Successful management of severe red blood cell alloimmunization in pregnancy with a combination of therapeutic plasma exchange, intravenous immune globulin, and intrauterine transfusion.

BACKGROUND: Antibodies to Rhesus and Kell antigens have been associated with severe hemolytic disease of the fetus and newborn (HDFN) necessitating intrauterine transfusion (IUT) of red blood cells (RBCs). We report a case series of five women with severe HDFN secondary to maternal RBC alloimmunization who were successfully managed with therapeutic plasma exchange (TPE), intravenous immune globulin (IVIG), and IUT. STUDY DESIGN AND METHODS: This is a retrospective case series of five women with severe HDFN who underwent a total of three TPE procedures during Weeks 10 to 13 of pregnancy, followed by weekly IVIG infusions. They were followed with serial middle cerebral artery peak systolic velocity studies beginning at 16 weeks' gestation to detect fetal anemia. For IUT, fetuses were administered RBC units that fully matched the maternal phenotype to D, C, E, K, Fy, Jk, and S antigen groups. The delivery outcomes and newborn information were followed. RESULTS: Anti-D and anti-K alloantibodies were implicated in HDFN. A two- to fourfold dilution reduction in anti-D and anti-K titers was observed after TPE. IUT was initiated between 21 to 27 weeks' gestation. The total number of IUTs for each patient ranged from four to seven. All five women delivered healthy infants at 33 to 38 weeks' gestation. CONCLUSION: A combined regimen of TPE and IVIG early in pregnancy and IUT later in pregnancy results in successful management of severe maternal RBC alloimmunization and HDFN. IUT with fully phenotypically matched RBC units may help prevent further RBC alloimmunization in complex cases of HDFN.

Unexplained Case of Intrauterine Fetal Demise Resolved: Case Report and Literature Review.

The association between umbilical cord ulceration and intestinal atresia has been previously established. Umbilical cord ulceration is a seemingly rare, potentially life threatening complication of intestinal atresia. The exact etiological mechanism is unknown and recent literature indicates more intensive prenatal monitoring may alter fetal outcome. In this paper we will review the previously reported cases of intestinal atresia complicated by umbilical cord ulceration and comment on the pathophysiological mechanism of umbilical cord ulceration, with emphasis on the unique location of the atresia at the gastroduodenal junction in our case.

Cytomegalovirus enteritis manifesting as recurrent bowel obstruction and jejunal perforation in patient with acquired immunodeficiency syndrome: rare report of survival and review of the literature.

BACKGROUND: Cytomegalovirus (CMV) enteritis presenting with perforation in the setting of acquired immunodeficiency syndrome (AIDS) represents a particularly deadly combination. METHODS: Case report and review of the pertinent literature. CASE REPORT: The authors report a patient with AIDS and CMV enteritis presenting as recurrent small-bowel obstruction and leading to perforation of the jejunum with subsequent survival. CONCLUSION: This is believed to represent the second case in the English-language literature of survival after CMV-induced small intestinal perforation in a patient with AIDS.