Immunoglobulin administration to fetuses with anemia due to alloimmunization to D

Authors

  • B. Ulm,

    1. From the Division for Prenatal Diagnosis and Therapy, Department of Obstetrics and Gynecology; the Department of Pediatrics; the Institute for Medical Statistics; the Department of Clinical Pharmacology; and the Clinic for Blood Group Serology, University Hospital of Vienna, Vienna, Austria.
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  • L. Kirchner,

    1. From the Division for Prenatal Diagnosis and Therapy, Department of Obstetrics and Gynecology; the Department of Pediatrics; the Institute for Medical Statistics; the Department of Clinical Pharmacology; and the Clinic for Blood Group Serology, University Hospital of Vienna, Vienna, Austria.
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  • G. Svolba,

    1. From the Division for Prenatal Diagnosis and Therapy, Department of Obstetrics and Gynecology; the Department of Pediatrics; the Institute for Medical Statistics; the Department of Clinical Pharmacology; and the Clinic for Blood Group Serology, University Hospital of Vienna, Vienna, Austria.
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  • B. Jilma,

    1. From the Division for Prenatal Diagnosis and Therapy, Department of Obstetrics and Gynecology; the Department of Pediatrics; the Institute for Medical Statistics; the Department of Clinical Pharmacology; and the Clinic for Blood Group Serology, University Hospital of Vienna, Vienna, Austria.
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  • J. Deutinger,

    1. From the Division for Prenatal Diagnosis and Therapy, Department of Obstetrics and Gynecology; the Department of Pediatrics; the Institute for Medical Statistics; the Department of Clinical Pharmacology; and the Clinic for Blood Group Serology, University Hospital of Vienna, Vienna, Austria.
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  • G. Bernaschek,

    1. From the Division for Prenatal Diagnosis and Therapy, Department of Obstetrics and Gynecology; the Department of Pediatrics; the Institute for Medical Statistics; the Department of Clinical Pharmacology; and the Clinic for Blood Group Serology, University Hospital of Vienna, Vienna, Austria.
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  • S. Panzer

    1. From the Division for Prenatal Diagnosis and Therapy, Department of Obstetrics and Gynecology; the Department of Pediatrics; the Institute for Medical Statistics; the Department of Clinical Pharmacology; and the Clinic for Blood Group Serology, University Hospital of Vienna, Vienna, Austria.
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  • Address reprint requests to: Prof. Dr. Simon Panzer, Clinic for Blood Group Serology, University Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; e-mail: simon.panzer@univie.ac.at.

Abstract

BACKGROUND: The purpose of this study was to examine fetal tolerance of high-dose intravenous immunoglobulin (IVIG), given directly at the time of intravascular transfusion, and its effects on fetal hemolysis and pregnancy outcome in the setting of alloimmunization to D.

STUDY DESIGN AND METHODS: Thirteen consecutive D+ fetuses requiring transfusion for maternal alloimmunization received high-dose IVIG (1.0 g/kg) and red cell transfusions. Twenty-four previous, consecutive fetuses with maternal anti-D served as controls. The schedules for subsequent transfusions were the same in the two groups.

RESULTS: High-dose IVIG was well tolerated by all fetuses. In the IVIG group, daily decreases in hematocrit were smaller than those in controls after the second administration of IVIG (mean hematocrit decrease, 0.72 percent/day vs. 1.45 percent/day; p = 0.007). No significant difference was found in the total number of fetal transfusions, the gestational age at delivery, the duration of neonatal intensive care, the number of neonates requiring postnatal transfusion therapy, and perinatal mortality.

CONCLUSION: In this small pilot study, direct administration to fetuses of IVIG with red cell transfusions was well tolerated and appeared to have a beneficial effect on fetal hemolysis.

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