[Active immunotherapy of habitual abortion: is the danger greater than the therapeutic gain?]

Abstract

Active immunotherapy is widely employed in the treatment of patients with habitual abortion, but it is comparable to the transfusion of blood or blood components with respect to possible complications such as undesirable immune responses and the possibility of transmitting infectious diseases. In fact, immunization with lymphocytes carries a greater risk of infection with cytomegalovirus than does transfusion of erythrocytes or platelets, a fact of particular relevance, since it represents a potential risk to the child. In addition, irregular antibodies to erythrocytes or platelets may be induced, which may have a harmful effect on both the mother and the child. The subsequent formation of autoantibodies and antibodies against cardiolipin in patients subjected to active immunotherapy has only recently been described. The significance of these and other possible immune responses is by no means clear, so that further investigation of the immunological side effects is urgently required. Active immunotherapy for habitual abortion demands strict medical indication, since the mechanism by which it protects the pregnancy has not been elucidated, and controlled studies have yielded differing results concerning therapeutic success. These factors must be taken into account when affected couples are counselled. The possible complications should be carefully weighed against the anticipated effects, since no vital indication exists in the case of habitual abortion, unlike most situations where the transfusion of blood products is contemplated.