Plasma exchange in the treatment of hemolytic disease of the newborn.

Plasma exchange has become a widely used therapeutic tool in the treatment of immune-mediated disease. This technique has been applied to the treatment of gravid women whose high antibody titers and past history of stillbirths indicate a significant possibility of fetal loss due to HDN. The procedure was effective in decreasing both antibody titer and the quantity of antibody in four of five patients. In one other case, the antibody titer rose toward the end of the pregnancy; however, the quantity of anti-D remained low. The IgG:IgM ratio and the subclass specificity of IgG did not significantly change with treatment. Hematologic monitoring also indicated no adverse effects, and three of the five women delivered viable fetuses. Two of the other women produced infants only moderately affected by HDN but stillborn within days of intrauterine transfusion. The results indicate that plasma exchange is a useful therapeutic consideration in the sensitized gravid women.