Abstract
Intrauterine transfusion is the standard antenatal treatment for a fetus with severe anemia. Plasmapheresis is an alternative treatment for cases with a history of severe hemolytic disease of the fetus and newborns at less than 20 weeks of gestation. There is only one previous report of plasmapheresis for the anti-M alloimmunization in pregnancy, and we report here on the successful treatment of plasmapheresis for anti-M alloimmunization. A woman with a history of intrauterine fetal death at 24 weeks of gestation due to severe fetal anemia caused by anti-M alloimmunization received plasmapheresis once or twice a week from 14 weeks of gestation onward. An intrauterine blood transfusion was conducted at 28 weeks, and a cesarean section was performed at 31 weeks. The infant had anemia and jaundice but was discharged at day 46. Plasmapheresis may delay the development of fetal anemia and reduce the risk of early and repeat intrauterine transfusion in cases of anti-M alloimmunization in pregnancy.
Highlights
Red cell alloimmunization in pregnancy causes hemolytic disease of the fetus and newborn (HDFN), resulting in fetal anemia, fetal hydrops, and fetal death
Intrauterine transfusion is feasible after 20 weeks of gestation, with several case reports and case series showing the usefulness of alternative treatment, including plasmapheresis, intravenous immunoglobulin (IVIG), or a combination thereof for cases with a history of pregnancy with severe HDFN at less than 20 weeks of gestation
A guideline by the American Society for Apheresis published in 2016 proposes that plasmapheresis should be considered for these cases early in pregnancy and continued until intrauterine transfusion can safely be administered [2] despite the low evidence level
Summary
Red cell alloimmunization in pregnancy causes hemolytic disease of the fetus and newborn (HDFN), resulting in fetal anemia, fetal hydrops, and fetal death. Intrauterine transfusion for the fetus with severe anemia is the standard antenatal treatment with survival rates of approximately 90-100% [1]. Intrauterine transfusion is feasible after 20 weeks of gestation, with several case reports and case series showing the usefulness of alternative treatment, including plasmapheresis, intravenous immunoglobulin (IVIG), or a combination thereof for cases with a history of pregnancy with severe HDFN at less than 20 weeks of gestation. We report here on the successful treatment using a new modality of simple plasma exchange (selective plasma exchange, SePE), for a case of anti-M alloimmunization with a history of fetal death due to HDFN in a previous pregnancy
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