Treatment of Rh D alloimmunization in pregnancy with therapeutic plasma exchange and IVIgG: two cases at an academic center
Hemolytic disease of the fetus and newborn (HDFN) can occur when an Rh D-negative female with an anti-D alloantibody is pregnant with an Rh D-positive fetus. Maternal sensitization often occurs during a previous pregnancy with an Rh D positive fetus after maternal-fetal hemorrhage, but can occur after transfusion of red blood cells expressing Rh D. The effects of HDFN are catastrophic, including fetal demise, fetal hydrops, and kernicterus. The mainstay of treatment for fetal anemia to prevent fetal hydrops is intrauterine transfusion (IUT). Transcranial middle cerebral artery (MCA) ultrasounds are the gold standard test for fetal anemia. MCA measurements more than 1.5 multiples of the median (MoM) predict moderate – severe fetal anemia, and IUT is indicated. IUT is dangerous before 20 weeks gestation age (WGA), and therapeutic plasma exchange (TPE) and IVIgG can be employed to delay the onset of fetal anemia until IUT can be safely performed.
Presented at Phyllis Unger Case Studies Conference 2018