Rh hemolytic disease of the newborn treated with high‐dose intravenous immunoglobulin and plasmapheresis

Intravenous immunoglobulin G (IVIG) therapy for significant hyperbilirubinemia in ABO hemolytic disease of the newborn

“…The mechanism by which IVIG is thought to reduce the degree of hemolysis is by blocking the reticuloendothelial Fc receptor sites and hence preventing the extravascular destruction of neonatal red blood cells by transplacentally acquired maternal isoantibodies 12,13 . This competitive action of IVIG with isoantibodies has led to the suggestion that, in order for IVIG to be effective, it must be administered as soon as the diagnosis of isoimmune hemolytic anemia is made 4,14 .…”

Consumption of anti-D in the erythroblastotic fetus

“…The consumption of anti-D in the fetus with hemolytic disease depends on the number of Fcreceptors in the RES and their availability and affinity to the (D)-anti(D) complex. IVIG given to the mother passes the placenta and has been suggested (5)(6)(7)(8)(9)(10)(11)(12)(13) to decrease the hemolytic process in the fetus, possibly by affecting the availability of Fc-receptors in the fetal RES (8)(9)(10)(11)(12)(13)(14)(15). In IVIGtreated pregnancies we observed an increase in the fetal/maternal anti-D ratio from 10-30% between 26-34 gestational weeks (Fig.…”

Transfer of Anti‐d Antibodies Across the Isolated Perfused Human Placental Lobule and Inhibition by High‐dose Intravenous Immunoglobulin: A Possible Mechanism of Action

“…There has been some initial evidence that giving highdose intravenous immunoglobulin (IVIgG; 0 . 4 g/kg) prevents severe RhD-HD, although this finding was complicated by the additional use of maternal plasma exchange (Berlin et al, 1985;Besalduch et al, 1991). In contrast, two studies have shown the effectiveness of high-dose IVIgG alone when administered consecutively for 4-5 d, every 2 weeks (de la Camera et al, 1988) and particularly when initiated before 28 weeks gestation to severely affected neonates in the absence of hydrops fetalis (Margulies et al, 1991).…”

“…Although controversial, the use of intravenous immunoglobulin (IVIgG) may provide a relatively safe and non-invasive form of treatment for the fetus at a time before intrauterine transfusion can be given safely. Highdose IVIgG administered early in pregnancy may reduce the severity of HDN (Rewald, 1985;Berlin et al, 1985;de la Camera et al, 1988;Scott et al, 1988;Besalduch et al, 1991;Margulies et al, 1991). On the other hand, a maternal dose of 1 g/kg once per week was reported as ineffective in preventing RhD hydrops fetalis, but may have had an effect in reducing fetal morbidity from anti-Kell (Chitkara et al, 1990).…”