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High-Dose Intravenous Gamma Globulin: Does it Have a Role in the Treatment of Severe Erythroblastosis Fetalis?

From the Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai Medical Center, New York; and the Department of Pediatrics, Cornell University Medical Center, New York Hospital, New York, New York.

Abstract

The role of high-dose intravenous (IV) gamma globulin in the treatment of erythroblastosis fetalis was assessed in five pregnancies with severe Rh (four) or Kell (one) isoimmunization. These women were treated with IV gamma globulin (1.0 g/kg body weight) once a week. In addition, fetal blood transfusions were performed when indicated. In four patients with Rh sensitization, high-dose IV gamma globulin treatment had no apparent effect on the total number of intrauterine transfusions required, the interval between transfusions, or the volume of blood required at each transfusion. The treatment did not prevent fetal hydrops and had no effect on maternal antibody titers. In one patient with Kell sensitization, however, the course of the disease was less severe than anticipated, suggesting that IV gamma globulin treatment may have modified the severity of the disease. We conclude that high-dose IV gamma globulin does not appear to be useful in the treatment of severe Rh disease. Its role in Kell and other types of red-cell isoimmunization deserves further evaluation.

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				R Gottstein and R W I Cooke Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2003; 88(1): F6 - 10. [Abstract] [Full Text]