A pregnant patient was diagnosed with hemolytic disease of the fetus and newborn ( HDFN) due to two antigen groups; however, the clinical course proceeded uneventfully after coordinated care between her doctors. This case report was recently published in Transfusion.
A 33 year-old-woman presented for a prenatal visit for her sixth pregnancy. Four of her previous five pregnancies were uneventful and resulted in healthy deliveries, but the fourth pregnancy ended in a spontaneous abortion.
During the patient’s latest pregnancy, care was afforded to ensure that she was subject to all relevant tests. The mother’s blood type was identified as anti-e and anti-Dib. Anti-e and anti-Dib are not commonly seen in pregnancies. She was referred to the maternal-fetal specialist team for further input.
The patient underwent middle cerebral artery Doppler ultrasonography at 2-week intervals from 18 weeks of gestation onwards. Fortunately, repeated measurements indicated that there was a low likelihood of fetal anemia.
Read more about HDFN testing and diagnosis
Because a suitable donor, who must be of the O blood group and be negative for both anti-e and anti-Dib, could not be found, the patient’s doctors suggested an autologous blood donation: a procedure in which a patient’s own blood is extracted only to be returned at a later date. This proceeded uneventfully. Her doctors later scheduled blood donation at 22, 28 and 36 weeks’ gestation.
A healthy male child was born via vaginal delivery. The child had normal hemoglobin levels upon delivery and no obvious signs of jaundice. A closer inspection revealed mild jaundice but no treatment was required.
“Antibodies to high prevalence blood group antigens are rarely encountered in obstetric practice, but they can be significant and will always require a coordinated clinical approach,” the authors of the study wrote. “Obstetricians, neonatologists, and transfusion medicine specialists will serve their patients best when they work together in cases of maternal alloimmunization, especially when high prevalence blood group antibodies are involved.”
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