Hemolytic disease of the fetus and newborn due to antibodies to minor red blood cell groups: two case reports

Abstract

This study reports two cases of hemolytic disease of the fetus and newborn (HDFN) associated with antibodies to minor red blood cell (RBC) groups. Case 1 was a 35 week-gestational age (GA) female newborn, diagnosed with fetal anemia and hydrops by prenatal ultrasound. The primigravida mother had been diagnosed with beta-thalassemia/hemoglobin E disease and after being transfused, red cell alloimmunization and autoimmunization were detected during pregnancy. Antibody identification in the mother revealed anti-c, anti-E, anti-Mia and autoantibody. At birth, the patient was severely anemic and required ventilator support due to respiratory failure. Hematocrit was 15.1%. Direct and indirect antiglobulin tests (DAT and IAT) were strongly positive. Case 2 was a 36 week-GA male newborn with early onset of indirect hyperbilirubinemia and anemia. The mother had been diagnosed with systemic lupus erythematosus and transfused several times. At delivery, antibody identification revealed anti-c and anti-Mia in the mother, while DAT and IAT were positive in the newborn. Antibody identification revealed anti-c. The patient was given phototherapy. Maximum bilirubin was 16.9 mg/dL, and the lowest hematocrit was 31% on day 11.