Sarker Minhazur, DeBolt Chelsea, Strong Noel
Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System & Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
Case Rep Womens Health. 2022 May 17;35:e00422. doi: 10.1016/j.crwh.2022.e00422. eCollection 2022 Jul.
Gestational alloimmune liver disease is a rare complication associated with reactive maternal immunoglobulins resulting in neonatal liver pathology. The mainstay treatment for prevention in future pregnancies is intravenous immunoglobulins. Although relatively well tolerated, adverse reactions may occur. In this report, we highlight a case of intravenous immunoglobulin induced pancytopenia diagnosed by exclusion after thorough work-up. The patient was counseled on options and an informed decision was made to proceed with re-trial of intravenous immunoglobulin without systemic prednisone. This resulted in the delivery of a healthy neonate. We propose that future adverse reactions to intravenous immunoglobulin in pregnancy may warrant the trial of a new medication lot and use of systemic steroids only if subsequently indicated.
妊娠期同种免疫性肝病是一种罕见的并发症，与母体反应性免疫球蛋白有关，可导致新生儿肝脏病变。预防未来妊娠的主要治疗方法是静脉注射免疫球蛋白。尽管其耐受性相对良好，但仍可能发生不良反应。在本报告中，我们重点介绍了一例经全面检查后通过排除法诊断为静脉注射免疫球蛋白引起的全血细胞减少症的病例。我们向患者提供了各种选择的建议，并在充分知情的情况下做出了继续静脉注射免疫球蛋白而不使用全身泼尼松的再试验决定。这使得患者顺利产下一名健康的新生儿。我们建议，未来妊娠期静脉注射免疫球蛋白出现不良反应时，可能有必要试用新一批药物，只有在后续有指征时才使用全身类固醇。
