Severe Rh alloimmunization and hemolytic disease of the fetus managed with plasmapheresis, intravenous immunoglobulin and intrauterine transfusion: A case report

Houston, Brett L.; Govia, Rachelle; Abou‐Setta, Ahmed M; Reid, Gregory J.; Hadfield, Marie; Menard, Chantalle; Noyd, Jocelyn; Main, Susan; Zarychanski, Ryan

doi:10.1016/j.transci.2015.07.010

Cited by 17 publications

(9 citation statements)

References 7 publications

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“…Maternal antibody titers were reduced, IUT seemed to be postponed and all babies were alive and well at birth [78]. Several case reports have been published with favorable outcome following this combined approach [86,[92][93][94][95][96]. Reported side effects of IVIG are rare but may include: headache, fever, myalgia and low back pain, rush or chills, urticaria, nausea and vomiting, tachycardia, chest tightness, hypotension and shortness of breath [42,50,97,98].…”

Section: Intravenous Immunoglobulins (Ivig)mentioning

confidence: 99%

Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn – review on current management and outcome

Zwiers

Kamp

Oepkes

et al. 2017

Expert Review of Hematology

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Introduction: Hemolytic disease of the fetus and newborn (HDFN) remains a serious pregnancy complication which can lead to severe fetal anemia, hydrops and perinatal death. Areas covered: This review focusses on the current prenatal management, treatment with intrauterine transfusion (IUT) and promising non-invasive treatment options for HDFN. Expert commentary: IUTs are the cornerstone in prenatal management of HDFN and have significantly improved perinatal outcome in the past decades. IUT is now a relatively safe procedure, however the risk of complications is still high when performed early in the second trimester. Non-invasive management using intravenous immunoglobulin may be a safe alternative and requires further investigation. ARTICLE HISTORY

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Section: Intravenous Immunoglobulins (Ivig)mentioning

confidence: 99%

Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn – review on current management and outcome

Zwiers

Kamp

Oepkes

et al. 2017

Expert Review of Hematology

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“…The principal of plasmapheresis in Rh alloimmunization is the removal of maternal alloantibodies which reduces their titer and subsequently reduces the placental transfer of harmful maternal alloantibodies 9. Some of the complications which might limit the implementation of plasmapheresis include the risk of catheter-related infection and thrombosis, hemodynamic instability and severe resource utilization 11. Fortunately, our patient developed none of the above and received 20 PEs without any complications from 17 to 36 weeks of gestation.…”

Section: Discussionmentioning

confidence: 79%

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

Tara

Maleki

Taheri

et al. 2019

JBM

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One of the most common causes of fetal anemia is red cell alloimmunization. The standard treatment in fetuses with anemia is intrauterine transfusion (IUT); but this approach may have adverse effects, or sometimes it is not available or even possible. Therefore, immune modulating approaches such as therapeutic plasma exchange (TPE) and the use of intravenous immunoglobulin should be implemented to avoid or delay IUT. We report here the successful management of a case of D alloimmunization in pregnancy solely with TPE, without the need for IUT. The patient was a 33-year-old G4, L2, and D1, who had a history of alloimmunization in her previous pregnancy. TPE was initiated at 17 weeks gestation and was repeated weekly. Altogether, 20 times of plasma exchange were performed and a normal fetus was delivered at week 37.

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“…In addition to phototherapy, GG has been recognized in clinic, there are many reports about the efficacy of them. Some studies indicate that GG can reduce patients’ need for exchanging transfusion and reduce the complications related to exchange transfusion ( 14 ). Hemolytic disease of a 35-year-old and Rh-negative pregnant woman with Rh allogeneic immunity was treated successfully by plasmapheresis, intravenous injection of GG, and intrauterine transfusion ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

The Improvement Effect of Different Doses of Gamma Globulin on the Disease Condition of Infants with Hemolytic Disease of Newborn and Their Effects on Immune Factors in Serum

Huang¹,

Lin²,

Qian³

et al. 2020

ijph

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Background: To explore the effect of different doses of Gamma Globulin (GG) on the condition of children with Hemolytic Disease of Newborn (HDN) and the influence of immune factors in serum. Methods: Overall, 180 infants with hemolytic disease of newborn in the People’s Hospital of Zhangqiu Area, Jinan, China from April 2016 to August 2018 were divided into group A (88 cases) and group B (92 cases). Group A was given intravenous low-dose GG on the basis of phototherapy, and group B was given intravenous high-dose GG on the basis of phototherapy. The level of serum total bilirubin of the infants, the levels of CD3+, CD4+, CD8+, IgA, IgG and IgM of the infants, the time of jaundice disappearance and the length of hospital stay, hemoglobin and reticulocyte levels were recorded before treatment and after treatment. The number and condition of adverse reactions were recorded. Results: After treatment, the levels of TBiL, hemoglobin and reticulocyte, the time of jaundice disappearance and hospital stay in group B were significantly lower than those in group A. The level of immune cells in group B was significantly higher than that in group A after 7 days of treatment, and the levels of IgA / IgG / IgM in group B were significantly higher than those in group A after 28 days of treatment. Conclusion: Intravenous high-dose GG has a better effect on the condition of neonatal hemolytic disease patients, and more effectively improve the immune function of children.

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Severe Rh alloimmunization and hemolytic disease of the fetus managed with plasmapheresis, intravenous immunoglobulin and intrauterine transfusion: A case report

Cited by 17 publications

References 7 publications

Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn – review on current management and outcome

Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn – review on current management and outcome

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

The Improvement Effect of Different Doses of Gamma Globulin on the Disease Condition of Infants with Hemolytic Disease of Newborn and Their Effects on Immune Factors in Serum

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