A Case of a E-isoimmunized Woman by Previous Transfusion who sas Treated with Antenatal Plasma Exchanges, IVIG and Intrauterine Transfusion.
- Author:
Wee Gyo LEE
;
Dong Wha LEE
;
Tae Youn CHOI
;
Won Bae KIM
;
Kwon Hae LEE
;
Duk Yong KANG
- Publication Type:Case Report
- MeSH:
Antibodies;
Blood Transfusion;
Blood Transfusion, Intrauterine*;
Brain;
Cesarean Section;
Disseminated Intravascular Coagulation;
Erythroblastosis, Fetal;
Female;
Fetus;
Humans;
Immunization;
Immunoglobulins, Intravenous*;
Incidence;
Infant, Newborn;
Korea;
Marriage;
Parturition;
Plasma Exchange*;
Plasma Volume;
Plasma*;
Pregnancy;
Pregnant Women;
Stillbirth
- From:Korean Journal of Blood Transfusion
1994;5(1):63-69
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Since the introduction of Rh-immune globulin in 1968, the incidence of Rh D hemolytic disease of the newborn(HDN) had become markedly reduced but in the contrary the HDN by minor blood group antibodies has become increased relatively. As anti-E is the most common minor blood group antibody identified in antenatal serology and because of the frequency of E-negative people in Korea is ranged from 38.8% to 50.3%, the probability of HDN caused by anti-E is expected relatively high. We had experienced antenatal therapy for a E-isoimmunized pregnant woman, who has the history of one previous stillbirth and one neonatal death. In addition to above obstetric history, she had a history of blood transfusion, in which she was given 7 units of whole blood during the operation of brain cyst 7 years ago, before her marriage. Therapeutic plasma exchanges were repeated from the 22nd to 25th weaks of gestation. During the period a mean volume of 350mL plasma volume was exchanged on average twice a week. After the period, therapeutic plasma exchange procedure was failed because of unsuccessful vascular access. So that we gave her intravenous immunoglobulin(IVIG), 0.4gm/kg for 5 days, and two intrauterine transfusion were given at 25th and 27th weeks of gestation to relief from grave HDN. The maximal antiglobulin titer of anti-E during the gestation period was 1:32. In spite of intensive therapy as above mentioned, she was delivered a severely hydropic fetus weighing 1,900g at 29th weeks of gestation under Cesarean section. The neonate died 2 days after the birth with severe erythroblastosis fetalis and disseminated intravascular coagulation (DIC). Even though we could not save the baby, we report this experience as a reviewable case of antenatal treatment modalities for Rh immunization and the serious consequence of blood transfusion before marriage.
