Hemolytic disease of the fetus and newborn (HDFN) can result in severe anemia and jaundice if not detected early, and a case report published recently in Transfusion Medicine underscored this importance.
This case highlighted how critical it is to monitor levels of maternal Anti-Ce antibody throughout pregnancy, the researchers stated. As the newborn in the case required multiple transfusions after an unexpected rise in levels of maternal antibody near term, the case may also suggest that expanding current monitoring guidelines could improve outcomes for babies at risk of HDFN.
A 29-year-old woman, in her third pregnancy, was found to have low levels of Anti-Ce and Anti-e antibodies at 11 weeks. Standard testing at 28 weeks showed no concerning changes, and she delivered a healthy baby girl at term. However, within days, the baby developed severe jaundice and anemia, requiring phototherapy and hospital readmission. Testing revealed a significant rise in maternal Anti-Ce antibodies from a level of 4 at 28 weeks to 32 at delivery—an eightfold increase.
“Specialist team management of all pregnancies presenting with Anti-Ce, irrespective of titre levels and previous HDFN history, may be justified due to the delayed and unexpected nature of red cell hemolysis and subsequent severe anemia displayed in this case, as may extended neonatal monitoring following delivery,” explained the authors of this case report.
Read more about testing and diagnosis of HDFN
The newborn’s condition worsened, with hemoglobin dropping to 57 g/L by day 14, necessitating a blood transfusion. A second transfusion was required two weeks later when hemoglobin fell again. Fortunately, by two months of age, hemoglobin levels stabilized, and no further treatment was needed. However, the severity of the case was unexpected given the initially low antibody levels, demonstrating the need for closer monitoring in similar pregnancies.
Why monitoring throughout pregnancy is critical to outcomes
HDFN occurs when maternal antibodies attack the baby’s red blood cells, leading to anemia and jaundice. While the most well-known antibody causing this condition is Anti-D, other antibodies, including Anti-Ce, can also lead to serious complications. Current guidelines suggest monitoring antibody levels at 28 weeks, but this case indicates that additional testing beyond that point may be necessary.
Identifying and tracking antibody levels later in pregnancy could allow earlier interventions, such as intrauterine transfusions or early delivery if needed. In this case, the delayed recognition of rising levels of Anti-Ce meant the baby required multiple transfusions after birth, prolonging hospital stays and increasing the risk of complications.
For expectant parents, this case underscores the importance of prenatal antibody screening and follow-up testing when risk factors are present. Researchers stated clinicians should consider extending antibody monitoring beyond 28 weeks for pregnancies with known antibodies to prevent severe cases of HDFN and improve newborn outcomes.
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