Ann Clin Case Rep | Volume 6, Issue 1 | Case Series | Open Access

Exploring Role of Intravenous Immunoglobulin in Management of Alloimmune Hemolysis Caused by Minor Blood Group Incompatibilities Leading to Severe Hyperbilirubinemia Requiring Exchange Transfusion

Bhabesh Kant Chowdhry1, Arnab Ghorui2, Neha Singh3 and Chandra Mohah Kumar2*

1Department of Neonatology, All India Institute of Medical Sciences, India
2Department of Pediatrics, All India Institute of Medical Sciences, India 3Department of Transfusion Medicine, All India Institute of Medical Sciences, India

*Correspondance to: Chandra Mohan Kumar 

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Abstract

With better antenatal care and widespread use of Anti-D antibody in Rh negative pregnancies, hemolytic disease of fetus and newborn due to minor blood group antigens incompatibility has gradually increased in proportion in recent years. However most of them are mild to moderate. This series has two cases of minor blood group incompatibility in which IVIG was used as alternate therapy for exchange transfusion. In first case serum bilirubin was persistently rising high despite two exchange transfusions, so we used a single dose of IVIG @ 1 gm/kg iv over 6 h after which SB fell gradually to below phototherapy range. In second baby serum bilirubin was in exchange level at 8 h of life, DVET was contemplated but compatible blood was unavailable in blood bank. Based on first experience we started IVIG as alternative to exchange therapy while blood bank was arranging the blood. Serum bilirubin fell below exchange level after 6 h of IVIG infusion and phototherapy stopped after 72 h of IVIG. Conclusion: Though it will be very early to say as there is limited data and still considered as an off label use in immune HDN but we may consider IVIG as an alternative for exchange transfusion.

Keywords:

Rh antigen; Direct Coombs test; Fetomaternal bleed; Alloimmunization; Phototherapy; IVIG; Bilirubin; Pregnancy

Citation:

Chowdhry BK, Ghorui A, Singh N, Kumar CM. Exploring Role of Intravenous Immunoglobulin in Management of Alloimmune Hemolysis Caused by Minor Blood Group Incompatibilities Leading to Severe Hyperbilirubinemia Requiring Exchange Transfusion. Ann Clin Case Rep. 2021; 6: 2040..

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