Antenatal immunoglobulin for fetal red blood cell alloimmunization

Abstract

BackgroundRed blood cell alloimmunization in pregnancy can lead to fetal anaemia with potentially disastrous consequences. Traditional management involves the use of intrauterine transfusion, which is associated with significant procedure-related risks. An alternative treatment that has been trialled is the use of immunoglobulin administered intravenously to the mother.

Clinical response to therapeutic plasmapheresis and intravenous immunoglobulin in pregnancies complicated by alloimmunization despite persistently high titers: Report of two cases

“…Several case reports, case series, and case-control studies support the effectiveness and safety of their use, separately or in combination, in patients at risk of early HDFN to delay the need for the first IUBT. 3,4,[6][7][8][9][10][11][12][13][14] A Cochrane review search for randomized clinical trials evaluating the effect of IVIG in pregnancies affected by HDFN failed to identify any trials, 15 and we could not identify any such trials in our literature search. Such a trial is eagerly awaited, given the risk of publication bias and the various regimens described.…”

Clinical response to therapeutic plasmapheresis and intravenous immunoglobulin in pregnancies complicated by alloimmunization despite persistently high titers: Report of two cases

“…Several case reports, case series, and case-control studies support the effectiveness and safety of their use, separately or in combination, in patients at risk of early HDFN to delay the need for the first IUBT. 3,4,[6][7][8][9][10][11][12][13][14] A Cochrane review search for randomized clinical trials evaluating the effect of IVIG in pregnancies affected by HDFN failed to identify any trials, 15 and we could not identify any such trials in our literature search. Such a trial is eagerly awaited, given the risk of publication bias and the various regimens described.…”

Recurrent miscarriage associated with rare anti-PP1Pk antibody: a case series and literature review

“…The possible mechanism may be as follows: avoidance of the rebound in antibody synthesis following immunoglobulin depletion; reduction of placental transfer of unnecessary antibodies by competing with placental Fc receptors; high-dose IVIG may saturate the FcRn receptor, which is a protective receptor against IgG catabolism; thus IVIG treatment may increase IgG catabolism [23]. However, IVIG treatment for anti-PP1Pk antibody positivity in pregnancy is not evidence-based [31]. Currently, successful pregnancies of RSA associated with anti-PP1PK antibody positivity are treated with plasmapheresis or plasmapheresis combined with IVIG, but not IVIG alone.…”

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

“…There is, however, evidence that IVIG treatment may be useful in certain circumstances. 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].…”

Clinical response to therapeutic plasmapheresis and intravenous immunoglobulin in pregnancies complicated by alloimmunization despite persistently high titers: Report of two cases

“…Several case reports, case series, and case-control studies support the effectiveness and safety of their use, separately or in combination, in patients at risk of early HDFN to delay the need for the first IUBT. 3,4,[6][7][8][9][10][11][12][13][14] A Cochrane review search for randomized clinical trials evaluating the effect of IVIG in pregnancies affected by HDFN failed to identify any trials, 15 and we could not identify any such trials in our literature search. Such a trial is eagerly awaited, given the risk of publication bias and the various regimens described.…”

Recurrent miscarriage associated with rare anti-PP1Pk antibody: a case series and literature review

“…The possible mechanism may be as follows: avoidance of the rebound in antibody synthesis following immunoglobulin depletion; reduction of placental transfer of unnecessary antibodies by competing with placental Fc receptors; high-dose IVIG may saturate the FcRn receptor, which is a protective receptor against IgG catabolism; thus IVIG treatment may increase IgG catabolism [23]. However, IVIG treatment for anti-PP1Pk antibody positivity in pregnancy is not evidence-based [31]. Currently, successful pregnancies of RSA associated with anti-PP1PK antibody positivity are treated with plasmapheresis or plasmapheresis combined with IVIG, but not IVIG alone.…”

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

“…There is, however, evidence that IVIG treatment may be useful in certain circumstances. 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].…”

Clinical response to therapeutic plasmapheresis and intravenous immunoglobulin in pregnancies complicated by alloimmunization despite persistently high titers: Report of two cases

“…Several case reports, case series, and case-control studies support the effectiveness and safety of their use, separately or in combination, in patients at risk of early HDFN to delay the need for the first IUBT. 3,4,[6][7][8][9][10][11][12][13][14] A Cochrane review search for randomized clinical trials evaluating the effect of IVIG in pregnancies affected by HDFN failed to identify any trials, 15 and we could not identify any such trials in our literature search. Such a trial is eagerly awaited, given the risk of publication bias and the various regimens described.…”

Recurrent miscarriage associated with rare anti-PP1Pk antibody: a case series and literature review

“…The possible mechanism may be as follows: avoidance of the rebound in antibody synthesis following immunoglobulin depletion; reduction of placental transfer of unnecessary antibodies by competing with placental Fc receptors; high-dose IVIG may saturate the FcRn receptor, which is a protective receptor against IgG catabolism; thus IVIG treatment may increase IgG catabolism [23]. However, IVIG treatment for anti-PP1Pk antibody positivity in pregnancy is not evidence-based [31]. Currently, successful pregnancies of RSA associated with anti-PP1PK antibody positivity are treated with plasmapheresis or plasmapheresis combined with IVIG, but not IVIG alone.…”

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

“…There is, however, evidence that IVIG treatment may be useful in certain circumstances. 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].…”