title: Severe Rh alloimmunization and hemolytic disease of the fetus managed with plasmapheresis, intravenous immunoglobulin and intrauterine transfusion: A case report.
abstract: Rh alloimmunization remains a potentially devastating complication of pregnancy, with fetal anemia causing hydrops and intrauterine death. Intrauterine transfusion is the standard treatment, but is particularly dangerous before 20 weeks gestation. When the need for intrauterine transfusion is anticipated early in pregnancy, immune-modulating therapies such as plasmapheresis and IVIG have been used to delay transfusion to a later gestational age. We report a 35-year-old G5P1 Rh(D)-negative woman with severe Rh alloimmunization managed successfully with sequential plasmapheresis, intravenous immune globulin and intrauterine transfusion. The optimal plasmapheresis treatment protocol and incremental benefit of IVIG remains unknown.
authors: Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: brett.houston@mail.utoronto.ca.
authors: Brett L
authors: BL
authors: Houston
authors: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Rachelle
authors: R
authors: Govia
authors: George & Fay Yee Centre for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada.
authors: Ahmed M
authors: AM
authors: Abou-Setta
authors: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Gregory J
authors: GJ
authors: Reid
authors: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Marie
authors: M
authors: Hadfield
authors: Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Chantalle
authors: C
authors: Menard
authors: Health Sciences Centre, Winnipeg, Manitoba, Canada.
authors: Jocelyn
authors: J
authors: Noyd
authors: Health Sciences Centre, Winnipeg, Manitoba, Canada.
authors: Susan
authors: S
authors: Main
authors: George & Fay Yee Centre for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Sections of Critical Care and of Haematology/Medical Oncology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Ryan
authors: R
authors: Zarychanski
mesh_terms: D000328:Adult; D001805:Blood Transfusion, Intrauterine; D004899:Erythroblastosis, Fetal / Q000097:blood / Q000628:therapy*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D010956:Plasmapheresis; D011247:Pregnancy; D012203:Rh Isoimmunization / Q000097:blood / Q000628:therapy*
chemical_list: D016756:Immunoglobulins, Intravenous
keywords: Alloimmunization; Hemolytic disease of the fetus and newborn; Intravenous immune globulin; Plasmapheresis; Pregnancy