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