Abstract
Large-volume plasma exchange was used to reduce the maternal anti-D concentration in a case of severe rhesus disease. The treatment commenced at 19 weeks' gestation and continued until the infant was successfully delivered at 35.2 weeks' gestation. The initial anti-D level of 30 IU/ml was lowered to 10 and was maintained below that level, with few exceptions throughout the program. The volume of plasma exchanged each week varied between 6.8 and 13.4 liters, a total of 154 1. Three IUTs were accomplished, starting from 31 weeks' gestation. The patient's OD values remained far below those recorded in her previous pregnancy which terminated in neonatal death. The replacement fluids consisted of 98 1 PPS with FFP added to equilibrate the patient at the end of each procedure, altogether 33 1. At 33 weeks' gestation she developed a transient non-A, non-B hepatitis probably caused by the use of FFP. However, she later made a complete recovery. Large-volume plasma exchanges commenced early in high-risk pregnancy must be individually designed and based on the kinetics of anti-D production. The replacement fluids should preferably consist of pasteurized albumin solutions and intravenous immune globulin.