Medical therapy to attenuate fetal anaemia in severe maternal red cell alloimmunisation

Abstract

Summary Haemolytic disease of the fetus and newborn (HDFN) remains an important cause of fetal mortality with potential neonatal and longer‐term morbidity. HDFN is caused by maternal red cell alloimmunisation, with IgG antibodies crossing the placenta to destroy fetal erythroid cells expressing the involved antigen. Intrauterine fetal blood transfusion is the therapy of choice for severe fetal anaemia. Despite a strong evidence base and technical advances, invasive fetal therapy carries risk of miscarriage and preterm birth. Procedure‐related risks are increased when invasive, in utero transfusion is instituted prior to 22 weeks to treat severe early‐onset fetal anaemia. This review focuses upon this cohort of HDFN and discusses intravenous immunoglobin (IVIg) and novel monoclonal antibody (M281, nipocalimab) treatments which, if started at the end of the first trimester, may attenuate the transplacental passage and fetal effects of IgG antibodies. Such therapy has the ability to improve fetal survival in this severe presentation of HDFN when early in utero transfusion may be required and may have wider implications for the perinatal management in general.

Clinical Effect of Microneedle Injection Combined with Blood Transfusion in the Treatment of Severe Anemia Complicated with Vitiligo under Regenerative Medical Technology

“…A, B, and C represented the recovery, clinical marked effect, and improvement, respectively. Equation (2) shows how the wound healing rate of patients was calculated.…”

“…However, as anemia worsens, symptoms worsen, as does breathing difficulty. Mild anemia, moderate anemia, and severe anemia refer to haemoglobin concentrations below normal but greater than 90 g/L, 60 g/L, and 89 g/L and less than 60 g/L, respectively [1,2]. Some factors can cause severe anemia, such as decreased erythropoiesis, increased damage to erythrocytes, and blood loss.…”

Maternal bleeding complications in pregnancies affected by red blood cell alloimmunization

“…Fetal distress during or after the procedure is the most serious complication that may result in emergency delivery with the risk of prematurity, neonatal asphyxia or even infant death [18]. Procedurerelated risks are increased when invasive, in utero transfusion is instituted prior to gestational weeks 22 to treat severe early-onset fetal anemia [19]. Data on the long-term outcome of children after antenatal transfusion demonstrated a normal neurodevelopmental outcome in more than 95%, with the highest risk for neurodevelopmental impairment in the presence of fetal hydrops [20].…”

Pharmacotherapy of Generalized Myasthenia Gravis with Special Emphasis on Newer Biologicals

“…One notable pharmacokinetic property of nipocalimab is that with a transfer rate of 0.002%, it is practically impervious to placental transfer and does not reach the foetal circulation [ 162 ]. Since the risk of teratogenicity and foetal health are a major concern in the treatment of women of reproductive age, the low rate of placental transfer may prove to be an advantage of nipocalimab and this agent is currently being explored in pregnant women at risk of autoimmune haemolytic disease of the newborn [ 163 ].…”