J Perinat Med. 2025 Nov 3. doi: 10.1515/jpm-2025-0347. Online ahead of print.
ABSTRACT
OBJECTIVES: Hemolytic disease of the fetus and newborn (HDFN) is a potentially life-threatening condition, caused by maternal alloimmune antibodies targeting fetal red blood cells. This report aims to present a case of severe early-onset anti-K-mediated HDFN, managed successfully with intravenous immunoglobulin (IVIG), therapeutic plasma exchange (TPE) and intrauterine transfusion (IUT), and to discuss comparable alternative approaches reported in the literature.
METHODS: We treated a 32-year old woman in her third pregnancy with a high titer of anti-K alloantibodies (1:2048), detected in the first trimester. Weekly IVIG therapy of 1 g/kg was initiated at 15 weeks of gestation, followed by four TPEs and two IUTs. Due to suspected fetal anemia at 33 weeks of gestation, we opted for delivery. The newborn required phototherapy and erythropoietin treatment, with normal development at age two.
RESULTS: To contextualize our approach, we reviewed published cases of anti-K-mediated HDFN and compiled a comparative table of treatment strategies and outcomes. Analysis showed that treatment protocols varied in IVIG dosing, TPE use, and timing, reflecting the absence of standardized approaches. These strategies were associated with delayed IUT and improved neonatal outcomes following prior fetal losses.
CONCLUSIONS: Our case, along with the review of published cases, supports the use of IVIG, with or without TPE, in managing anti-K alloimmunized pregnancies. 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.
PMID:41170822 | DOI:10.1515/jpm-2025-0347
