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CC BY-NC-ND 4.0 · AJP Rep 2025; 15(01): e1-e5
DOI: 10.1055/a-2496-8690
Case Report

The Effect of Prolonged Antenatal Intravenous Immunoglobulin Treatment in Preventing Gestational Alloimmune Liver Disease—A Case Series with Literature Review

Eena Sunya Lin
1   Cooper Medical School of Rowan University, Camden, New Jersey
,
Faraz Afridi
3   Department of Pediatric Hematology-Oncology, MD Anderson Children's Cancer Hospital, Houston, Texas
,
Sukrita Sheshu Mysore
4   Department of Pediatric Gastroenterology, University of Maryland, Baltimore, Maryland
,
Thomas Presenza
5   Department of Diagnostic Imaging, Cooper Medical School of Rowan University, Camden, New Jersey
,
Alla Kushnir 
6   Department of Neonatal-Perinatal Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
,
Rafat Ahmed
2   Department of Pediatric Hematology-Oncology, Cooper Medical School of Rowan University, Camden, New Jersey
› Author Affiliations Funding None.
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Abstract

Background Gestational alloimmune liver disease (GALD) is characterized by maternal IgG-directed fetal hepatocyte damage and can lead to severe liver failure and fetal or infant death. Moreover, GALD is associated with a near 90% risk of recurrence in subsequent pregnancies.

Case We present a case of a newborn patient delivered to a 32-year-old G2P1000 mother who received prolonged antenatal intravenous immunoglobulin (IVIG) treatment during the current pregnancy due to the neonatal death of the first child from GALD-related liver failure. Postnatal testing, including a liver magnetic resonance imaging (MRI) and buccal biopsy of this newborn, showed normal morphology of the liver without any abnormal iron deposition. Additional laboratory testing showed a lack of any liver injury.

Conclusion This case supports the use of antenatal IVIG immunotherapy to prevent the recurrence of GALD in subsequent pregnancies.

Key Points

  • GALD can lead to severe fetal liver injury.

  • GALD is highly recurrent in subsequent pregnancies.

  • Prophylactic IVIG may prevent GALD recurrence.

Keywords

gestational alloimmune liver disease - neonatal hemochromatosis - antenatal IVIG - recurrence - fetal liver injury


Publication History

Received: 04 June 2024

Accepted: 10 July 2024

Accepted Manuscript online:
05 December 2024

Article published online:
07 January 2025

© 2025. 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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