A K-negative patient was able to avoid complications associated with hemolytic disease of the fetus and newborn (K-HDFN) with administration of immune-modulating therapies, according to a case report published recently in the journal Cureus.
The report described a 32-year-old K-negative female who was pregnant for the second time. Her first pregnancy resulted in the birth of a healthy baby seven years prior to the study.
The patient became sensitized against the K antigen at the time of her previous pregnancy. Her sensitization to the K antigen likely occurred during her prior uneventful pregnancy with her K-positive husband.
Standard-of-care therapy for K-sensitized pregnancies typically involves the utilization of watchful waiting and IUT, but if left untreated, K-HDFN can lead to the development of severe anemia. In fact, early pregnancy is known to be the time when the use of IUT is less feasible.
In an effort to avoid the development of HDFN, the patient underwent preventive treatment to decrease her immune response.
Prophylactic therapy and delivery of a healthy baby
The pregnant patient underwent three rounds of therapeutic plasma exchange (TPE), which were able to lower her anti-K antibody titer. The TPE was followed by weekly intravenous immunoglobulin (IVIG) infusions, which were administered at a dosage one g/kg of body weight.
In addition, she underwent middle cerebral artery peak systolic velocity (MCA-PSV) Doppler imaging to monitor for the presence of fetal anemia.
Read more about the testing and diagnosis of HDFN
Ultimately, the fetus required the administration of two intrauterine transfusions (IUTs) in the woman’s third trimester.
She delivered a healthy baby at 36 weeks’ gestational age. Mild anemia and a positive direct antiglobulin test were reported.
“It is possible that this pregnancy may have been viable without the TPE/IVIG therapy,” the authors noted. “[I]t is also possible that this pregnancy might have ended in severe early anemia and fetal death.”
K sensitization is both dangerous and unpredictable in pregnancy. The use of a combination therapeutic regimen of TPE/IVIG provides a possible “way for clinicians to protect their pregnant patients from the uncertainty of HDFN.”
The results of this report are in accordance with many other small case studies in which a link between a combined TPE/IVIG treatment regimen and satisfactory outcomes has been noted.
