{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T07:23:56Z","timestamp":1789025036649,"version":"build-2803163510"},"reference-count":14,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2014,3,28]],"date-time":"2014-03-28T00:00:00Z","timestamp":1395964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2014,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Maternal <jats:styled-content style=\"fixed-case\">D<\/jats:styled-content> alloimmunization detected in early gestation requires aggressive intervention to prevent severe fetal anemia. An intrauterine transfusion (<jats:styled-content style=\"fixed-case\">IUT<\/jats:styled-content>) is indicated to prevent fetal death once severe fetal anemia has been detected, but is not without risk. Protocols combining therapeutic plasma exchange (<jats:styled-content style=\"fixed-case\">TPE<\/jats:styled-content>) and intravenous immunoglobulin (<jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content>) have been described, but they usually bridge to <jats:styled-content style=\"fixed-case\">IUT<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design and Methods<\/jats:title><jats:p>We describe a 27\u2010year\u2010old <jats:styled-content style=\"fixed-case\">G<\/jats:styled-content>4, <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>0\u20101\u20102\u20100 Caucasian female with a history of ruptured ectopic pregnancy presented at 12 weeks' gestation with a very high anti\u2010<jats:styled-content style=\"fixed-case\">D<\/jats:styled-content> titer (2048). <jats:styled-content style=\"fixed-case\">TPE<\/jats:styled-content> was performed on that week and twice more in the following week, with a fourth final exchange during <jats:styled-content style=\"fixed-case\">W<\/jats:styled-content>eek 14. A loading dose of <jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content> (2\u2009g\/kg) was administered over 2 days after the third <jats:styled-content style=\"fixed-case\">TPE<\/jats:styled-content> and then 1\u2009g\/kg per week until <jats:styled-content style=\"fixed-case\">W<\/jats:styled-content>eek 28 (total, 14 doses).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The antibody titer decreased to 256 by the beginning of 15 weeks' gestation and remained stable at that level for the remainder of the pregnancy. Doppler ultrasonographic measurements of the fetal middle cerebral artery peak flow velocity performed throughout gestation showed no evidence of fetal anemia. A healthy male infant was delivered at 37 weeks' gestation with mild immune\u2010mediated hemolysis. The infant underwent successful treatment with an <jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content> dose of 750\u2009mg\/kg and a red blood cell exchange.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our unique <jats:styled-content style=\"fixed-case\">TPE<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content> protocol was successful at preventing the onset of severe fetal anemia in a patient with high titer anti\u2010<jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>. Since <jats:styled-content style=\"fixed-case\">IUT<\/jats:styled-content> may be fatal, our approach offers a safer and less\u2010invasive treatment regime that can adequately sustain a fetus until term.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.12633","type":"journal-article","created":{"date-parts":[[2014,3,28]],"date-time":"2014-03-28T20:56:01Z","timestamp":1396040161000},"page":"2118-2121","source":"Crossref","is-referenced-by-count":17,"title":["Therapeutic plasma exchange and intravenous immunoglobulin as primary therapy for <scp>D<\/scp> alloimmunization in pregnancy precludes the need for intrauterine transfusion"],"prefix":"10.1111","volume":"54","author":[{"given":"Michael","family":"Bellone","sequence":"first","affiliation":[{"name":"Division of Transfusion Medicine Department of Pathology North Shore University Hospital and Hofstra North Shore\u2010LIJ School of Medicine  Manhasset New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fouad N.","family":"Boctor","sequence":"additional","affiliation":[{"name":"Division of Transfusion Medicine Department of Pathology North Shore University Hospital and Hofstra North Shore\u2010LIJ School of Medicine  Manhasset New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,3,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0041-1132.2003.00632.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1423-0410.1986.tb00226.x"},{"key":"e_1_2_7_4_1","first-page":"1","article-title":"Births; final data for 2002","volume":"52","author":"Martin JA","year":"2003","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(02)02180-4"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.10.890"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.1980.tb07185.x"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpme.1995.23.6.443"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/985646"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpme.1997.25.1.85"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.2003.00519.x"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2011.633668"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2012.03862.x"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.05.030"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/der227"}],"container-title":["Transfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Ftrf.12633","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/trf.12633","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T10:11:07Z","timestamp":1696155067000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/trf.12633"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,3,28]]},"references-count":14,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2014,8]]}},"alternative-id":["10.1111\/trf.12633"],"URL":"https:\/\/doi.org\/10.1111\/trf.12633","archive":["Portico"],"relation":{},"ISSN":["0041-1132","1537-2995"],"issn-type":[{"value":"0041-1132","type":"print"},{"value":"1537-2995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,3,28]]}}}