Severe blood-type incompatible pregnancy

Each year, nearly one-half million pregnancies in the USA are complicated by maternal-fetal blood type incompatibility. In severe blood-type incompatible pregnancy, maternal irregular antibodies passing through the placenta destroy fetal red blood cells, causing hemolysis. The hemolysis results in jaundice, hemolytic anemia, edema, congestive heart disease, hepatosplenomegaly, and fetal death. D (RhD and Rh-positive), Kell (K1), c, Duffy (Fya), and Kidd (Jka and Jkb) antigens are particularly problematic.
The usual treatment for maternal-fetal severe blood type incompatibility after 18 weeks of pregnancy is intrauterine fetal blood transfusion under ultrasound guidance. However, in early pregnancy before 18 weeks, plasmapheresis is performed to reduce the irregular antibodies in the maternal blood. Many studies have reported the effectiveness of double filtration plasmapheresis (DFPP) using a plasma separator and plasma exchange (PE) in treating maternal-fetal severe blood type incompatibility.