Intravenous immunoglobulin in the management of severe early onset red blood cell alloimmunisation

• Published in: British journal of haematology 2023-01, Vol.200 (1), p.100-106
• Main Authors: Vlachodimitropoulou, Evangelia, Lo, Tsz Kin, Bambao, Clarissa, Denomme, Greg, Seaward, Gareth R., Windrim, Rory, Tessier, Francine, Kelly, Edmond, Van Mieghem, Tim, Ryan, Greg
• Format: Article
• Language: English
• Subjects: Antibodies; Blood Transfusion, Intrauterine - methods; Case-Control Studies; Erythroblastosis, Fetal - therapy; Erythrocytes; Female; Fetuses; Gestational age; Hematology; Hemoglobin; Humans; Immunoglobulins; Immunoglobulins, Intravenous - therapeutic use; Infant, Newborn; intrauterine blood transfusion; Intravenous administration; intravenous immunoglobulin; Pregnancy; red blood cell alloimmunisation; Rh Isoimmunization
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/bjh.18449

Summary Our objective was to assess the effect of maternal intravenous immunoglobulin (IVIG) administration for severe red blood cell (RBC) alloimmunisation on fetal outcomes. This is a case–control study. Women with a history of severe early onset alloimmunisation resulting in fetal loss in a previous pregnancy and high anti‐D or anti‐K antibody titres received IVIG in a subsequent pregnancy. We assessed gestational age at first transfusion and fetal outcomes in the subsequent pregnancy and compared these with the outcomes in the previous pregnancy. The most responsible antibody was anti‐D in 17 women and anti‐K in two others, whilst seven had more than one antibody. In all, 19 women received IVIG in 22 pregnancies, two of which did not even need an intrauterine transfusion (IUT). For previous early losses despite transfusion, IVIG was associated with a relative increase in fetal haemoglobin between treated and untreated pregnancies of 36.5 g/L (95% confidence interval 19.8–53.2, p = 0.0013) and improved perinatal survival (eight of eight vs. none of six, p = 0.001). For previous losses at