A recent case study has described the occurrence of hemolytic disease of the fetus and newborn (HDFN) that was associated with multiple alloantibodies, including a rare combination of anti-C and anti-Jkb. The report was recently published in the Asian Journal of Transfusion Science.
HDFN is known to be caused by the destruction of fetal red blood cells (RBCs) by maternal RBC antibodies. These antibodies attack those fetal RBCs that express paternal antigens, which is linked to the development of anemia and jaundice in the newborn, along with many possible long-term complications.
The case report describes a newborn infant who was admitted to the neonatal intensive care unit at five days of age due to anemia and severe jaundice. The baby’s hemoglobin level was 12.1 g/dL, and total bilirubin serum concentration was 30.78 mg/d, and direct antiglobulin test (DAT) was positive. The newborn was treated with phototherapy because of hyperbilirubinemia.
The baby did not exhibit an acceptable response to phototherapy, and the administration of intravenous immunoglobulin (IVIg) was initiated. The newborn’s hemoglobin levels continued to decline, with the current value reported at 7.5 g/dL. Blood testing revealed that the newborn’s blood was incompatible with the available ABO-matched blood units, thus an exchange transfusion (ET) could not be performed.
Read more about HDFN causes and risk factors
During the antenatal period, the mother did not undergo an antibody screen because she was Rhesus (Rh)-positive. Via use of the column agglutination technique (CAT), the forward blood group of the newborn was A-positive. The utilization of both forward and reverse blood grouping revealed that the mother was A-positive as well. Based on these findings, “fetomaternal incompatibility due to ABO or the Rh group” was excluded.
Upon performance of a polyspecific DAT using CAT, a 4+ reaction was detected. A monospecific DAT that used an IgG and a C3b, C3d gel card revealed an IgG4+ reaction. A mixed-field reaction was demonstrated by autocontrol, which was probably due to the administration of IVIg. The researchers suspected the presence of multiple alloantibodies, including anti-c and others.
According to the results of extended phenotyping carried out on the mother’s RBCs, the following alloantibodies were observed: C+, c–, E–, e+, K–, Fya+, Fyb–. Jka+, and Jkb–. These findings suggested the presence of anti-c and anti-Jkb (Kidd) antibodies, which were eventually accurately identified.
Upon confirmation of the suspected antibodies, the transfusion service at the hospital placed a request at the regional blood bank for ABO group–specific, c-negative, Jkb-negative packed RBC units. Compatible units were utilized in the ET, leading to a rise in the baby’s hemoglobin level to 10.4 g/dL. The child was able to be discharged home in stable condition.
“This case highlights the importance of a multidisciplinary approach from obstetricians, neonatologists, and transfusion services to diagnose and manage cases of HD[F]N due to multiple alloantibodies,” the authors explained. “[T]he importance of antenatal screening for alloantibodies cannot be undermined and shall be performed [regardless] of the Rh status of the mother,” they concluded.
