International guidelines regarding the role of IVIG in the management of Rh- and ABO-mediated haemolytic disease of the newborn


Lani Lieberman, Department of Clinical Pathology, University Health Network, Toronto, Ontario, Canada.
Enrico Lopriore, Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
Jillian M. Baker, Department of Pediatrics, Unity Health Toronto (St. Michael's Hospital), Toronto, Ontario, Canada.
Rachel S. Bercovitz, Division of Hematology, Oncology, and Stem Cell Transplant, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Robert D. Christensen, Divisions of Neonatology and Hematology/Oncology, University of Utah Health, Salt Lake City, UT, USA.
Gemma Crighton, Department of Haematology, Royal Children's Hospital, Melbourne, Australia.
Meghan Delaney, Division of Pathology & Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.
Ruchika Goel, Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Jeanne E. Hendrickson, Departments of Laboratory Medicine and Pediatrics, Yale University, New Haven, Connecticut, USA.
Amy Keir, SAHMRI Women and Kids, South Australian Health and Medical Institute, North Adelaide, South Australia, Australia.
Denise Landry, Canadian Blood Services, Ottawa, Ontario, Canada.
Ursula La Rocca, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
Brigitte Lemyre, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
Rolf F. Maier, Children's Hospital, University Hospital, Philipps University, Marburg, Germany.
Eduardo Muniz-Diaz, Department of Immunohematology, Blood and Tissue Bank of Catalonia, Barcelona, Spain.
Susan Nahirniak, Alberta Precision Laboratories and Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
Helen V. New, Clinical Directorate, NHS Blood and Transplant, London, UK.
Katerina Pavenski, Department of Laboratory Medicine and Pathology, Unity Health Toronto (St. Michael's Hospital), Toronto, Ontario, Canada.
Maria Cristina Dos Santos, IFF/Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Glenn Ramsey, Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Nadine Shehata, Departments of Medicine, Laboratory Medicine and Pathobiology, Institute of Health, Policy Management and Evaluation, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.

Document Type

Journal Article

Publication Date



British journal of haematology




alloimmunization; evidence-based guidelines; haemolytic disease of the newborn; intravenous immunoglobulin; pregnancy


Haemolytic disease of the newborn (HDN) can be associated with significant morbidity. Prompt treatment with intensive phototherapy (PT) and exchange transfusions (ETs) can dramatically improve outcomes. ET is invasive and associated with risks. Intravenous immunoglobulin (IVIG) may be an alternative therapy to prevent use of ET. An international panel of experts was convened to develop evidence-based recommendations regarding the effectiveness and safety of IVIG to reduce the need for ETs, improve neurocognitive outcomes, reduce bilirubin level, reduce the frequency of red blood cell (RBC) transfusions and severity of anaemia, and/or reduce duration of hospitalization for neonates with Rh or ABO-mediated HDN. We used a systematic approach to search and review the literature and then develop recommendations from published data. These recommendations conclude that IVIG should not be routinely used to treat Rh or ABO antibody-mediated HDN. In situations where hyperbilirubinaemia is severe (and ET is imminent), or when ET is not readily available, the role of IVIG is unclear. High-quality studies are urgently needed to assess the optimal use of IVIG in patients with HDN.