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Prevention of Fetal Anemia with Plasma Exchange and Intravenous Immunoglobulin in a Pregnancy with a Complex Anti-K and Anti-C AlloimmunizationFunding none.
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.
Keywordsalloimmunization - fetal anemia - hemolytic disease of the fetus and newborn - fetal therapy - intravenous immunoglobulin - plasma exchange
Informed consent was obtained from the patient regarding the data.
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.
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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