Successful management of severe red blood cell alloimmunization in pregnancy with a combination of therapeutic plasma exchange, intravenous immune globulin, and intrauterine transfusion

Successful management of severe red blood cell alloimmunization in pregnancy with a combination... ABBREVIATIONSHDFNhemolytic disease of the fetus and newbornIUFDintrauterine fetal demiseIUT(s)intrauterine transfusion(s)MCA‐PSVmiddle cerebral artery peak systolic velocityMoMmultiples of the medianNICUneonatal intensive care unitNIPTnoninvasive prenatal testingTPEtherapeutic plasma exchangeThe antibodies most commonly associated with severe hemolytic disease of the fetus and newborn (HDFN) and necessitating intrauterine red blood cell (RBC) transfusion are anti‐D, anti‐c, anti‐K, and anti‐E. The current practice of RhIG prophylaxis for D– women during pregnancy has decreased the incidence of D‐associated HDFN to 0.1% to 0.6%. Maternal alloimmunization to certain non‐D antigens, most notably c and E antigens, and minor RBC antigens such as Kell, Duffy, Kidd, and MNS antigens are now more common causes of HDFN because no prophylactic immune globulins are available. In this retrospective case series, we report our experience with five patients diagnosed with HDFN due to maternal RBC alloimmunization who were managed with a combined immunomodulatory regimen consisting of therapeutic plasma exchange (TPE) and intravenous immune globulin (IVIG) in early gestation, followed by multiple RBC intrauterine transfusions (IUTs) later in gestation (at gestational age > 20 weeks). In addition to providing insight into the treatment process and efficacy, this information may be especially important for patients with limited treatment options due to potential contraindications and/or unavailability of http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Transfusion Wiley

Successful management of severe red blood cell alloimmunization in pregnancy with a combination of therapeutic plasma exchange, intravenous immune globulin, and intrauterine transfusion

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Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
© 2018 AABB
ISSN
0041-1132
eISSN
1537-2995
D.O.I.
10.1111/trf.14453
Publisher site
See Article on Publisher Site

Abstract

ABBREVIATIONSHDFNhemolytic disease of the fetus and newbornIUFDintrauterine fetal demiseIUT(s)intrauterine transfusion(s)MCA‐PSVmiddle cerebral artery peak systolic velocityMoMmultiples of the medianNICUneonatal intensive care unitNIPTnoninvasive prenatal testingTPEtherapeutic plasma exchangeThe antibodies most commonly associated with severe hemolytic disease of the fetus and newborn (HDFN) and necessitating intrauterine red blood cell (RBC) transfusion are anti‐D, anti‐c, anti‐K, and anti‐E. The current practice of RhIG prophylaxis for D– women during pregnancy has decreased the incidence of D‐associated HDFN to 0.1% to 0.6%. Maternal alloimmunization to certain non‐D antigens, most notably c and E antigens, and minor RBC antigens such as Kell, Duffy, Kidd, and MNS antigens are now more common causes of HDFN because no prophylactic immune globulins are available. In this retrospective case series, we report our experience with five patients diagnosed with HDFN due to maternal RBC alloimmunization who were managed with a combined immunomodulatory regimen consisting of therapeutic plasma exchange (TPE) and intravenous immune globulin (IVIG) in early gestation, followed by multiple RBC intrauterine transfusions (IUTs) later in gestation (at gestational age > 20 weeks). In addition to providing insight into the treatment process and efficacy, this information may be especially important for patients with limited treatment options due to potential contraindications and/or unavailability of

Journal

TransfusionWiley

Published: Jan 1, 2018

References

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