Purpose of investigation: This report describes successful treatment, using invasive and noninvasive techniques, of a 36-year-old woman (gravida 10, para 0) referred to our center at 13 weeks' gestation for severe Rhalloimmunization. Pre-pregnancy indirect Coombs titers ranged from 1: 1024-2048. All nine past pregnancies (conceived with three different partners) had ended in abortion, intrauterine death or neonatal death Methods: The patient was treated with a single session of plasmapheresis (week 14) immediately followed by five days of immu­noglobulin therapy and immunosuppressive therapy based on azathioprine and prednisone (weeks 15-22). Seven fetal transfusions (one intraperitoneal, six intravascular) were performed beginning at 16 weeks Results: The pregnancy, which was characterized by insulin-dependent gestational diabetes, spontaneously resolving polyhy­dramnios and peak indirect Coombs titers of 1 :65536, ended at 27 weeks with cesarean section delivery of a viable female weighing 1,000 g. In spite of numerous neonatal complications, the child is physically well at age 3, with normal intellectual and psycho­motor development. Conclusion: In light of the negative outcomes of the patient's nine past pregnancies, our experience suggests that the early im­tiation of an integrated approach based on noninvasive and invasive techniques can play a potentially decisive role in the manage­ment of severe Rh-alloimmunization.