Successful management of fetal hemolytic disease due to strong anti-Rh17 with plasma exchange and intrauterine transfusion in a woman with the D−− phenotype

The rare blood phenotype D−− is characterized by the absence of RhCcEe antigens. Women with this blood type who have experienced previous pregnancies may produce anti-Rh17 antibodies, which may cause severe fetal hemolytic anemia or fetal death in subsequent pregnancies. We report successful managem...

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Bibliographic Details
Published in:International journal of hematology 2020, Vol.111 (1), p.149-154
Main Authors: Mimura, Kazuya, Endo, Masayuki, Takahashi, Atsushi, Doi, Yohei, Sakuragi, Mikiko, Kiyokawa, Tomoko, Taniguchi, Hidetoshi, Kitabatake, Yasuji, Handa, Mika, Tomimatsu, Takuji, Tomiyama, Yoshiaki, Isaka, Yoshitaka, Kimura, Tadashi
Format: Article
Language:English
Subjects:
Anemia
Antibodies
Antigens
Apheresis
Birth weight
Blood groups
Case Report
Complications
Disease control
Edema
Exchanging
Fetuses
Hematology
Hemolytic anemia
Hemolytic disease
Immunoglobulins
Intravenous administration
Medicine
Medicine & Public Health
Oncology
Phenotypes
Pregnancy
Pregnancy complications
Transfusion
Vagina
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Summary:The rare blood phenotype D−− is characterized by the absence of RhCcEe antigens. Women with this blood type who have experienced previous pregnancies may produce anti-Rh17 antibodies, which may cause severe fetal hemolytic anemia or fetal death in subsequent pregnancies. We report successful management of a pregnancy associated with fetal hemolytic disease owing to high titers of anti-Rh17 (1:4096) in a woman with a history of a pregnancy with fetal hydrops and intrauterine fetal death. During her second pregnancy, she received two sets of plasma exchange (PE) per week from weeks 12 till 20. Intrauterine transfusions (IUTs) were performed at 26, 27, 29, and 31 weeks. A male infant was born at 32 weeks and 4 days by normal vaginal delivery, with a birth weight of 1916 g (+ 0.16 SD). He received an exchange transfusion on day 0, immunoglobulin (intravenous immunoglobulin: 1 g/kg) on days 0 and 1, and photo therapy from days 0 to 6. He showed normal development without neurological abnormality and was discharged from the hospital on day 36. We successfully prevented complications caused by the presence of anti-Rh17 antibodies in the mother during pregnancy. The IUT and maternal PE may have promoted this favorable outcome.
ISSN:0925-5710
1865-3774
DOI:10.1007/s12185-019-02735-6