Intravenous immunoglobulins (IVIGIntravenous immunoglobulin A therapy made from donated antibodies that may help reduce the mother’s immune response and protect the fetus.) should be considered a treatment option as early as 10 to 12 weeks of gestation in cases 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. caused by early-onset hemolytic disease of the fetus and newborn (HDFN), according to a study recently published in Best Practice & Research Clinical Obstetrics & Gynaecology.
There is currently no definition of early-onset HDFN that has widespread consensus among OB-GYNs. Some choose to classify early-onset HDFN as the need for intrauterine blood transfusions prior to 24 weeks of gestation, while others propose that a definition in line with the risk of fetal/newborn loss during pregnancy or shortly after delivery to be more suitable.
Studies have shown that subsequent pregnancies previously affected by HDFN can result in fetal anemia a few weeks earlier than in a previous pregnancy. Fetal anemia is a condition in which the fetus lacks a key component of red blood cells called hemoglobin. The earliest occurrence in which fetal anemia has been documented in early-onset HDFN is at 16 weeks of gestation.
Should a pregnant woman have a history of early-onset HDFN, doctors are advised to closely monitor fetal well-being during pregnancy. One way to monitor for fetal anemia in a non-invasive manner is by measuring the middle cerebral artery peak systolic velocity (MCA-PSVDoppler ultrasound A non-invasive scan that measures blood flow speed in the fetus' brain to diagnose anemia. Specifically, it checks the middle cerebral artery peak systolic velocity (MCA-PSV).). This method may be used as early as 15 weeks of gestation in at-risk pregnancies.
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Immune therapies, such as IVIG and total plasma exchange, are considered potential medical interventions during pregnancy, alongside intrauterine transfusions. Intrauterine transfusions allow compatible red blood cells to be transfused directly to the fetus affected by anemia and is widely regarded as a relatively safe and proven therapy in HDFN. Intrauterine transfusions prior to 20 weeks of gestation are usually done intraperitoneally, meaning through the abdominal cavity.
It remains the chief goal of OB-GYNs to ensure that a pregnant patient with a history of early-onset HDFN receives optimal care during pregnancy and after delivery to ensure the health and well-being of the fetus/newborn. Future studies should be able to further clarify the role of relatively new therapies such as nipocalimab in preventing the need for intrauterine transfusions in pregnancies affected by HDFN.
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