A case report and literature review published in the Journal of Perinatal Medicine supports the use of intravenous immunoglobulin (IVIG) in patients with anti-Kell (K) mediated hemolytic disease of the fetus and newborn (HDFN).
Anti-K antibodies typically cause severe HDFN by promoting the breakdown of fetal red blood cells and preventing the production of new red blood cells. Therefore, intrauterine transfusion (IUT), a common treatment for HDFN, may carry additional risks in some anti-K alloimmunized pregnancies. Therefore, the authors sought to determine which treatments are safest and most effective in patients with anti-K HDFN.
The authors described a 32-year-old pregnant women with high levels of anti-K antibodies detected during her first trimester. At 15 weeks of gestation, she began weekly IVIG treatment. Testing at 22 weeks of gestation confirmed that the fetus was positive for the K antigen.
At 24 weeks gestation, the authors noted that the mother’s antibody levels increased. In response, they doubled her IVIG dose and administered four therapeutic plasma exchanges (TPEs), which successfully lowered her anti-K levels.
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The following week, an ultrasound showed signs of severe fetal anemia. Throughout the pregnancy, the fetus required two intrauterine transfusions (IUTs). When anemia returned at 33 weeks of gestation, the authors decided to schedule a cesarean section rather than perform a third IUT.
The baby was born weighing 1890 grams (approximately 4.2 pounds). She received phototherapy and erythropoietin, a treatment that stimulates blood cell production. The patient was discharged after three weeks. At two years of age, her development remained normal.
The researchers then reviewed other published studies of patient treated for anti-K HDFN. They found that IVIG dose levels and decisions to perform IUTs or therapeutic plasma exchanges vary significantly from case to case. However, IVIG appeared to improve outcomes and delay the need for IUT when used with or without therapeutic plasma exchange.
“The variability in treatment approaches underscores the need for individualized care based on maternal antibody titers, fetal antigen status, and disease progression, while emphasizing the importance of standardized protocols and prospective studies to guide optimal management,” the authors concluded.
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