title: Treatment of D alloimmunization in pregnancy with plasmapheresis and intravenous immune globulin: case report.
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.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Cádiz, Spain. Electronic address: jjesus.fernandez@uca.es.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Fernández Alba
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Cádiz, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: León
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Cádiz, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: González-Macías
authors.affiliation: Department of Hematology, University Hospital of Puerto Real, Cádiz, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Paz
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Cádiz, Spain.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Prado
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Cádiz, Spain.
authors.forename: Luis J
authors.initials: LJ
authors.lastname: Moreno
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Puerto Real, Cádiz, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Torrejón
mesh_terms: D000328:Adult; D004899:Erythroblastosis, Fetal / Q000097:blood / Q000276:immunology / Q000628:therapy*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage*; D007518:Isoantibodies / Q000097:blood / Q000276:immunology; D010956:Plasmapheresis; D011247:Pregnancy; D012204:Rh-Hr Blood-Group System
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D007518:Isoantibodies; D012204:Rh-Hr Blood-Group System; C026410:Rho(D) antigen
keywords: Alloimmunization; Hemolytic disease of the newborn; Intravenous immunoglobulin; Therapeutic plasma exchange