Kell hemolytic disease of the fetus. Combination treatment with plasmapheresis and intrauterine blood transfusion

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

“…A potential explanation for the enhanced perinatal survival reported in these series is that plasma exchange can remove the damaging antibodies but cannot inhibit further antigen stimulation; the adjuvant administration of IVIG would retain this decline in antibody levels, inhibiting a " rebound " effect soon after treatment in the majority of patients [66] . Lakhwani et al [39] reported a case of a pregnant woman with Kell alloimmunization and severe hemolytic disease of the fetus, which was managed with only one fetal blood transfusion by cordocentesis and repeated plasmapheresis performed between 29 and 33 weeks ' gestation. With this scheme, a newborn with mild anemia was born with normal delivery at 34 weeks.…”

Therapeutische Apherese als erfolgreiches Behandlungskonzept einer Alloimmunisierung in der Schwangerschaft am Beispiel von maternalen Anti-Kell- und Anti-Duffy-Antikörpern

“…Die Kombination beider Verfahren scheint sich zu ergänzen und damit positiv auf den Schwangerschaftsverlauf auszuwirken [20 -22]. Nur wenige Fallbeispiele beschreiben die kombinierte Therapie mittels TA und Ig-Gabe mit anschließender IUT speziell im Fall von Kell-oder Duffy-AK [19,20,23]. Tatsächlich ist das vorliegende Therapieregime aus alleiniger TA mit IA und anschließender Ig-Gabe ohne den Einsatz invasiver Methoden von der Frühschwangerschaft bis zur Geburt einzigartig und hat damit eine unmittelbare klinische Relevanz für die Zukunft in der Geburtshilfe.…”

Prevalence of Red Blood Cell Alloantibodies in Pregnant Women and Hemolytic Disease of Newborn in a Tertiary Care Hospital

“…in which the antibody implicated was anti-K 18 . A combination of ITU and plasmapheresis was employed from 27 gestation week´s with good newborn outcome.…”

“…In these reports, plasmapheresis was used in addition to the IG with the aim of reducing the start of fetal anemia, and consequently the ITU requirements. Other authors 18 have used plasmapheresis alone for the same purpose. We also initiated plasmapheresis to the case number 10 of the table 3, in order to decrease the alloantibody titers and consequently the ITU needs.…”