NO BENEFICIAL EFFECT OF LOW-DOSE FETAL INTRAVENOUS GAMMA-GLOBULIN ADMINISTRATION IN COMBINATION WITH INTRAVASCULAR TRANSFUSIONS IN SEVERE RH-D HEMOLYTIC-DISEASE

Recent observations have shown that treatment with high-dose intraveno us gammaglobulin (IVIgG) given to the mother may improve fetal outcome in cases of severe Rh D alloimmunization. Unfortunately, the costs of this new method of treatment are too high for routine use. Therefore, we decided to apply this treatment to the fetus and to investigate wh ether the effect of IVlgG might be attributable to blockade of the fet al mononuclear phagocyte system. We have performed a randomized study in which 20 fetuses with severe Rh D-haemolytic disease (HDN) were tre ated with intrauterine intravascular red cell transfusions (IUT). In 1 0 of these 20 cases transfusions were followed by administration to th e fetus of low-dose IVIgG (85.7 +/- 11.6 mg/kg by ultrasound-estimated fetal weight because of fetal vascular Volume considerations). We com pared the number of IUTs, postnatal exchange transfusions, haematocrit (Ht) and haemoglobulin (Hb) values before and after transfusion (s) n eeded by the newborns of the two groups. No significant differences in the transfusion requirements of the fetuses and in the clinical outco me could be demonstrated. However, the 95% confidence interval for the difference in the improvement of cord blood Ht was too wide for any c onclusions. The 95% confidence interval for the difference in the impr ovement of Hb levels suggests that any clinically relevant advantage o f IVIgG on Hb is unlikely.