Double-filtration plasmapheresis, or DFPP, may help some pregnant women with hemolytic disease of the fetus and newborn (HDFN) safely delay invasive treatment, according to a small study focused on severe early-onset disease published recently in BMC Pregnancy Childbirth.
HDFN occurs when a mother’s immune system attacks fetal red blood cells, leading to anemia that can become life-threatening early in pregnancy. Because standard intrauterine blood transfusion carries higher risks before 20 weeks, DFPP was used to reduce the antibodies that drive HDFN and slow disease progression.
“This study pioneers the use of DFPP as a salvage therapy for severe early-onset HDFN when traditional treatment is unavailable before 20 gestational weeks, creating opportunities for subsequent IUT [intrauterine transfusion],” said this study’s authors.
In this study, six pregnant women at high risk for early-onset HDFN were treated, including five cases related to Rh incompatibility and one linked to the MN blood group. DFPP was started at a median of 14 weeks of pregnancy, with patients receiving a median of eight sessions over about four weeks. Each session filtered roughly 3000 mL of plasma, selectively removing harmful antibodies while returning most beneficial blood components.
Read more about treatment and care for HDFN
The results showed that DFPP reduced disease-causing antibodies by a median of 50% per treatment session. This reduction mattered clinically. Five of the six women, or 83.3%, were able to prolong their pregnancies to at least 20 weeks, allowing intrauterine transfusions to be performed at a safer stage for the fetus. One woman developed severe fetal anemia at 15 weeks despite treatment and required an emergency transfusion that ended in fetal loss, highlighting the limits of the approach in the most aggressive cases of HDFN.
From a safety standpoint, DFPP was generally well tolerated. No serious complications such as infection, severe bleeding or allergic reactions were reported. Some blood proteins temporarily dropped after treatment, including clotting factors, but these levels returned to normal within a day. Four women received preventive fibrinogen to reduce bleeding risk, and no lasting problems were observed.
After DFPP, all women eventually underwent intrauterine transfusions, with a median start at 21 weeks. Five babies were born alive at a median of 35 weeks and required neonatal intensive care for a median of 10 days. Birth weights and hemoglobin levels were generally appropriate for gestational age.
For patients and families affected by HDFN, these findings suggest DFPP may offer valuable time by delaying risky early transfusions and improving the chances of fetal survival. However, the study was small, and larger trials with long-term follow-up are needed before DFPP becomes a standard option.
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