1072 Viewed1030 Downloaded
Prevention of Gestational Alloimmune Liver Disease by Intravenous Immunoglobulin Administration in the Second Trimester: A Presentation of Two Cases
Received: 11 May 2023 | Received in revised form: 21 Jul 2023
Accepted: 21 Aug 2023 | Available online: 19 Sep 2023Gül ALKAN BÜLBÜLa , Emine KİRTİŞa , Hülya KANDEMİRa, Arzu ARASb , Özlem ELPEKc , Cem Yaşar SANHALa
aClinic of Obstetrics and Gynecology, Akdeniz University Hospital, Antalya, Türkiye
bClinic of Pediatric Gastroenterology, Antalya Training and Research Hospital, Antalya, Türkiye
cDepartment of Medical Pathology, Akdeniz University Faculty of Medicine, Antalya, Türkiye
JCOG. 2023;33(3):191-4
DOI: 10.5336/jcog.2023-97913
Article Language: EN
Copyright Ⓒ 2024 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (
http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Gestational alloimmune liver disease (GALD) is characterized by complement-mediated hepatocyte damage by transplacental transmission of maternal antibodies against fetal hepatocyte antigens. GALD's recurrence occurs up to 90% in pregnancies after an affected pregnancy. Intravenous immunoglobulin (IVIG) is a sterile, purified immunoglobulin (IgG) product that is manufactured from pooled human plasma. IVIG typically contains more than 95% unmodified IgG which has intact fragment crystallizable-dependent effector functions in addition to trace amounts of IgA and/or IgM. Indeed, antenatal high-dose IVIG treatment effectively reduces the risk of recurrence. In the present study, we reported two cases with GALD recurrence which was prevented by maternal IVIG administration in the second trimester.
REFERENCES:- Whitington PF, Kelly S, Taylor SA, Nóbrega S, Schreiber RA, Sokal EM, et al. Antenatal treatment with intravenous immunoglobulin to prevent gestational alloimmune liver disease: comparative effectiveness of 14-week versus 18-week initiation. Fetal Diagn Ther. 2018;43(3):218-25. [Crossref] [PubMed]
- Whitington PF. Fetal and infantile hemochromatosis. Hepatology. 2006;43(4):654-60. [Crossref] [PubMed]
- Whitington PF. Gestational alloimmune liver disease and neonatal hemochromatosis. Semin Liver Dis. 2012;32(4):325-32. [Crossref] [PubMed]
- Whitington PF, Kelly S. Outcome of pregnancies at risk for neonatal hemochromatosis is improved by treatment with high-dose intravenous immunoglobulin. Pediatrics. 2008;121(6):e1615-21. [Crossref] [PubMed]
- Okada N, Sasaki A, Saito J, Mitani Y, Yachie A, Takahashi H, et al. The Japanese experience and pharmacokinetics of antenatal maternal high-dose immunoglobulin treatment as a prophylaxis for neonatal hemochromatosis in siblings. J Matern Fetal Neonatal Med. 2020;33(1):142-8. [Crossref] [PubMed]
- Chaigne B, Mouthon L. Mechanisms of action of intravenous immunoglobulin. Transfus Apher Sci. 2017;56(1):45-9. [Crossref] [PubMed]
- D'Mello RJ, Hsu CD, Chaiworapongsa P, Chaiworapongsa T. Update on the use of intravenous immunoglobulin in pregnancy. Neoreviews. 2021;22(1):e7-e24. [Crossref] [PubMed]
- Whitington PF, Hibbard JU. High-dose immunoglobulin during pregnancy for recurrent neonatal haemochromatosis. Lancet. 2004;364(9446):1690-8. [Crossref] [PubMed]
- Baruteau J, Heissat S, Broué P, Collardeau-Frachon S, Bouvier R, Fabre M, et al. Transient neonatal liver disease after maternal antenatal intravenous Ig infusions in gestational alloimmune liver disease associated with neonatal haemochromatosis. J Pediatr Gastroenterol Nutr. 2014;59(5):629-35. [Crossref] [PubMed]
- Lopriore E, Mearin ML, Oepkes D, Devlieger R, Whitington PF. Neonatal hemochromatosis: management, outcome, and prevention. Prenat Diagn. 2013;33(13):1221-5. [Crossref] [PubMed]
- Herrmann A, Samelson-Jones BJ, Brake S, Samelson R. IVIG-associated maternal pancytopenia during treatment for neonatal alloimmune thrombocytopenia. AJP Rep. 2017;7(3):e197-e200. [Crossref] [PubMed] [PMC]
- Pierce LR, Jain N. Risks associated with the use of intravenous immunoglobulin. Transfus Med Rev. 2003;17(4):241-51. [Crossref] [PubMed]
- Rink BD, Gonik B, Chmait RH, O'Shaughnessy R. Maternal hemolysis after intravenous immunoglobulin treatment in fetal and neonatal alloimmune thrombocytopenia. Obstet Gynecol. 2013;121(2 Pt 2 Suppl 1):471-3. [Crossref] [PubMed]
- Hutchings G, Williams O, Sokal E, Wittington PF. Plasmapheresis as an alternative to high-dose intravenous immunoglobulin in the prevention of gestational alloimmune liver disease. Fetal Diagn Ther. 2013;34(3):180-3. [Crossref] [PubMed]