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CC BY-NC-ND 4.0 · Journal of Fetal Medicine 2023; 10(02): 065-068
DOI: 10.1055/s-0043-1770735
Case Report

Prevention of Fetal Anemia with Plasma Exchange and Intravenous Immunoglobulin in a Pregnancy with a Complex Anti-K and Anti-C Alloimmunization

Paola Galoppi
1   Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
,
Ursula La Rocca 
2   Department of Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy
3   Division of Haematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
,
Gianluca Giovannetti
2   Department of Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy
,
Giuseppina Perrone
1   Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
,
Maria Gozzer
2   Department of Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy
,
Mahnaz Shafii Bafti
2   Department of Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy
,
Giovanna Biondino
4   Department of Transfusion Medicine, POS Formia, AUSL Latina, Latina, Italy
,
Francesco Equitani
5   Department of Transfusion Medicine, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy
,
Alessia Neri
2   Department of Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy
,
Giovanna Savastano
1   Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
,
Damiana Pompeo
1   Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
,
Benedetta Lobozzo
1   Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
,
Isabella Santilio
2   Department of Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy
,
Federica Falco
2   Department of Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy
3   Division of Haematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
,
Adele Delli Paoli
2   Department of Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy
3   Division of Haematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
,
Roberto Brunelli
1   Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
,
Serelina Coluzzi 
2   Department of Immunohematology and Transfusion Medicine, Sapienza University, Rome, Italy
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Abstract

Hemolytic disease of the fetus and newborn (HDFN) remains the main cause of fetal anemia primarily due to RH-D maternal incompatibility but also to other rarer antigens. Anti-Kell mediated immunization is a rare disease involving about 0.1% of pregnant women causing a more severe HDFN compared to RH-D both for its anemia mechanism and because of lack of preventive immunoglobulin therapy. Although the standard treatment of fetal anemia is intrauterine transfusion (IUT), at early gestational age with high antibody titer and absence of ultrasound anemia signs, noninvasive strategies can be offered. We present a case of severe anti-Kell and anti-C Rh positive immunized pregnancy with high Kell titer at 14 weeks of gestation that successfully treated with plasma exchange and intravenous immunoglobulin to prevent the onset of fetal anemia and to avoid the need for IUT.

Keywords

alloimmunization - fetal anemia - hemolytic disease of the fetus and newborn - fetal therapy - intravenous immunoglobulin - plasma exchange

Patient Consent

Informed consent was obtained from the patient regarding the data.


Authors' Contributions

G.P., S.C., U.L.R.: conception and design of the study.


G.G., M.G., M.F.B.: acquisition of data.


G.B., F.E., A.N., I.S., A.D.P.: analysis and interpretation of data


G.S., D.P., B.L., F.F.: drafting the article.


G.P., S.C.: revising it critically for important intellectual content.


P.G., R.B., G.P., S.C.: final approval of the version to be submitted.




Publication History

Article published online:
24 August 2023

© 2023. Society of Fetal Medicine. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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