Severe alloimmunization is surrounded by vague information and confusion, but this episode will prepare patients and providers for available treatment. Patients with previous fetal death, previous IUT before 24 weeks, or with a titer of 256 or higher may be diagnosed with severe disease. Remember, options do exist for severe situations, and prevention and monitoring are the key elements to having a healthy baby. This episode discusses IVIG and plasmapheresis, early MCA Scans and early IUTs, and phenobarbital. 

Episode themes: 

• Common misconceptions about severe disease
• Defining severe disease
• Delaying IUTs with IVIG and plasmapheresis treatment
• What to expect during IVIG and plasmapheresis
• Oral phenobarbital for mom to reduce need for newborn transfusion after birth
• Tips for patients entering a pregnancy complicated by severe disease

IVIG: Intravenous Immunoglobulin:  An infusion of mostly IgG immunoglobulins that is made by extracting the immunoglobulins from the plasma of ~1,000 donors. It is thought to lessen the mother’s antibody response and delay fetal anemia. It can also be given after birth to newborns to treat hyperbilirubinemia. 

Phenobarbital: An oral medication given to an alloimmunized mother before baby’s birth to improve baby’s liver function, allowing the baby to more efficiently break down bilirubin and reducing the need for exchange transfusion after birth.

Plasmapheresis: The process of removing the plasma from the body whereby the blood is removed and run through a machine that separates the plasma from the red blood cells. The plasma is discarded and the red blood cells are returned to the body with fewer antibodies (which live in plasma).

Allo Hope Terminology Library https://allohopefoundation.org/library/terminology/

Guests: Dr. Ken Moise https://partnersincare.health/directory/kenneth-moise

Dr. Thomas Travett http://www.georgiaperinatal.com/dr-trevett/

Links mentioned in this episode: 

PETIT study on IVIG:l https://pubmed.ncbi.nlm.nih.gov/29902448/

Ruma et al. on plasmapheresis & IVIG:  https://www.sciencedirect.com/science/article/abs/pii/S0002937806022058

Trevett et al. on phenobarbital: https://www.ajog.org/article/S0002-9378(04)00938-X/fulltext

Jansen nipocalimab clinical trials for severe disease patients: 

https://clinicaltrials.gov/ct2/show/NCT03755128

https://clinicaltrials.gov/ct2/show/NCT03842189

Research for this episode provided by Bethany Weathersby and Molly Sherwood of the Allo Hope Foundation. Find more information at https://allohopefoundation.org.

The Allo Podcast is produced and edited by https://www.mediaclub.co.