Treatment with plasmapheresis and intravenous immunoglobulin in pregnancies complicated with anti-PP1Pk or anti-K immunization: a report of two patients

Background and Objectives In addition to anti-D alloantibody, other antibod ies such as anti-K antibody and anti-PP(1)p(k) antibody have been reported to cause severe haemolytic disease of the newborn (HDN). HDN caused by anti -K results not only from destruction of red cells but also from suppression of erythropoiesis, Anti-PP(1)p(k) has been associated with abortion early in pregnancy. We report on two patients, one with anti-PP(1)p(k) and the ot her with anti-K, who were treated with plasmapheresis and intravenous immun oglobulin (MG) during pregnancy in an attempt to reduce the plasma antibody levels. Materials and Methods The patient with anti-PP,pk had lost all seven previo us fetuses in the first trimester and therefore therapy in this patient was started at 8 weeks of gestation. The second patient had been sensitized to the K antigen through blood transfusion and had had two intrauterine fetal deaths at 26 weeks of gestation with signs of hydrops fetalis. Treatment i n this patient was started during the 16th week of pregnancy. Results As a result of therapy, the antibody titre was reduced in both pati ents. In the first patient a healthy infant was delivered by Caesarean sect ion at 37 weeks of gestation. The second patient gave birth at 36 weeks of gestation. Neither newborn required exchange transfusion. Conclusions In our two patients, plasmapheresis combined with IVIG proved s uccessful in the management of fetomaternal incompatibilities where the mec hanism of fetal loss differs from the classical anti-D.