{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T12:46:20Z","timestamp":1792500380567,"version":"4.5.0"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Maternal anti\u2010Kell and anti\u2010Rhesus D\u2010alloimmunization cause severe hemolytic disease of the fetus and newborn (HDF) by crossing the placenta, leading to anemia and hydrops fetalis. Early\u2010onset HDF from anti\u2010K and anti\u2010RhD alloimmunization often requires multiple, early intrauterine transfusions (IUTs), with higher complication rates and decreased sensitivity after the first intervention. Mortality remains high.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Report<\/jats:title>\n                    <jats:p>We report the successful treatment of three pregnant women with high\u2010titer red cell alloantibodies\u2014two with anti\u2010K and one with anti\u2010RhD\u2014during the first trimester, a period with otherwise limited therapeutic options. We applied a novel triple therapy consisting of immunoadsorption (IA), high\u2010dose intravenous immunoglobulin (IVIG), and rituximab (Rtx) (IIR). This approach resulted in a marked reduction of antibody titers: anti\u2010D decreased from 1:1024 to 1:16, and anti\u2010K from 1:8192 and 1:2048 to 1:32, respectively. One patient presented at 19\u2009weeks of gestation with fetal hydrops, severe anemia, and thrombocytopenia. IIR reduced the need for invasive procedures (intrauterine transfusions) and led to resolution of fetal thrombocytopenia. In the remaining two high\u2010risk cases, IIR prevented the onset of fetal anemia. All neonates were delivered healthy and without anemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case series presents a novel, safe personalized prophylactic and therapeutic approach that may delay anemia onset and reduce invasive procedures in high\u2010risk patients with limited options and resulted in healthy neonates without apparent comorbidities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/trf.70426","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T12:00:54Z","timestamp":1792497654000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effective combined immunotherapy for severe hemolytic disease of the fetus"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1488-5639","authenticated-orcid":false,"given":"Annina","family":"Capraru","sequence":"first","affiliation":[{"name":"Department of Hematology and Central Hematology Laboratory Inselspital, Bern University Hospital  Bern Switzerland"},{"name":"Department of Hematology Luzerner Kantonsspital  Lucerne Switzerland"},{"name":"Department of Hematology University of Berne  Lucerne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8138-0505","authenticated-orcid":false,"given":"Michael","family":"Daskalakis","sequence":"additional","affiliation":[{"name":"Department of Hematology and Central Hematology Laboratory Inselspital, Bern University Hospital  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5594-0532","authenticated-orcid":false,"given":"Martin","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Lindenhofspital Bern  Bern Switzerland"},{"name":"Institute of Biochemistry and Molecular Medicine University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3957-3810","authenticated-orcid":false,"given":"Luigi","family":"Raio","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University Hospital of Bern, University of Bern, Inselspital  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Behrouz Mansouri","family":"Taleghani","sequence":"additional","affiliation":[{"name":"Department of Hematology and Central Hematology Laboratory Inselspital, Bern University Hospital  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2290-2019","authenticated-orcid":false,"given":"Sacha","family":"Zeerleder","sequence":"additional","affiliation":[{"name":"Department of Hematology Luzerner Kantonsspital  Lucerne Switzerland"},{"name":"Department of Hematology University of Berne  Lucerne Switzerland"},{"name":"Faculty of Health Sciences and Medicine University of Lucerne  Lucerne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/vox.12265"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/985646"},{"issue":"2","key":"e_1_2_5_4_1","first-page":"201","article-title":"Transfer of IgG subclasses across placenta in term and preterm newborns","volume":"29","author":"Costa\u2010Carvalho BT","year":"1996","journal-title":"Braz J Med 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