A recent case of hemolytic disease of the fetus and newborn (HDFN) linked to anti-Jkb antibodies highlights the urgent need for broader antibody screening in all pregnancies, not just those involving RhD-negative women, stated authors of a case report published recently in Cureus.
The case underscores how maternal alloimmunization, even in RhD-positive individuals, can lead to life-threatening conditions in newborns, including anemia, jaundice and even death.
The patient, who was O positive and had a history of multiple pregnancies, did not have prenatal care during the pregnancy, which was her fifth. She was admitted with premature rupture of membranes and later diagnosed with anemia. Following a cesarean section at 30 weeks, she experienced heavy bleeding and required a blood transfusion. Pre-transfusion testing revealed the presence of anti-Jkb antibodies in her blood—an uncommon but serious cause of HDFN.
“The presented case reinforces the need for a more detailed assessment regarding the risk of maternal alloimmunization and the subsequent potential development of PHD [perinatal hemolytic disease],” the authors wrote. “Previous transfusion history and prior pregnancies must be taken into account during prenatal care, as well as the development of obstetric protocols aimed at identifying the potential risk of PHD even in non-RhD-negative pregnant women.”
The newborn twins were delivered prematurely. Twin one, who weighed 1,180 grams, suffered severe perinatal asphyxia and died within 24 hours. Twin two, weighing 1,330 grams, survived but required intensive care, phototherapy, and multiple blood transfusions for anemia and jaundice. Both infants tested positive for direct antiglobulin tests, and anti-Jkb was identified in their blood, confirming maternal-fetal incompatibility as the cause of their conditions.
Read more about HDFN prognosis
Despite the established importance of the indirect antiglobulin test in detecting irregular antibodies during pregnancy, it is usually limited to RhD-negative women. This case, the authors stated, illustrates that RhD-positive women with high-risk pregnancies should also be screened, as uncommon antibodies like anti-Jkb can cause severe or even fatal outcomes. In this case, the lack of prenatal indirect antiglobulin test delayed diagnosis and intervention.
Anti-Jkb-related HDFN is typically considered mild to moderate, but this case was unusually severe. It joins a growing body of literature showing that non-anti-D antibodies can lead to significant neonatal disease. Variation in red cell antigens by ethnicity further complicates detection, reinforcing the value of universal antibody screening.
For patients, expanded screening could mean earlier detection, better preparation for transfusion needs, and a greater chance of preventing complications. While cost-effectiveness studies are still needed, the authors of this study call for more inclusive and proactive prenatal testing protocols.
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