A 28-year-old pregnant woman with a history of multiple pregnancy losses successfully delivered a healthy baby at 36 weeks after receiving three intrauterine transfusions to treat severe fetal anemia caused by hemolytic disease of the fetus and newborn (HDFN), according to a recent case report published in the Asian Journal of Transfusion Science.
This case highlighted the importance of early diagnosis, advanced transfusion medicine and coordinated medical care in managing this condition. The patient was referred to a specialized center at 24 weeks after finding a compatible blood unit for her second intrauterine transfusions became difficult.
A detailed immunohematology workup identified three maternal antibodies—anti-D, anti-C, and anti-s—complicating the search for compatible blood. The mother’s immune system had developed these antibodies over multiple pregnancies, making her fetus vulnerable to HDFN. She ultimately received O RhD-negative, C-negative, and s-negative red blood cells for her transfusions at 24, 29 and 33 weeks.
“Patients should be counseled and educated about the significance of alloimmunization and provided with comprehensive IH [immunohematology] details in the reports for future transfusions or pregnancies,” the authors stated.
Read more about HDFN treatment and care
HDFN occurs when maternal antibodies cross the placenta and attack fetal red blood cells, leading to anemia, jaundice, and in severe cases, hydrops fetalis—a condition marked by life-threatening fluid buildup in the baby’s body. In this case, routine fetal monitoring at 20 weeks detected significant anemia using Doppler ultrasound, which measured the baby’s middle cerebral artery peak systolic velocity. Without intervention, the baby faced a high risk of stillbirth or severe complications.
The mother’s condition stemmed from inadequate Rh immune prophylaxis in previous pregnancies, leading to the development of multiple antibodies. While anti-D prophylaxis has significantly reduced Rh-related HDFN, non-Rh antibodies such as anti-C and anti-s remained serious risks. Finding antigen-negative blood for transfusions is essential in such cases, highlighting the need for expanded blood antigen typing and close monitoring in high-risk pregnancies.
After a planned cesarean section at 36 weeks, the newborn developed jaundice, a common complication of HDFN, but recovered with phototherapy. The baby was discharged after a two-week hospital stay, and the mother remained stable. Postnatal care included additional bloodwork and antibody screening to prevent further complications.
This case demonstrated the critical role of specialized transfusion medicine in managing HDFN. Early detection, close fetal monitoring, and access to antigen-matched blood can significantly improve outcomes for affected pregnancies.
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