A case report published in Neonatal Medicine shows a combination of intensive treatment with ultraviolet light (phototherapy) and injected human antibodies (immunoglobulin) could be a valid treatment strategy for infants born with hemolytic disease of the fetus and newborn (HDFN) caused by minor blood group incompatibility.
HDFN is caused by maternal antibodies that travel through the placenta and target antigens—specific proteins present in the membrane of fetal blood cells. There are various types of antigens in the red blood cell membrane, and they can be broadly classified into three types: ABO antigens, Rh antigens and minor blood antigens.
Most cases of HDFN are caused by anti-Rh antibodies, and a small minority are caused by antibodies against minor blood antigens such as C, E, c, e, Kelly and Duffy. The symptoms caused by minor blood group incompatibility can vary from nonexistent to extremely severe, depending on the involved antigen.
Combined C and E incompatibility is extremely rare, and the effectiveness of conventional treatment has not been fully established.
Read more about HDFN causes
The study involved a female infant who presented with jaundice due to red blood cell destruction shortly after birth. In this case, the mother did not undergo antibody screening to rule out HDFN during the pregnancy. Testing after birth revealed C and e antigen incompatibility.
Despite undergoing phototherapy on the third day of life, the infant was anemic, and bilirubin levels, a product of red blood cell destruction, kept rising, which led to her admission to the pediatric intensive care unit (ICU). After three hours of intensive phototherapy in the ICU, bilirubin levels decreased significantly. The administration of intravenous immunoglobulin further improved bilirubin levels.
Five days after ICU admission, bilirubin levels were almost within normal range, and the patient was no longer anemic. The medical team considered the patient to be well enough to be discharged. Controls performed during the six months following discharge were all positive.
“In conclusion, through phototherapy, neonates with HDFN caused by rare minor blood incompatibility due to anti-C and anti-e antibodies could avoid hyperbilirubinemia,” the authors wrote.
