Abstract
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 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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 183-195 |
| Number of pages | 13 |
| Journal | British Journal of Haematology |
| Volume | 198 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jul 2022 |
Funding
This guideline was prepared on behalf of the ICTMG ( www.ICTMG.org ). The ICTMG receives funding from Canadian Blood Services [funded by the federal government (Health Canada) and the provincial and territorial ministries of health]. The views herein do not necessarily reflect the views of Canadian Blood Services or the federal, provincial, or territorial governments of Canada. Canadian Blood Services did not have any role in the design, analysis and interpretation of the data or preparation, review, and approval of the manuscript. International Collaboration for Transfusion Medicine Guidelines (ICTMG) members: Arwa Al Riyami MD, FRCPC, Sultan Qaboos University Hospital, Oman; Shubha Allard, MD, FRCP, FRCPath, National Health Service Blood & Transplant, United Kingdom; Melissa Brouwers, PhD, University of Ottawa, Canada; Jeannie Callum, MD, FRCPC, Sunnybrooke Health Sciences Centre and University of Toronto, Canada; James Daly, MBBS, FRACP, FRCPA, Australian Red Cross Lifeblood, Australia; Gregory A. Denomme, PhD, FCSMLS(D), Versiti Blood Center of Wisconsin, United States; Lise Estcourt, MB BChir, MA(Cantab), MA(MEL), MSc, DLSHTM, DPhil, MRCP, FRCPath, National Health Services Blood & Transplant, United Kingdom; Dean Fergusson, PhD, MHA, Ottawa Hospital Research Institute, Canada; Mark Fung, MD, PhD, University of Vermont Medical Center, United States; Laura Green, MBBS, MD (Res), FRCP, FRCPath, National Health Service Blood & Transplant, United Kingdom; Andreas Greinacher, MD, University of Greifswald, Germany; Heather Hume, MD, FRCPC, MSc, University of Montreal, Canada; Rachel Jug, MB, BCh, BAO, Canadian Blood Services, Canada; Richard Kaufman, MD, Brigham & Woman's Hospital Adult Transfusion Service, United States; Hyungsuk Kim, MD, Seoul National University Hospital, Korea; Vernon Louw, MBChB (Stell), MMed(Int Med)(Stell), PhD(HPE)(UFS), Groote Schuur Hospital, University of Cape Town, South Africa; Tadashi Matsushita, Nagoya University Hospital, Japan; Michael Murphy, MD FRCP, FRCPath, FFPath, University of Oxford and National Health Service Blood & Transplant, United Kingdom; Joanne Pink, MBBS, FRACP, FRCPA, GAICD, Australian Red Cross Lifeblood, Australia; Susan Robinson, MBBS, FRACP, FRCPA, GAID, Guy's and St. Thomas' NHS Foundation Trust, United Kingdom; Cynthia So-Osman, MD, PhD, Sanquin and Erasmus Medical Center, The Netherlands; Simon Stanworth, MA, FRCP (Peads, UK), PhD, FRCPath, NHS Blood and Transplant and Oxford University, United Kingdom; Zbigniew M. Szcezepiorski, MD, PhD, Dartmouth-Hitchcock Medical Center, United States; Aaron Tobian, MD, PhD, Johns Hopkins University, United States; Erica Wood, MBBS, FRACP, FRCPA, Monash University, Australia. The authors thank Ms Kimberly Figures for administrative support, Ms Melanie Anderson for assistance with the library searches, and Dr Prakesh Shah for sharing forest plots.
Keywords
- alloimmunization
- evidence-based guidelines
- haemolytic disease of the newborn
- intravenous immunoglobulin
- pregnancy
ASJC Scopus subject areas
- Hematology