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Lieberman, L.; Lopriore, E.; Baker, J.M.; Bercovitz, R.S.; Christensen, R.D.; Crighton, G.; ... ; Int Collaboration Transfusion Medicine Guidelines (ICTMG) (2022)

International guidelines regarding the role of IVIG in the management of Rh- and ABO-mediated haemolytic disease of the newborn

Article / Letter to editor
Haemolytic disease of the newborn (HDN) can be associated with significant morbidity. Prompt treatment with intensive phototherapy (PT) and exchange transfusions (ETs) can dramatically improve outcomes. ET is invasive and associated with risks. Intravenous immunoglobulin (IVIG) may be an alternative therapy to prevent use of ET. An international panel of experts was convened to develop evidence-based recommendations regarding the effectiveness and safety of IVIG to reduce the need for ETs, improve neurocognitive outcomes, reduce bilirubin level, reduce the frequency of red blood cell (RBC) transfusions and severity of anaemia, and/or reduce duration of hospitalization for neonates with Rh or ABO-mediated HDN. We used a systematic approach to search and review the literature and then develop recommendations from published data. These recommendations conclude that IVIG should not be routinely used to treat Rh or ABO antibody-mediated HDN. In situations where hyperbilirubinaemia is...Show moreHaemolytic disease of the newborn (HDN) can be associated with significant morbidity. Prompt treatment with intensive phototherapy (PT) and exchange transfusions (ETs) can dramatically improve outcomes. ET is invasive and associated with risks. Intravenous immunoglobulin (IVIG) may be an alternative therapy to prevent use of ET. An international panel of experts was convened to develop evidence-based recommendations regarding the effectiveness and safety of IVIG to reduce the need for ETs, improve neurocognitive outcomes, reduce bilirubin level, reduce the frequency of red blood cell (RBC) transfusions and severity of anaemia, and/or reduce duration of hospitalization for neonates with Rh or ABO-mediated HDN. We used a systematic approach to search and review the literature and then develop recommendations from published data. These recommendations conclude that IVIG should not be routinely used to treat Rh or ABO antibody-mediated HDN. In situations where hyperbilirubinaemia is severe (and ET is imminent), or when ET is not readily available, the role of IVIG is unclear. High-quality studies are urgently needed to assess the optimal use of IVIG in patients with HDN.Show less
alloimmunization
evidence-based guidelines
haemolytic disease of the newborn
intravenous immunoglobulin
pregnancy
All authors
Lieberman, L.; Lopriore, E.; Baker, J.M.; Bercovitz, R.S.; Christensen, R.D.; Crighton, G.; Delaney, M.; Goel, R.; Hendrickson, J.E.; Keir, A.; Landry, D.; Rocca, U. la; Lemyre, B.; Maier, R.F.; Muniz-Diaz, E.; Nahirniak, S.; New, H.V.; Pavenski, K.; Santos, M.C.P. dos; Ramsey, G.; Shehata, N.; Int Collaboration Transfusion Medicine Guidelines (ICTMG)
Date
2022-04-12
Journal
British Journal of Haematology
Volume
198
Issue
1
Pages
183 - 195
DOI
doi:10.1111/bjh.18170