According to a recently published study in Transfusion Medicine, a young woman with an RhD-positive blood type who tested negative for the RhCE protein developed anti-Rh antibodies after a blood transfusion, which resulted in hemolytic disease of the fetus and newborn (HDFN) in subsequent pregnancies.
Most cases of HDFN occur after pregnancies in which the mother does not have a protein called Rh antigen in the membrane of their red blood cells, but the fetus does. During birth, the red blood cells enter the mother’s bloodstream, causing the maternal immune system to recognize the Rh antigen as a foreign substance that must be eliminated and develop antibodies against it. In a subsequent pregnancy, these antibodies cross the placental barrier and destroy fetal red blood cells, causing HDFN.
Two genes are responsible for coding for Rh antigens, namely the RHD and RHCE genes. Some people don’t have the RHD gene and are Rh-negative; however, almost everybody has the RHCE gene.
Read more about HDFN treatment and care
The described case involved a 23-year-old woman with the rare condition of being RHD positive and RHCE negative who had previously undergone a blood transfusion as a toddler. As the patient was Rh-positive, she received Rh-positive blood, which caused her to develop antibodies against the RHCE protein.
“The adverse outcomes could have been prevented by active prenatal management,” the authors wrote.
The patient came from a rural community with no access to specialized centers with advanced diagnostic tools, and the woman was, unfortunately, poorly educated and malnourished.
The patient had a history of recurrent fetal losses in the past. However, the cause was not deciphered during those first pregnancies. Dqespite recommendations of planned pregnancy with a large interval during pregnancies, the patients suffered three more losses in the following years.
“Maternal alloimmunization with anti-Rh17 is extremely challenging for management. However, evidence exists that appropriate prenatal care and management of HDFN can result in a positive outcome in such patients,” the authors concluded.
