Severe haemolytic disease of foetus and new born due to Rhesus D alloimmunisation in highly sensitised Rhesus D negative pregnant woman

Introduction: Severe hemolytic disease of the fetus and newborn (HDFN) due to red cell alloimmunization is a frequent cause of recurrent fetal loss. This condition becomes critical when standard treatments like intrauterine transfusion (IUT) or immune-modulating therapies such as therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) are unavailable or not administered in a timely manner. This case report emphasizes the potential benefits of early TPE and IVIG administration. Case Presentation: A 28-year-old Rhesus D (RhD) negative woman (G3P2) experienced recurrent fetal loss due to severe HDFN and had a history of RhD alloimmunization and fetal loss in her second pregnancy. In her third pregnancy, high anti-D titers (1:2,024) were identified at weeks 12 and 16. Despite the need, TPE and IVIG were not administered properly due to the patient missing follow-ups and the absence of IUT facilities, culminating in macerated intrauterine death (IUD) at 27 weeks. Discussion: The failure to implement early TPE and IVIG interventions, alongside systemic treatment inadequacies, contributed to the adverse pregnancy outcome. This case accentuates the necessity of accessible and timely intervention in pregnancies complicated by high anti-D titers. Conclusion: For RhD alloimmunized pregnancies with high anti-D titers, early administration of TPE and IVIG before 20 weeks of gestation is crucial in reducing fetal morbidity and mortality. This case underscores the importance of early intervention and continuous monitoring in managing sensitized pregnancies.