Prevention of Fetal Anemia with Plasma Exchange and Intravenous Immunoglobulin in a Pregnancy with a Complex Anti-K and Anti-C Alloimmunization

Hemolytic disease of the fetus and newborn (HDFN) remains the main cause of fetal anemia primarily due to RH-D maternal incompatibility but also to other rarer antigens. Anti-Kell mediated immunization is a rare disease involving about 0.1% of pregnant women causing a more severe HDFN compared to RH-D both for its anemia mechanism and because of lack of preventive immunoglobulin therapy. Although the standard treatment of fetal anemia is intrauterine transfusion (IUT), at early gestational age with high antibody titer and absence of ultrasound anemia signs, noninvasive strategies can be offered. We present a case of severe anti-Kell and anti-C Rh positive immunized pregnancy with high Kell titer at 14 weeks of gestation that successfully treated with plasma exchange and intravenous immunoglobulin to prevent the onset of fetal anemia and to avoid the need for IUT.