Treatment with plasmapheresis and intravenous immunoglobulin in pregnancies complicated with anti-PP1Pk or anti-K immunization: a report of two patients.
OBJECTIVE
In addition to anti-D alloantibody, other antibodies such as anti-K antibody and anti-PP1Pk antibody have been reported to cause severe haemolytic disease of the newborn (HDN). HDN caused by anti-K results not only from destruction of red cells but also from suppression of erythropoiesis. Anti-PP1Pk has been associated with abortion early in pregnancy. We report on two patients, one with anti-PP1Pk and the other with anti-K, who were treated with plasmapheresis and intravenous immunoglobulin (IVIG) during pregnancy in an attempt to reduce the plasma antibody levels.


METHODS
The patient with anti-PP1Pk had lost all seven previous fetuses in the first trimester and therefore therapy in this patient was started at 8 weeks of gestation. The second patient had been sensitized to the K antigen through blood transfusion and had had two intrauterine fetal deaths at 26 weeks of gestation with signs of hydrops fetalis. Treatment in this patient was started during the 16th week of pregnancy.


RESULTS
As a result of therapy, the antibody titre was reduced in both patients. In the first patient a healthy infant was delivered by Caesarean section at 37 weeks of gestation. The second patient gave birth at 36 weeks of gestation. Neither newborn required exchange transfusion.


CONCLUSIONS
In our two patients, plasmapheresis combined with IVIG proved successful in the management of fetomaternal incompatibilities where the mechanism of fetal loss differs from the classical anti-D.
Fernández-Jiménez
M C
MC
Department of Hematology and Hemotherapy, Hospital La Paz, Universidad Autónoma de Madrid, Madrid, Spain. fdezjnez@teleline.es
Jiménez-Marco
M T
MT
Hernández
D
D
González
A
A
Omeñaca
F
F
de la Cámara
C
C
D000328:Adult; D000942:Antigens, Bacterial; D000954:Antigens, Surface / Q000276:immunology; D004899:Erythroblastosis, Fetal / Q000209:etiology / Q000276:immunology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007231:Infant, Newborn; D007518:Isoantibodies / Q000276:immunology*; D010127:P Blood-Group System / Q000276:immunology*; D010956:Plasmapheresis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology* / Q000628:therapy*
D000942:Antigens, Bacterial; D000954:Antigens, Surface; D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies; C030659:K antigens; D010127:P Blood-Group System