Treatment of D alloimmunization in pregnancy with plasmapheresis and intravenous immune globulin: case report |
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| Authors: | Juan J. Fernández Alba Raquel León Carmen González-Macías Antonio Paz Fabiana Prado Luis J. Moreno Rafael Torrejón |
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| Affiliation: | 1. Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Cádiz, Spain;2. Department of Hematology, University Hospital of Puerto Real, Cádiz, Spain;1. Department of Blood Collection, Blood Transfusion Institute, Sv.Save 39, Belgrade, Serbia;2. Transfusion Medicine Department, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy;3. Laboratory for Statistics, Faculty of Organizational Sciences, University of Belgrade, Jove Ili?a 154, Belgrade, Serbia;4. Independent practitioner in Psychotherapy, Ancona, Italy;1. Neonatology Unit, Pediatrics Service, Reina Sofía University Hospital (RSUH), Andalusian Health Service (AHS), Menéndez Pidal Avenue, 14004 Córdoba, Spain;2. Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Menéndez Pidal Avenue, 14004 Córdoba, Spain;3. Experimental Unit Córdoba District (EUCD), AHS, Isla Lanzarote s/n, 14011 Córdoba, Spain;4. Department of Biochemistry and Molecular Biology (DBMB-UCO), S. Ochoa Building, Rabanales Campus, University of Córdoba, A4 Highway, Km 396a, 14071 Córdoba, Spain;5. Pediatric Endocrinology Section, Pediatrics Service, RSUH, AHS, Menéndez Pidal Avenue, 14004 Córdoba, Spain;1. University Medical Center Utrecht, Department of Pediatric Cardiology, Utrecht, The Netherlands;2. Academic Medical Center of Amsterdam, Heart Center, Department of Cardiology, Amsterdam, The Netherlands;3. Radboud University Medical Center Nijmegen, Department of Pediatric Cardiology, Nijmegen, The Netherlands;4. Erasmus University Medical Center Rotterdam, Department of Pediatric Cardiology, Rotterdam, The Netherlands;5. University of Groningen and University Medical Center Groningen, Department of Pediatric Cardiology, Groningen, The Netherlands;6. Academic Medical Center of Amsterdam, Department of Pediatric Cardiology, Amsterdam, The Netherlands;7. Leiden University Medical Center, Department of Obstetrics and Gynecology, Leiden, The Netherlands;8. Maastricht University Medical Center, Department of Pediatric Cardiology, Maastricht, The Netherlands;9. VU University Medical Center, Department of Pediatric Cardiology, Amsterdam, The Netherlands;10. Leiden University Medical Center, Department of Pediatric Cardiology, Leiden, The Netherlands;11. University of Oldenburg, Campus Klinikum Oldenburg, Department of Pediatric Cardiology, Oldenburg, Germany;12. University Medical Center Utrecht, Department of Obstetrics and Gynecology, Utrecht, The Netherlands;13. Radboud University Medical Center Nijmegen, Department of Obstetrics and Gynecology, Nijmegen, The Netherlands;14. Erasmus University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Rotterdam, The Netherlands;15. University of Groningen and University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands;1. Division of Neurotoxicology, National Center for Toxicological Research, Jefferson, AR 72079, USA;2. Division of Biochemical Toxicology, National Center for Toxicological Research, Jefferson, AR 72079, USA;3. U.S. Food and Drug Administration and Priority One Services Corp, Jefferson, AR 72079, USA |
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| Abstract: | ![]()
The prevalence of D alloimmunization occurs between 0.15% and 0.4%. The anti-D can cross the placenta and cause hemolysis and fetal anemia. At present, a Doppler study of the middle cerebral artery allows the monitoring of the degree of fetal anemia. The treatment in cases of moderate to severe anemia in fetuses of less than 34–35 weeks of gestation is intrauterine transfusion via cordocentesis. However, with high titers of anti-D, in the absence of fetal anemia it is possible to modulate the maternal immune response by plasmapheresis and intravenous immunoglobulin administration. We present a case report of an Rh(D) alloimmunized pregnancy treated with plasmapheresis followed by intravenous immunoglobulin administration. We performed a caesarean section at 31 weeks, 5 days of gestation. The hemoglobin at birth was 13.8 g/dl and hematocrit 40.8%. Intrauterine transfusion was not necessary. |
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