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
Transfusion – Wiley
Published: Jan 1, 2018
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