Successful Perinatal Management of Hydrops Fetalis Due to Hemolytic Disease Associated with D−− Maternal Phenotype

Aref, Karim; Boctor, Fouad N.; Pande, Sumati; Uehlinger, Joan; Manning, FM; Eglowstein, M.; Mallozzi, Angela; Bebbington, Michael; Weinberg, Gerard; Rosen, Ora M.; Raab, Cheryl; Brion, Luc P.

doi:10.1038/sj.jp.7210775

Cited by 14 publications

(21 citation statements)

References 11 publications

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“…There has been a report on a patient treated with 0.5 g/kg of immunoglobulin added to 20 mL/kg of packed RBC [16]. Although fetal transfusion is usually possible at the 22nd gestational week, it is technically challenging and incurs the risk of developing bradycardia.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Fetal Intraperitoneal Administration of Immunoglobulin in a Case of Fetal Hemolytic Anemia with 131,072-Fold Anti-E Alloimmunization

Yoshida

Matsuda²,

Hayata

et al. 2011

Case Reports in Obstetrics and Gynecology

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Object. We present here the case of severe fetal anemia caused by anti-E antibody positive, which showed a favorable course only with fetal intraperitoneal administration of immunoglobulin. Case. The mother was 31 years old, blood type B Rh : CCDee, gravida 1, with no history of transfusion. Anti-E antibody was detected in the maternal cross-match test at the 18th gestational week. In percutaneous umbilical blood sampling, the umbilical blood hemoglobin level was 9.1 g/dL and the result of the direct Coombs' test was positive at the 26th gestational week. Immunoglobulin injection into fetal abdominal cavity (IFAC) was administered a total 7 times. During the pregnancy, the indirect Coombs' test showed a 131,072-fold increase. Conclusion. In this case, IFAC to block the reticuloendothelial system Fc receptor was successful. This procedure is promising as one of the treatment options for blood group incompatible pregnancy.

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Section: Discussionmentioning

confidence: 99%

Successful Treatment of Fetal Intraperitoneal Administration of Immunoglobulin in a Case of Fetal Hemolytic Anemia with 131,072-Fold Anti-E Alloimmunization

Yoshida

Matsuda²,

Hayata

et al. 2011

Case Reports in Obstetrics and Gynecology

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“…Blood exchange not only rids serum of uncombined bilirubin in large quantities, thus lowering serum bilirubin concentration, and preventing occurrence of kernicterus, but also corrects anemia and prevents cardiac failure. Yet, success of such management is also limited in individual case reports 2,3 …”

Section: Discussionmentioning

confidence: 99%

“…Yet, success of such management is also limited in individual case reports. 2,3 For the fetus, the middle cerebral artery Doppler flow is non-invasive and considered the best test for assessing fetal anemia. In this case, with the parturient at 35 weeks gestation and evidence of placental insufficiency, we did not feel that a Doppler flow study was necessary as delivery was nevertheless indicated.…”

Section: Discussionmentioning

confidence: 99%

Rare case of hemolytic death of the newborn due to anti‐hr0 and anti‐e

Gong

Zhou

2011

J of Obstet and Gynaecol

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“…In Western populations, -D-/-D-is an extremely rare Rh phenotype, with only 3 cases of hemolytic disease of the fetus and newborn in sensitized -D-/-D-women reported in the English language literature [2][3][4]. On the other hand, the frequency of the -D-/-D-phenotype among Japanese is much higher (approximately 1 in 100,000) and 50 cases of hemolytic disease of the fetus and newborn in -D-/-D-women have been reported in Japan.…”

Section: Discussionmentioning

confidence: 99%

“…Three cases were found in English language reports and 50 cases in Japanese literature, of which prenatal diagnosis was made in 2 and 5, respectively [3,4,[7][8][9][10][11]. Those 7 cases and the present one are summarized in table 1.…”

Section: Review Of the Literaturementioning

confidence: 99%

Fetal Hemolytic Disease due to Anti-Rh17 Alloimmunization

Hirose¹,

Nakanishi²,

Kaku³

et al. 2004

Fetal Diagn Ther

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Objective: To delineate clinical features of a case of fetal hemolytic disease due to anti-Rh17, along with a review of relevant studies published in English and Japanese. Methods: We present clinical features of a –D-/-D- phenotype woman with anti-Rh17 alloimmunization during pregnancy. Relevant English literature in the MEDLINE database was reviewed, while Japanese studies were searched in the Japana Centra Revuo Medicina database. Results: A Japanese –D-/-D- woman with anti-Rh17 (Hro) was treated during pregnancy. Serial ultrasonography, antibody titers, amniocenteses, and cordocenteses were conducted for perinatal management. Amniocentesis results demonstrated a high delta optical density level of 450 in the amniotic fluid, while cordocentesis revealed alloimmunization between the mother and the fetus as well as fetal hemolytic anemia. Blood flow velocity in the middle cerebral artery indicated a rapid development of fetal anemia. The newborn demonstrated severe anemia and hyperbilirubinemia, which were successfully treated with exchange transfusions. Two cases of prenatally diagnosed fetal hemolytic disease due to anti-Rh17 were found published in English and 5 in Japanese. Conclusion: A –D-/-D- phenotype patient with anti-Rh17 was successfully managed during pregnancy and a good outcome for the neonate was achieved. Our results and a review of related literature led to the following suggestions. The first pregnancy in a –D-/-D- woman may be affected, an anamnestic immune response can easily occur during pregnancy, the level of anti-Rh17 titer is indicative of the degree of fetal hemolysis, and appropriate intrauterine intervention is warranted for achievement of a good outcome.

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Successful Perinatal Management of Hydrops Fetalis Due to Hemolytic Disease Associated with D−− Maternal Phenotype

Abstract: We report the successful management of a case of hemolytic disease and hydrops fetalis secondary to anti Rh 17 antibodies in a woman with the rare D-- phenotype. We discuss the efficacy of intravenous immunoglobulins in treating hemolytic disease of the newborn infant.

Cited by 14 publications

References 11 publications

Successful Treatment of Fetal Intraperitoneal Administration of Immunoglobulin in a Case of Fetal Hemolytic Anemia with 131,072-Fold Anti-E Alloimmunization

Successful Treatment of Fetal Intraperitoneal Administration of Immunoglobulin in a Case of Fetal Hemolytic Anemia with 131,072-Fold Anti-E Alloimmunization

Rare case of hemolytic death of the newborn due to anti‐hr0 and anti‐e

Fetal Hemolytic Disease due to Anti-Rh17 Alloimmunization

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