A case of D alloimmunization in pregnancy: successfully treated solely with therapeutic plasma exchange (TPE)

Abstract

Fatemeh Tara,1 Asieh Maleki,2 Nayereh Taheri,2 Somayeh Moein Darbari21Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; 2Department of Obstetrics and Gynecology, Mashhad University of Medical Sciences, Mashhad, IranAbstract: One of the most common causes of fetal anemia is red cell alloimmunization. The standard treatment in fetuses with anemia is intrauterine transfusion (IUT); but this approach may have adverse effects, or sometimes it is not available or even possible. Therefore, immune modulating approaches such as therapeutic plasma exchange (TPE) and the use of intravenous immunoglobulin should be implemented to avoid or delay IUT. We report here the successful management of a case of D alloimmunization in pregnancy solely with TPE, without the need for IUT. The patient was a 33-year-old G4, L2, and D1, who had a history of alloimmunization in her previous pregnancy. TPE was initiated at 17 weeks gestation and was repeated weekly. Altogether, 20 times of plasma exchange were performed and a normal fetus was delivered at week 37.Keywords: alloimmunization, therapeutic plasma exchange, hemolytic disease of the newborn

Keywords

• Alloimmunization
• Therapeutic plasma exchange
• Hemolytic disease of the Newborn