A 51-year-old woman who conceived through egg donation via in vitro fertilization (IVF) was diagnosed with hemolytic disease of the fetus and newborn (HDFN), according to a case report recently published in Transfusion and Apheresis Science.
The report describes a 51-year-old woman who underwent tubal ligation 25 years ago. In 2019, she received a donor egg via in vitro fertilization but failed to conceive. In 2021, she successfully became pregnant and delivered a healthy boy.
In 2023, she became pregnant again with the implantation of a frozen embryo. At 15 weeks of gestation, the patient tested positive for alloantibodies, which were subsequently identified as anti-Ce and anti-Jka. At 29 weeks of gestation, the patient was admitted to the hospital due to placenta previa, which occurs when the placenta covers the opening to the cervix, and velamentous placenta, which occurs when the umbilical cord inserts into the fetal membranes instead of the placenta. There was no evidence of destruction of red blood cells in the fetus.
At 34 weeks’ gestation, the patient showed signs of premature labor. This prompted her treating obstetrician to perform an emergency cesarean section, with blood prepared in case of postpartum bleeding. However, due to the rarity of the blood type she needed, the hospital was unable to provide sufficient red blood cells should she suffer from a massive hemorrhage.
Read more about HDFN testing and diagnosis
Fortunately, the Shanghai Blood Center had the red blood cells required, which was administered after the patient underwent a postpartum hemorrhage of approximately 1200 mL.
The newborn female was diagnosed with Rhesus HDFN and respiratory distress syndrome after birth. She received care at the Shanghai Children’s Hospital. Her care included respiratory support, alongside phototherapy and intravenous immunoglobulins. The child recovered well and was discharged two weeks later.
Women who have given birth multiple times and are donor ovum or egg recipients are at a higher risk of alloimmunization and HDFN. As such, they require close monitoring and support during pregnancy.
“For multiparous women with complex alloantibodies and [donor ovum] recipients, early identification and regular monitoring of alloantibodies, along with awareness of [donor ovum] status, can help predict the HDFN risk and prepare for potential transfusions for both the mother and the newborn,” the authors of the report wrote.
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