title: Successful treatment of severe rhesus D-incompatible pregnancy with repeated double-filtration plasmapheresis.
abstract: Fetal anemia is caused by Rhesus (RhD) sensitization as a result of RhD incompatibility during pregnancy. The severe form of this disease can cause hydrops fetalis leading to intrauterine death. We experienced a highly sensitized 39-year-old woman with B Rh-negative blood. She had a history of three induced abortions and experienced perinatal death associated with hydrops fetalis. During the pregnancy prior to her most recent one, she was treated with double-filtration plasmapheresis (DFPP), high dose γ-globulin and intrauterine fetal blood transfusion (IUT). For her most recent pregnancy, we performed only weekly or fortnightly DFPP from 13 weeks until delivery. Anti-D antibody titer was maintained between 32 and 256 without any signs of fetal anemia. IUT was not required at any stage of the pregnancy. No adverse events were observed. She successfully delivered a healthy male infant weighing 2,289 g by Cesarean section at 35 weeks. Repeated DFPP may be an effective and safe strategy to reduce antibody titers in highly sensitized women with RhD-incompatible pregnancy, avoiding the need for IUT.
authors.affiliation: Department of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Kamei
authors.affiliation: Center of Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
authors.forename: Koushi
authors.initials: K
authors.lastname: Yamaguchi
authors.affiliation: Department of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
authors.forename: Mai
authors.initials: M
authors.lastname: Sato
authors.affiliation: Department of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Ogura
authors.affiliation: Department of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ito
authors.affiliation: Center of Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Okada
authors.affiliation: Center of Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Wada
authors.affiliation: Center of Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Sago
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D004899:Erythroblastosis, Fetal / Q000276:immunology / Q000517:prevention & control*; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000209:etiology / Q000628:therapy; D007231:Infant, Newborn; D008297:Male; D010789:Phototherapy; D010956:Plasmapheresis / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology / Q000628:therapy*; D012203:Rh Isoimmunization / Q000097:blood / Q000628:therapy*; D018029:Rho(D) Immune Globulin / Q000097:blood*
chemical_list: C061961:RHO(D) antibody; D018029:Rho(D) Immune Globulin
keywords: anti-D antibody; double-filtration plasmapheresis; fetal anemia; intrauterine fetal blood transfusion; rhesus D-incompatible pregnancy