SEVERE RH(D) IMMUNIZATION - ANTI-D QUANTITATION AND TREATMENT POSSIBILITIES DURING PREGNANCY AND AFTER BIRTH

An extremely aggressive Rh(D), (C) and Kell alloimmunization during pr egnancy is reported. Exceptionally high concentrations of anti-D were observed in the mother, in the fetus and in the amniotic fluid, indica ting an active transport across the placenta and a passive excretion i nto the amniotic fluid. Treatment during pregnancy included maternal p lasmapheresis and high-dose intravenous immunoglobulin. Intravascular transfusions were given to the fetus. Postpartum the newborn was given immunoglobulin, one exchange transfusion and four top-up transfusions . In the newborn the elimination rate of anti-D could be followed. Not until almost 4 months postpartum did the anti-D concentration drop be low the level of detection. This coincided with an elevated reticulocy te production and appearance of the child's true blood group in parall el with ceasing need for blood transfusions. Elimination rate and abso lute anti-D values can be used as a prognostic tool to predict the nee d of blood transfusions. Immunoglobulin treatment can also be consider ed as an optional form of treatment in newborns affected by alloimmuni zation.