One of the treatment options for hemolytic disease of the fetus and newborn (HDFN)-affected fetuses and neonates is intravenous immunoglobulinIntravenous immunoglobulin A therapy made from donated antibodies that may help reduce the mother’s immune response and protect the fetus. (IVIGIntravenous immunoglobulin A therapy made from donated antibodies that may help reduce the mother’s immune response and protect the fetus.).
In pregnancies at high-risk of HDFN, it has been shown to delay the need for intrauterine transfusions (IUTIntrauterine transfusion A procedure that delivers donor red blood cells to the fetus through the umbilical vein to treat severe anemia caused by HDFN.), and post-delivery, it can reduce the need for exchange transfusions in newborns. While it is considered low risk, there are some common side effects to take into consideration.
What is HDFN?
Hemolytic disease of the fetus and newborn (HDFN) is an immune-mediated red blood cell (RBC) disorder that occurs when a baby’s RBCs break down quickly, which is called hemolysis. HDFN is caused by a mismatch between a mother’s and her baby’s blood type (A, B, AB, or O) or Rhesus (RhRh factor A protein or antigen found on red blood cells. When an Rh-negative mother carries an Rh-positive fetus, her immune system may make antibodies that attack the fetus' red blood cells.) factor (Rh-positiveRh-Positive A blood type trait that means your red blood cells have the Rh(D) antigen. or Rh-negativeRh-Negative A blood type trait that means your red blood cells lack the Rh(D) antigen.) during pregnancy. Numerous antibodiesAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. to RBC antigensAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. can be linked to HDFN, such as those from the ABO and Rh blood groupBlood group A classification of blood based on inherited markers found on red blood cells. The ABO and Rh blood groups are most common in HDFN. systems.
What is IVIG?
IVIG is a kind of immunotherapy used to boost the immune system of the infusion recipient. It is an intravenous infusion that contains antibodies called immunoglobulins derived from the blood plasma of thousands of healthy donors. The blood plasma goes through a purification process to destroy any potential bacteria or viruses before being administered.
In pregnancies where the fetus is at high-risk or has already been diagnosed, IVIG can be administered to delay the onset of fetal anemiaAnemia A condition that occurs when the body doesn’t have enough healthy red blood cells to carry oxygen to its tissues. In HDFN, anemia occurs when maternal antibodies destroy fetal red blood cells.. It is given through a drip in a vein over a period of approximately two hours in doses over several consecutive days every two to three weeks. The exact dose and treatment plan is developed on a case-by-case basis.
Not all people affected by HDFN may be offered IVIG as a preventative treatment. If you’re wondering if IVIG could help you, but you haven’t discussed it with your healthcare team, you may want to ask your doctor if this treatment option is right for you.
Learn more about HDFN treatment and care
Common side effects
The use of IVIG in pregnancy has shown to safely and effectively reduce the severity of HDFN and to delay the use of intrauterine transfusions (IUT), which are more invasive and associated with a high rate of fetal loss.
Also used in newborns affected by HDFN to treat hyperbilirubinemiaHyperbilirubinemia A common cause of jaundice, this refers to higher than normal bilirubin levels in the blood. (jaundiceJaundice A common symptom of HDFN, jaundice is caused by excess bilirubin and is characterized by a yellow tint to the skin or eyes.), IVIG combined with phototherapyPhototherapy A treatment that uses special blue light to help newborns break down bilirubin and prevent kernicterus. has been shown to reduce – and even prevent – the need for exchange transfusions. It can also help improve outcomes by avoiding the serious complications of hyperbilirubinemia, such as kernicterusKernicterus A rare but serious brain condition caused by very high bilirubin levels..
Not all people experience side effects associated with IVIG, but a number of mild side effects have been reported to appear temporarily following the infusion. Headache and a skin rash are the most common side effects, in addition to the following side effects:
- Pain or skin irritation at the needle site
- Fevers/chills
- Flushing
- Muscle aches
- Nausea
- Anaphylaxis
These infusion reactions can be alleviated with analgesics and antihistamines.
Side effects are more likely to occur following the first dose of IVIG, after a large dose of IVIG, or if you switch to a different brand of IVIG.
Some serious rare side effects have also been documented and can have long-term implications if left untreated. These include: severe migraine, aseptic meningitis, renal damage, thrombosis and hemolytic anemia.
