Plasmapheresis, a procedure that separates plasma from blood cells, appears to be associated with good outcomes in pregnancies at risk of hemolytic disease of the fetus (HDFN) and newborn, according to a recently published case report in Clinical Case Reports.
Fetuses that develop 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. due to HDFN before reaching 20 weeks of gestation pose a significant therapeutic challenge as intrauterine blood transfusions, the treatment of choice for HDFN, are not recommended before 20 weeks of gestation due to an increased risk of complications at this stage.
Current therapeutic options for these cases included 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.) administration and plasmapheresis.
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During plasmapheresis, the blood of the mother is extracted and separated into two parts, one containing blood cells such as platelets and white and red blood cells, and the other containing plasma. Plasma contains several proteins, including the 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. that cause HDFN. The plasma part of the blood is exchanged for a plasma substitute, and the resulting new blood is injected into the patient again.
“The immunomodulatory effects of plasmapheresis and IVIG in these conditions are not entirely clear but are likely partially explained by antibodyAntibody 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. removal from maternal plasma,” the authors wrote.
The first case involved a 31-year-old woman in the 13th week of gestation and a history of three previous pregnancies, the first one without complications, one miscarriage, and one complicated with HDFN that led to the death of the baby two months after birth.
Due to her history, the patient was referred to a specialized center for her fourth pregnancy. Taking into account her previous history, physicians anticipated complications of HDFN before the fourth week of gestation. She received IVIG and plasmapheresis at 17 weeks of gestation. The patient was born with jaundiceJaundice A common symptom of HDFN, jaundice is caused by excess bilirubin and is characterized by a yellow tint to the skin or eyes. due to HDFN and mild anemia; after three sessions of phototherapyPhototherapy A treatment that uses special blue light to help newborns break down bilirubin and prevent kernicterus., the patient was discharged, evolving satisfactorily after six months.
“In conclusion, based on the available literature, plasmapheresis and IVIG are effective measures to delay the need for IUBT in pregnant women with alloimmunizationAlloimmunization When a person’s immune system develops antibodies against foreign antigens from the same species—such as when an Rh-negative mother’s body forms antibodies against her baby’s Rh-positive red blood cells. at risk of early HDFN,” the authors added.
