Immunoglobulin administration to fetuses with anemia due to alloimmunization to D

BACKGROUND: The purpose of this study was to examine fetal tolerance of hig h-dose intravenous immunoglobulin (IVIG), given directly at the time of int ravascular transfusion, and its effects on fetal hemolysis and pregnancy ou tcome in the setting of alloimmunization to D. STUDY DESIGN AND METHODS: Thirteen consecutive D+ fetuses requiring transfu sion for maternal altoimmunization received high-dose IVIG (1.0 g/kg) and r ed cell transfusions. Twenty-four previous, consecutive fetuses with matern al anti-D served as controls. The schedules for subsequent transfusions wer e the same in the two groups. RESULTS: High-dose IVIG was well tolerated by all fetuses. In the IVIG grou p, daily decreases in hematocrit were smaller than those in controls after the second administration of IVIG (mean hematocrit decrease, 0.72 percent/d ay vs. 1.45 percent/day; p = 0.007). No significant difference was found in the total number of fetal transfusions, the gestational age at delivery, t he duration of neonatal intensive care, the number of neonates requiring po stnatal transfusion therapy, and perinatal mortality. CONCLUSION: In this small pilot study, direct administration to fetuses of IVIG with red cell transfusions was well tolerated and appeared to have a b eneficial effect on fetal hemolysis.