A case of severe Rh (D) alloimmunization pregnant woman delivery an infant with limited treatment.

A 35-year-old woman with histories of frequent failed pregnancies was pregnant after having five plasma exchange procedures during which she was given Rh (D) positive plasma as replacement and her anti-D antibody titer went from 512 to 1024. Antenatal surveillance of the fetus showed no abnormality. At 36 weeks gestation she delivered an infant who initially had no significant clinical problems but was severely anemic on the following days. Using exchange transfusion and blood transfusions the infant's hemoglobin was normal at 4 months of age. Thus, the Rh (D) status of donor plasma should be considered when used as the replacement in plasma exchange for Rh (D) negative women. Severe Rh (D) alloimmunization pregnant woman may delivery an infant who seem in good condition at birth. If severe Rhesus isoimmunisation of the infant is confirmed, whole blood exchange should be done as early as possible and the infant must be considered to be at risk for late anemia. Clinical judgment plays a vital role in the decision to transfuse red cells or not.