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CC BY-NC-ND 4.0 · AJP Rep 2024; 14(02): e101-e105
DOI: 10.1055/s-0043-1777995
Case Report

Double-Filtration Plasmapheresis and High-Dose Intravenous Immunoglobulin Therapy in a Case of Anti-M Alloimmunization

Shun Yasuda
1   Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima City, Japan
,
Miho Ono-Okutsu
1   Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima City, Japan
,
Toma Fukuda
1   Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima City, Japan
,
Hyo Kyozuka
1   Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima City, Japan
,
Keiya Fujimori
1   Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima City, Japan
› Author Affiliations Funding None.
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Abstract

Hemolytic disease is a common cause of fetal morbidity and mortality. The anti-M blood cell alloantibodies are one of the most severe causes of fetal anemia and intrauterine death. Since no standard treatment method has been established for pregnant women, the management of this pathology is through conventional methods used for treating Rh blood-type alloimmunization. For the first time, we report a unique case wherein a pregnant woman who had intrauterine fetal death in two previous pregnancies with very low titers of anti-M antibodies had negative effects during very early pregnancy, which were successfully managed in her third pregnancy with a novel protocol. We aggressively managed the blood type (anti-M antibody) and blood platelet incompatibilities (anti-HPA-4b antibody) through combination therapy twice a week (46 cycles between 12 and 34 weeks) of double filtration plasmapheresis (DFPP) and high-dose γ-globulin (20–40 g/wk). An elective cesarean section was performed at 34 weeks, and a healthy neonate was born without detection of alloantibodies in the umbilical cord blood. Our report suggests that the combination of DFPP and intravenous immunoglobulin should be considered for the treatment of anti-M alloimmunization in pregnant women.

Keywords

alloimmunization - anti-M non-Rh antibody - anti-HPA-4b antibody - DFPP - high-dose IVIG

Ethical Approval and Informed Consent

Data for this retrospective study were obtained from the medical records of the patients treated until delivery at the Fukushima Medical University (FMU) Hospital, Japan. Informed consent was obtained from the patient, and this human subject research complied with all the relevant national regulations and institutional policies and was conducted in accordance with the tenets of the Declaration of Helsinki. The study was approved by the ethics committee of FMU (No. 29368).




Publication History

Received: 10 April 2020

Accepted: 22 October 2023

Article published online:
04 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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