DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20194755

Hemolytic disease of newborn caused by multiple Rh antibodies

Suman Sudha Routray, Rachita Behera, Jagdish Prasad Sahoo, Devi Prasad Acharya, Bibudhendu Pati

Abstract


Hemolytic disease of Fetus and Newborn (HDFN) usually results due to natural occurring antibodies or alloimmunization in mother but the presence of multiple red cell antibodies increases the risk of development of significant HDFN. Here author reported a case of hemolytic disease of fetus and newborn in a preterm baby caused by multiple maternal antibodies. Direct Antiglobulin Test (DAT) on neonate blood sample was positive (3+) with monospecific DAT showed IgG type which was confirmed by heat elution. Antibody identification of eluate was done using commercial 11-cell panel by gel method showing specificity to anti-D and anti-C antibody which was differentiated from anti-G by sequential adsorption and elution studies. Neonate was treated with double volume exchange transfusion (DVET) using leucoreduced, irradiated O Rh D and C negative PRBC suspended in AB plasma and discharged 6th day in a stable condition. So, all pregnant women should be at least advised for ICT irrespective of Rh D negative status. If ICT is positive, they should be referred to higher center for proper Immunohematological work up, so that proper blood unit for DVET could be identified.


Keywords


Alloimmunization, Anti-C, Anti-D, Antibody identification, Heat Elution, Sequential adsorption

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References


Robert Resnik Robert Creasy Jay Iams Charles Lockwood Thomas Moore Michael Greene. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice 7th Ed.; 2013:558-568.

Markham KB, Rossi KQ, Nagaraja HN, O’Shaughnessy RW. Hemolytic disease of the fetus and newborn due to multiple maternal antibodies. Am J Obstet Gynecol. 2015 Jul 1;213(1):68-e1.

Basu S, Kaur R, Kaur G. Hemolytic disease of the fetus and newborn: Current trends and perspectives. As J Trans Sci. 2011 Jan;5(1):3-7.

Negi G, Singh GD. Anti Rh hemolytic disease due to anti C antibody: is testing for anti D antibodies enough?. Ind J Hematol Blood Trans. 2012 Jun 1;28(2):121-2.

Sheeladevi CS, Suchitha S, Manjunath GV, Murthy S. Hemolytic disease of the newborn due to anti-c isoimmunization: a case report. Indian Journal of Hematology and Blood Transfusion. 2013 Sep 1;29(3):155-7.

Filbey D, Hanson U, Wesström G. The prevalence of red cell antibodies in pregnancy correlated to the outcome of the newborn: a 12 year study in central Sweden. Acta obstetricia et Gynecolog Scandinavica. 1995 Sep;74(9):687-92.

Nordvall M, Dziegiel M, Hegaard HK, Bidstrup M, Jonsbo F, Christensen B, et al. Red blood cell antibodies in pregnancy and their clinical consequences: synergistic effects of multiple specificities. Transfusion. 2009 Oct;49(10):2070-5.

Das S, Shastry S, Murugesan M, Baliga P. What is it really? Anti-G or anti-D plus anti-C: Clinical significance in antenatal mothers. Ind J Hematol Blood Trans. 2017 Jun 1;33(2):259-63.

Howard H, Martlew V, McFadyen I, Clarke C, Duguid J, Bromilow I, et al. Consequences for fetus and neonate of maternal red cell allo-immunisation. Archives of Disease in Childhood-Fetal and Neonatal Edition. 1998 Jan 1;78(1):F62-6.

Yousuf R, Mustafa AN, Ho SL, Tang YL, Leong CF. Anti-G with concomitant anti-C and anti-D: A case report in a pregnant woman. Asian J Transfusion Science. 2017 Jan;11(1):62-4.

Shirey RS, Mirabella DC, Lumadue JA, Ness PM. Differentiation of anti‐D,‐C, and‐G: clinical relevance in alloimmunized pregnancies. Transfusion. 1997 May;37(5):493-6.

Huber AR, Leonard GT, Driggers RW, Learn SB, Gilstad CW. Case report: moderate hemolytic disease of the newborn due to anti-G. Immunohematology-Washington DC. 2006 Jan 1;22(4):166-70.

Makroo RN, Kaul A, Bhatia A, Agrawal S, Singh C, Karna P. Anti-G antibody in alloimmunized pregnant women: Report of two cases. Asi J Transfusion Science. 2015 Jul;9(2):210-2.