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Multidisciplinary management of anti‐PP1P k or anti‐P alloimmunization during pregnancy: A new case with anti‐P and a literature review
Author(s) -
Lépine Marlène Sohier,
Goua Valérie,
Debouverie Odile Souchaud,
Giraud Christine,
Rafat Cédric,
Thonier Vincent,
Masmouhi Badrdine El,
Ndour Cécile Toly,
HuguetJacquot Stéphanie,
Mailloux Agnès,
Cortey Anne,
Jouannic JeanMarie,
Maisonneuve Emeline
Publication year - 2021
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.16384
Subject(s) - medicine , pregnancy , fetus , obstetrics , gestation , exchange transfusion , titer , abortion , gynecology , antibody , pediatrics , immunology , genetics , biology
Background Red blood cell alloimmunization is the first cause of fetal and neonatal anemia. Alloimmunizations with anti‐PP1P k or anti‐P can cause recurrent miscarriages and hemolytic disease of the fetus and newborn in the 2nd and 3rd trimesters of pregnancy. We report on a pregnant patient immunized with anti‐P and a history of recurrent miscarriages. Case Report This P 2 k (GLOB:‐1; P1PK:‐1,3) patient had a first pregnancy marked by a caesarean at 38 weeks of gestation (WG) for non‐reassuring fetal heart rate. Then, she had three early spontaneous miscarriages. The fifth pregnancy began with a high titer of anti‐P at 128. Early initiation of treatment with Intravenous Immunoglobulins (IVIg) and plasma exchanges (PE) starting at 5 WG permitted us to reduce the titer of anti‐P below 32. A healthy infant was delivered by caesarean at 38 WG without anemia at birth and no exchange transfusion was required. Discussion and Review of the Literature The P and P k antigens are expressed on placental, trophoblastic, and embryonic cells. This explains why P 1 k (GLOB:‐1; P1PK:1,3), P 2 k (GLOB:‐1; P1PK:‐1,3), or Tj(a‐)/p (GLOB:‐1; P1PK:‐1,‐3) patients are prone to recurrent abortions in the first trimester of pregnancy. A literature review demonstrated 87% (68/78) of miscarriages in p patients. However, publication biases are possible with the most severe cases being reported. Conclusion Immunizations to P and PP1P k antigens differ from others in their physiopathology and precocity. The association of PE and IVIg seems to be an effective treatment in the management of anti‐PP1P k or anti‐P fetomaternal incompatibilities.