Title: A case report of failure of
antenatal Intravenous Immunoglobulin to prevent Gestational Alloimmune Liver
Jonathan M. Blackwell 1, Emily K. Hartman 2,
Keith G Hartman 1, Guy D. Eslick 3.
1 Mater Hospital, North Sydney,
2 Notre Dame University, Sydney,
3 University of Sydney
Treatment for Gestational Alloimmune Liver
Disease (GALD) (also known as Neonatal Haemochromatosis) in mothers with a history
of the disease is antenatal intravenous immunoglobulin (IVIG). Reports have
demonstrated favourable outcomes. We report a case of failure of antenatal IVIG
to prevent GALD.
The mother has a history of one stillbirth at
39 weeks. A second pregnancy was lost at 10 weeks; the foetus had chromosomal
abnormalities. A third pregnancy was complicated by moderate thrombocytopenia
with an onset at 13 weeks. The child was delivered at 35 weeks. The child
developed liver disease rapidly and was diagnosed with GALD. A diagnosis of
GALD was made on the first pregnancy retrospectively after histopathology was
A fourth pregnancy was treated with IVIG
(Intragam P, CSL) according to the protocol current at that time. Mild
thrombocytopenia was noted late in this pregnancy. The neonate developed severe
liver disease in the third trimester precipitating an emergency delivery. The
child went on to have a successful liver transplant.
Results: The literature describes antenatal
treatment of GALD in 203 pregnancies. The majority of the neonates were
delivered at term. One third of the neonates (31%) presented with abnormal
liver function at birth and one quarter (24%) of the neonates required medical
treatment. No child required liver transplantation. It is possible that other
treatment failures have occurred and have not been reported.
We report a case of failure of antenatal IVIG to prevent GALD. Establishment of
a registry for GALD may facilitate a better understanding of this rare disease.