotypically matched RBC units may help prevent further RBC alloimmunization in complex cases of HDFN.

Cited by 31 publications

References 25 publications

The Outcome of Hemolytic Disease of the Fetus and Newborn Caused by Anti-Rh17 Antibody: Analysis of Three Cases and Review of the Literature

The Outcome of Hemolytic Disease of the Fetus and Newborn Caused by Anti-Rh17 Antibody: Analysis of Three Cases and Review of the Literature

Efficacy of Antenatal Intravenous Immunoglobulin Treatment in Pregnancies at High Risk due to Alloimmunization to Red Blood Cells

Untitled

Contact Info

Product

Resources

About