The Allo Podcast

When Kayla discovered anti-Kell antibodies at just 12 weeks, a sky-high titer and a terrifying 1.64 MCA score at 15 weeks sent her and her husband on a same-day flight from Pennsylvania to Austin, Texas for an emergency intraperitoneal transfusion—the first of nine lifesaving IUTs that would turn them into frequent flyers and the Dell Children’s fetal team into family. Kayla’s story is a powerful reminder that when the stakes are your child’s life, you do whatever it takes—and that knowledge, advocacy, and the right medical team really do save babies.

Show themes: 

• Anti-K alloimmunized pregnancy
• High-titer alloimmunized pregnancy
• Long-distance travel for specialty care 
• Intrauterine transfusion
• Phenobarbital (for the mother prior to delivery)
• Darbepoetin (in the newborn with HDFN)
• Severe HDFN survival

Watch this episode on YouTube

View all of our resources at www.allohopefoundation.org

If you are an alloimmunized mother from any country, you are welcome in our Facebook support group called “Antibodies in Pregnancy: An AHF Support Group. Join here. https://www.facebook.com/groups/antibodiesinpregnancy

Please consider donating to AHF. If you are a listener, you know we do a lot with a little. Not sure how much will make a difference? An antibody screen in Kenya costs $13 USD. A dose of RhIG for a mother who cannot afford it is $80 USD. Click Here to make a one-time or recurring donation.

References in this episode: 

Neonatal best practices document that Kayla used in the NICU: Read here.

Phenobarbital before delivery to help mature fetal liver: Trevett Jr TN, Dorman K, Lamvu G, Moise Jr KJ. Antenatal maternal administration of phenobarbital for the prevention of exchange transfusion in neonates with hemolytic disease of the fetus and newborn. American journal of obstetrics and gynecology. 2005 Feb 1;192(2):478-82. Read here.

Use of erythropoietin or darbepoetin to reduce the number of top-up transfusions in babies with HDFN and a history of IUT: Ree IM, de Haas M, van Geloven N, Juul SE, de Winter D, Verweij EJ, Oepkes D, van der Bom JG, Lopriore E. Darbepoetin alfa to reduce transfusion episodes in infants with haemolytic disease of the fetus and newborn who are treated with intrauterine transfusions in the Netherlands: an open-label, single-centre, phase 2, randomised, controlled trial. The Lancet Haematology. 2023 Dec 1;10(12):e976-84. 

Read Here

Bethany and Molly kick off Season 4 with a dive into the weirdest corners of HDFN — from mind-blowing bizarre facts (like babies born with 100% donor blood and drones parachuting blood bags in Africa) to rare case studies featuring anti-Kell + anti-D, the ultra-rare anti-KU and anti-PP1P˩K antibodies, and a mystery about false-positive newborn screens that still has experts stumped.

Watch this episode on YouTube 

Do you have any ideas about why some infants who have received IUTs test (falsely) positive for certain metabolic syndromes in their newborn screens? E-mail us at [email protected]

View all of our resources at www.allohopefoundation.org

If you are an alloimmunized mother from any country, you are welcome in our Facebook support group called “Antibodies in Pregnancy: An AHF Support Group. Join here. https://www.facebook.com/groups/antibodiesinpregnancy

Please consider donating to AHF. If you are a listener, you know we do a lot with a little. Not sure how much will make a difference? An antibody screen in Kenya costs $13 USD. A dose of RhIG for a mother who cannot afford it is $80 USD. Click here to make a one-time or recurring donation.

References in this episode: 

Read more about the “grandmother effect” here where a female fetus can become exposed to her mother’s Rh(D) positive blood in utero, priming her for Anti-D sensitization: here.

Gender as a risk factor for developing neutropenia in HDFN: Alkhani A, Arefi A, AlTayeb M, Naaz S, Alghanbar J, Alhuthil R, Alrowaily F, Almidani E. Incidence and risk factors of neutropenia in neonates with hemolytic disease of the newborn. International Journal of Pediatrics and Adolescent Medicine. 2024 Sep 1;11(3):83-7. Available here.; Blanco E, Johnston DL. Neutropenia in infants with hemolytic disease of the newborn. Pediatric blood & cancer. 2012 Jun;58(6):950-2. Available here.

Read about drone delivery of blood in Rwanda: here.

Anti-PP1PK literature review and case presentations: Di Ciaccio P, Cutts B, Alahakoon TI, Dennington PM, Soo LA, Curnow J. Clinical consequences of the extremely rare anti‐PP1Pk isoantibodies in pregnancy: a case series and review of the literature. Vox Sanguinis. 2021 May;116(5):591-600. 

Available here.

New Episodes of the Allo Podcast coming to a podcast platform near you 1-27-25.

Bethany and Molly close out Amanda’s incredible survival story that began in Episode 2 of this season (Low Titer Pregnancies). After a rapid increase in titers from too low to titer to 2,048, Amanda’s referral to an MFM team went unnoticed for a few weeks. By the time she was seen, her son was very sick, but he was in the right hands with Dr. Snowise and his team. Listen to this miraculous story unfold. 

Then, Bethany and Molly reflect on AHF’s accomplishments and goals for the year and close with a powerful reflection that will touch the hearts of every listener, ending with a special dedication. 

References in this episode: 

Nipocalimab trial results: Nipocalimab

Use of cffDNA to find fetal antigen status for D, E, C, c, K, Fya: Fetal Antigen Study

ESAs for newborns with HDFN to reduce the number of transfusions: Transfusion Reduction

Donate to AHF: Allo Hope Donate

AHF Merch: Allo Hope Merch

Watch this episode on YouTube: Allo Hope on YouTube

Join the AHF patient support group: 

AHF Support Facebook

Bethany, Katie and Molly talk together about how their parenting is affected during and after the life-changing experience of an alloimmunized pregnancy.

Donate to AHF: Allo Hope Donate

AHF Merch: Allo Hope Merch

Watch this episode on YouTube: Allo Hope on YouTube

Join the AHF patient support group: 

AHF Support Facebook

Bethany and Molly interview Dr. Timothy Bahr, a neonatologist with a specialty in neonatal hematology about all of your HDFN questions for newborns. Dr. Bahr patiently answers many of the common challenges and questions in neonatal HDFN care. This is an advanced discussion of neonatal HDFN. For a primer describing disease presentation, visit our neonatal episode in Season 1.

Questions answered in this episode:

What does it entail to prepare blood for a neonatal exchange transfusion?

When and how do you use erythropoietin/darbepoetin (ESAs)?

When does an HDFN baby need to be referred to hematology after discharge?

Heel prick versus blood draw from a vein, does it matter?

Is it ok to do transcutaneous bilirubin readings (with a small device on the skin instead of blood draw)?

When is a baby cleared from HDFN?

Why can’t we have the same neonatologist throughout a baby’s NICU stay?

How can a mother politely insist on regular laboratory testing for their newborn with HDFN?

How can a mother explain to the team at birth that it’s very important to get an immediate bilirubin check at birth (through cord or placenta if possible)?

What’s the difference between neonatal and pediatric hematologist?

Publications mentioned in this episode: 

Delayed cord clamping in alloimmunization: https://www.sciencedirect.com/science/article/abs/pii/S2589933323003075

Iron overload in HDFN: https://scholarlypublications.universiteitleiden.nl/access/item%3A2881417/download#page=194

Systematic review on IVIG in the neonate for HDFN: https://fn.bmj.com/content/99/4/F325.short

Leiberman et al on IVIG in the neonate for HDFN: https://onlinelibrary.wiley.com/doi/pdf/10.1111/bjh.18170

Darbepoetin to reduce the need for neonatal transfusion:  https://cdn.clinicaltrials.gov/large-docs/26/NCT03104426/Prot_000.pdf

Publications by Dr. Tim Bahr: https://pubmed.ncbi.nlm.nih.gov/?term=Bahr_TM

Publications by Tim’s mentor, Dr. Robert (Bob) Christensen: https://pubmed.ncbi.nlm.nih.gov/?term=Christensen_RD

Donate to AHF: Allo Hope Donate

AHF Merch: Allo Hope Merch

Watch this episode on YouTube: Allo Hope on YouTube

Join the AHF patient support group: AHF Support Facebook

Bethany and Molly interview Dr. Timothy Bahr, a neonatologist with a specialty in neonatal hematology about all of your HDFN questions for newborns. Dr. Bahr patiently answers many of the common challenges and questions in neonatal HDFN care. This is an advanced discussion of neonatal HDFN. For a primer describing disease presentation, visit our neonatal episode in Season 1.

Questions answered in this episode:

What is this research you’re doing on measuring hemolysis in a fetus from the mother’s breath?

Can you still have delayed cord clamping in alloimmunized pregnancies? 

Can I hold my baby for a few minutes before they are taken to the NICU?

Why are HDFN babies offered iron so often?

How quickly does a baby’s bilirubin level improve (go down) after an exchange transfusion?

What is your opinion on using IVIG on the neonate for HDFN, and when would you do it?

Publications mentioned in this episode: 

Delayed cord clamping in alloimmunization: https://www.sciencedirect.com/science/article/abs/pii/S2589933323003075

Iron overload in HDFN: https://scholarlypublications.universiteitleiden.nl/access/item%3A2881417/download#page=194

Systematic review on IVIG in the neonate for HDFN: https://fn.bmj.com/content/99/4/F325.short

Leiberman et al on IVIG in the neonate for HDFN: https://onlinelibrary.wiley.com/doi/pdf/10.1111/bjh.18170

Darbepoetin to reduce the need for neonatal transfusion:  https://cdn.clinicaltrials.gov/large-docs/26/NCT03104426/Prot_000.pdf

Publications by Dr. Tim Bahr: https://pubmed.ncbi.nlm.nih.gov/?term=Bahr_TM

Publications by Tim’s mentor, Dr. Robert (Bob) Christensen: https://pubmed.ncbi.nlm.nih.gov/?term=Christensen_RD

Donate to AHF: Allo Hope Donate

AHF Merch: Allo Hope Merch

Watch this episode on YouTube: Allo Hope on YouTube

Join the AHF patient support group: 

AHF Support Facebook

Bethany and Molly build on last season’s discussion of grief to expand to anxiety, stress, depression and PTSD during and after the experience of a high risk pregnancy. They talk through how these challenges present themselves, how they feel to an alloimmunized mother, and specific coping mechanisms. The close with a positive segment called “what’s in the bag”, where moms submitted lists of items that they packed for their delivery, IUT, and NICU visits.

Mental health burden in alloimmunized pregnancy: https://www.ajog.org/article/S0002-9378(23)01145-6/pdf

Donate to AHF: Allo Hope Donate

AHF Merch: Allo Hope Merch

Watch this episode on YouTube: Allo Hope YouTube

Join the AHF patient support group: 

AHF Support Facebook

Bethany, Molly and Katie talk through all aspects of Rh Immune Globulin (RhOGAM, WinRho, RhIG). They cover the history, how it’s made, its safety profile, understanding the RhIG shortage, and public health controversy. The women provide information for Rh negative women who are deciding whether or not to accept the RhIG injection for a pregnancy. 

Do you live in the U.S. and have Anti-D antibodies? You could be paid more than $100 per plasma donation (up to twice a week) with reimbursement for travel to a donation center. E-mail us at [email protected] and Bethany, Katie or Molly will respond to confirm your potential eligibility and refer you directly to our personal contact at Kedrion. 

Learn about Kedrion, the manufacturer of RhoGAM: https://www.kedrion.com/therapies/

RhoGAM website: https://www.rhogam.com/

Donate to AHF: Allo Hope Donate

AHF Merch: Allo Hope Merch

Watch this episode on YouTube: Allo Hope on YouTube

Join the AHF patient support group: 

AHF Support Facebook

Bethany, Molly and Katie talk through differences in HDFN care continent by continent. They review country-specific research, practice patterns, and patient stories. 

Donate to AHF: Allo Hope Donate

AHF Merch: Allo Hope Merch

Watch this episode on YouTube: Allo Hope on YouTube

Join the AHF patient support group: AHF Support Facebook

Cross-matching for Kell in Netherlands: Luken JS, Folman CC, Lukens MV, Meekers JH, Ligthart PC, Schonewille H, Zwaginga JJ, Janssen MP, van Der Schoot CE, van der Bom JG, de Haas M. Reduction of anti‐K‐mediated hemolytic disease of newborns after the introduction of a matched transfusion policy: a nation‐wide policy change evaluation study in the Netherlands. Transfusion. 2021 Mar;61(3):713-21. 

Iceland study: Gudlaugsson B, Hjartardottir H, Svansdottir G, Gudmundsdottir G, Kjartansson S, Jonsson T, Gudmundsson S, Halldorsdottir AM. Rhesus D alloimmunization in pregnancy from 1996 to 2015 in Iceland: A nation‐wide population study prior to routine antenatal anti‐D prophylaxis. Transfusion. 2020 Jan;60(1):175-83. 

South Korea study: Yang EJ, Shin KH, Song D, Lee SM, Kim IS, Kim HH, Lee HJ. Prevalence of unexpected antibodies in pregnant Korean women and neonatal outcomes. The Korean Journal of Blood Transfusion. 2019 Apr 30;30(1):23-32. 

Saudi Arabia study: Alkhaibary A, Ali M, Tulbah M, Al-Nemer M, Khan RM, Al Mugbel M, Al Sahan N, Hassounah MM, Alshammari W, Kurdi WI. Complications of intravascular intrauterine transfusion for Rh alloimmunization. Annals of Saudi Medicine. 2021 Nov;41(6):313-7.

Iran study: Niroomanesh S, Dadgar S, Shirazi M, Sharbaf FR, Golshahi F. Neonatal outcomes of Rh alloimmunization pregnancy treated with intrauterine transfusion. Med. Sci.. 2020;24(101):57-65.

Japan study: Mizuuchi M, Murotsuki J, Ishii K, Yamamoto R, Sasahara J, Wada S, Takahashi Y, Nakata M, Murakoshi T, Sago H. Nationwide survey of intrauterine blood transfusion for fetal anemia in Japan. Journal of Obstetrics and Gynaecology Research. 2021 Jun;47(6):2076-81.

Canada study: Jackson ME, Baker JM. Hemolytic disease of the fetus and newborn: historical and current state. Clinics in Laboratory Medicine. 2021 Mar 1;41(1):133-51.

Brazil study: Pares DB, Pacheco GH, Lobo GA, Araujo Júnior E. Intrauterine Transfusion for Rhesus Alloimmunization: A Historical Retrospective Cohort from A Single Reference Center in Brazil. Journal of Clinical Medicine. 2024 Feb 28;13(5):1362.