Multidisciplinary management of anti‐PP1Pk or anti‐P alloimmunization during pregnancy: A new case with anti‐P and a literature review. Issue 6 (3rd April 2021)

• Record Type: Journal Article
• Authors: Lépine, Marlène Sohier; Goua, Valérie; Debouverie, Odile Souchaud; Giraud, Christine; Rafat, Cédric; Thonier, Vincent; Masmouhi, Badrdine El; Ndour, Cécile Toly; Huguet‐Jacquot, Stéphanie; Mailloux, Agnès; Cortey, Anne; Jouannic, Jean‐Marie; Maisonneuve, Emeline
• Is Part Of: Transfusion. Volume 61:Issue 6(2021)
• Page Start: 1972
• Page End: 1979
• Publication Date: 2021-04-03
• Subjects: anti‐GLOB1 -- anti‐P alloimmunizations -- anti‐PP1Pk -- anti‐Tja -- fetal anemia -- fetomaternal red blood cell incompatibility -- intravenous immunoglobulin -- plasmapheresis -- recurrent miscarriages -- repeated miscarriages; Hematology -- Periodicals; Blood -- Transfusion -- Periodicals; Blood Group Antigens -- Periodicals; Blood Preservation -- Periodicals; Blood Transfusion -- Periodicals; 615
• DOI: 10.1111/trf.16384
• Languages: English
• ISSNs: 0041-1132

Abstract

Abstract: 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 P2 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 P1 k (GLOB:‐1; P1PK:1, 3), P2 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.