Rhesus haemolytic disease (RHD) after the introduction of high dose intravenous immunoglobulin (IVIg)

Background and Aims: RHD is characterised by haemolysis and hyperbilirubinaemia. New AAP guidelines recommended high-dose IVIg as an alternative of exchange transfusion (EXT). The aim of this study was to compare clinical outcomes of RHD patients before and after the introduction of IVIg. Methods: A chart-review of 88 Coombs-positive RHD patients (1999– 2009) was performed. Patients were divided into two groups, treated before (Group A [GA], n = 35) and after (Group B [GB], n = 53) the introduction of IVIg, respectively. Number of EXT and RBC transfusions, days of permanence of umbilical catheter (UC), duration of hospitalisation and phototherapy, maximum bilirubinaemia, changes in bilirubinaemia over time, and morbidity were compared in the two groups. Results: GB-patients had lower EXT need (13% vs 82% in GA, p = 0.000), UC need (58% vs 97%, p = 0.001) and UC days (mean 2.8/patient vs 4.6, p = 0.001), higher need of RBC transfusions (mean 0.9/patient vs 0.2, p = 0.000), longer hospitalisation (mean 12.1 days/patient vs 6.9, p = 0.000) and longer phototherapy (mean 7.6 days/patient vs 4.5, p = 0.000). No significant difference in maximum bilirubinaemia was found; in GB-patients bilirubinaemia overcame neurological-risk value for shorter period (mean 55.4 hours/patients vs 74.6, p = 0.047). 43.9% GA-patients had thrombocytopenia, 21.9% hypocalcaemia, 4.9% hypomagnesaemia, 19.5% UC-related complications, and 9.8% adverse reactions during EXT. Two infants in GB developed NEC. Conclusions: High-dose IVIg in RHD patients reduced EXT need, UC need and permanence time, and risk of hyperbilirubinaemia-related neurological damage. Instead, IVIg-treated patients needed longer hospitalisation, longer phototherapy, and had increased need of RBC transfusions.