&lt;p&gt;A case of D alloimmunization in pregnancy: successfully treated solely with therapeutic plasma exchange (TPE)&lt;/p&gt;

Tara, Fatemeh; Maleki, Asieh; Taheri, Nayereh; Darbari, Somayeh Moein

doi:10.2147/jbm.s204128

Cited by 6 publications

(11 citation statements)

References 11 publications

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“…Antenatal treatment data were available for 24 studies (Table S 8 ) [ 24 , 25 , 29 , 30 , 33 – 37 , 42 , 43 , 48 , 51 , 52 , 56 , 58 – 63 , 65 , 71 , 80 ]. The most commonly reported antenatal treatment across these studies was IUT ( n = 9 with representative data [ 25 , 29 , 33 , 36 , 37 , 56 , 59 , 60 , 65 ]; n = 3 with nonrepresentative data [ 35 , 58 , 62 ].…”

Section: Resultsmentioning

confidence: 99%

Hemolytic disease of the fetus and newborn: systematic literature review of the antenatal landscape

Winter

Kaminski

Tjoa

et al. 2023

BMC Pregnancy Childbirth

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Background Prevention of pregnancy-related alloimmunization and the management of hemolytic disease of the fetus and newborn (HDFN) has significantly improved over the past decades. Considering improvements in HDFN care, the objectives of this systematic literature review were to assess the prenatal treatment landscape and outcomes of Rh(D)- and K-mediated HDFN in mothers and fetuses, to identify the burden of disease, to identify evidence gaps in the literature, and to provide recommendations for future research. Methods We performed a systematic search on MEDLINE, EMBASE and clinicaltrials.gov. Observational studies, trials, modelling studies, systematic reviews of cohort studies, and case reports and series of women and/or their fetus with HDFN caused by Rhesus (Rh)D or Kell alloimmunization. Extracted data included prevalence; treatment patterns; clinical outcomes; treatment efficacy; and mortality. Results We identified 2,541 articles. After excluding 2,482 articles and adding 1 article from screening systematic reviews, 60 articles were selected. Most abstracted data were from case reports and case series. Prevalence was 0.047% and 0.006% for Rh(D)- and K-mediated HDFN, respectively. Most commonly reported antenatal treatment was intrauterine transfusion (IUT; median frequency [interquartile range]: 13.0% [7.2–66.0]). Average gestational age at first IUT ranged between 25 and 27 weeks. weeks. This timing is early and carries risks, which were observed in outcomes associated with IUTs. The rate of hydrops fetalis among pregnancies with Rh(D)-mediated HDFN treated with IUT was 14.8% (range, 0–50%) and 39.2% in K-mediated HDFN. Overall mean ± SD fetal mortality rate that was found to be 19.8%±29.4% across 19 studies. Mean gestational age at birth ranged between 34 and 36 weeks. Conclusion These findings corroborate the rareness of HDFN and frequently needed intrauterine transfusion with inherent risks, and most births occur at a late preterm gestational age. We identified several evidence gaps providing opportunities for future studies.

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Section: Resultsmentioning

confidence: 99%

Hemolytic disease of the fetus and newborn: systematic literature review of the antenatal landscape

Winter

Kaminski

Tjoa

et al. 2023

BMC Pregnancy Childbirth

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“…This phenomenon can trigger maternal red cell isoimmunization. 7,8 During the first exposure, the primary maternal antibody produces IgM isotype, and the response is usually mild and even asymptomatic. However, second exposure will trigger IgG production, destroying fetal red blood cells through the transplacental passage.…”

Section: Discussionmentioning

confidence: 99%

“…The consequences are anemia of the newborn, hydrops or intrauterine death for severe cases. [7][8][9] The International Society of Blood Transfusion (ISBT) had recognized 360 groups of antigens in 36 blood group systems. Only some antigens in those groups are clinically and immunologically important, one among those is CDE (rhesus) blood group or RhD antigen.…”

Section: Discussionmentioning

confidence: 99%

“…7,10 In RhD alloimmunization, when an RhD-negative pregnant woman exposed to RhD-positive fetus, she is at risk of developing anti-D antibodies. 7, 8 As the gestational age advancing, spontaneous fetomaternal hemorrhages could occur with increasing frequency and volume.…”

Section: Discussionmentioning

confidence: 99%

“…The immune response occurs in 15% after exposure of 1 mL of Rh-positive cells, while 70% after 250 mL. 8 In the meantime, several events will likely increase the volume of fetal blood exposed to maternal circulation and subsequently increase the risk of immune sensitization. Those events include early pregnancy loss (miscarriage, missed abortion, ectopic pregnancy), procedures prone to the risk of fetomaternal hemorrhages such as chorionic villus sampling, amniocentesis, fetal blood sampling, maternal trauma, manual placental removal, and external version.…”

Section: Discussionmentioning

confidence: 99%

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Rhesus incompatibility in pregnancy: a case report

Sungkar

Surya

2020

InaJPerinatol

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Introduction: Hemolytic disease of the fetus and newborn (HDFN) occurs due to the destruction of red blood cells, which the most common cause is rhesus incompatibility. This study aims to present a case of Rhesus incompatibility in pregnancy without a clinically significant effect on the baby. Case: A-38-years-old Indonesian woman with gravida 4 para 3 (G4P3A0), 32 weeks of gestational age came to the emergency department due to vaginal bleeding. On blood typing, she had an A-negative (A-) blood type. Her husband and all three of their children had O-positive (O+) blood type. The patient underwent a cesarean section due to recurrent antepartum hemorrhage following the total placenta previa. She gave birth to a baby girl, weighed 2,220 grams with an A-positive blood type. The hemoglobin level was 14.6 g/dL without any sign of neonatal jaundice during the first 24 hours of life. Conclusion: Our case illustrates a woman who did not show any sign of clinically Rhesus antigen alloimmunization. Low immunogenicity and dose-dependent response to a low fetal blood volume exposure might explain this phenomenon.

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

Bahkali,

Alhawsawi,

Althakafi

et al. 2023

Clinical Case Reports

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Key Clinical MessagePlasmapheresis and IVIG use in cases of alloimmunization during pregnancy are effective strategies when severe early fetal anemia is anticipated. Despite no change in antibody titer levels before and after plasmapheresis, clinical response was observed in both fetuses, and both had an excellent obstetrical outcome.AbstractHemolytic disease of the fetus and newborn is a potentially lethal complication of alloimmunization, and intrauterine fetal blood transfusion (IUBT) is the standard treatment and care plan for severe fetal anemia. However, IUBT is technically unattainable before 20 weeks of gestation. Plasmapheresis and intravenous immunoglobulin (IVIG) are the two treatment modalities described in the literature that postpone the need for transfusion until after 20 weeks. Here, we present two cases of alloimmunization (one with anti‐Kell and the other with anti‐D). Both had poor outcomes in previous pregnancies because of the early development of severe fetal anemia and hydrops before 24 weeks of gestation. Both patients underwent three sessions of plasmapheresis before 18 weeks, followed by weekly IVIG infusion, which continued until 23–27 weeks of pregnancy. Antibody titers were measured before and after plasmapheresis. In addition, weekly MCA Doppler was performed to monitor the development of severe fetal anemia requiring blood transfusion, which was diagnosed when the peak systolic velocity (PSV) was 1.5 multiples of the median or more. The first patient underwent IUBT at 24 weeks and the second at 28 weeks, as indicated by the MCA Doppler. Both patients were delivered by cesarean section, the first at 34 weeks and the second at 36 weeks, for different obstetrical indications. Both pregnancies resulted in a live birth. We conclude that the use of plasmapheresis and IVIG in alloimmunization during pregnancy is an effective treatment strategy when severe early fetal anemia is anticipated before 20 weeks of gestation. Despite no change in antibody titer levels before and after plasmapheresis, a clinical response was observed in both fetuses, and both had excellent obstetrical outcomes.

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<p>A case of D alloimmunization in pregnancy: successfully treated solely with therapeutic plasma exchange (TPE)</p>

Cited by 6 publications

References 11 publications

Hemolytic disease of the fetus and newborn: systematic literature review of the antenatal landscape

Hemolytic disease of the fetus and newborn: systematic literature review of the antenatal landscape

Rhesus incompatibility in pregnancy: a case report

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

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