A case report recently published in the Cureus Journal of Medical Science describes the case of a 19-year-old pregnant woman with Rh alloimmunization who was found to have a relatively uncommon Rh genotype.
Hemolytic disease of the fetus and newborn (HDFN) occurs due to mismatches between the maternal and fetal blood type or Rh factor. Many different antigens make up the Rh blood group system, several of which have been implicated in HDFN.
The patient, who lived in an underserved community in western India, presented at 28 weeks gestation for a routine prenatal check-up. She had one previous pregnancy with no complications.
Blood testing revealed that the patient was negative for the RhD antigen, though the father’s RhD status was unknown and could not be determined because of resource constraints. There were no medical records to indicate whether she had previously received anti-D immunoglobulin (RhIg), which is used to prevent HDFN in RhD-negative patients.
Read more about HDFN causes and risk factors
Further testing showed that the patient produced high levels of antibodies against the RhD antigen, suggesting significant alloimmunization. No other alloantibodies were detected.
The patient’s Rh genotype was later confirmed to be dCe/dce. This means that she lacked the RhD antigen, consistent with prior findings, but produced the RhC, Rhc and Rhe antigens. This combination, also known as the r′r phenotype, is not often seen.
Close monitoring of the fetus was recommended due to the high anti-D antibody levels. The patient was induced at 38 weeks and delivered a healthy boy who tested positive for the RhD antigen, confirming Rh incompatibility.
The mother received a dose of RhIg as a precautionary measure for future pregnancies. Both the mother and baby were discharged after three days.
“This case emphasizes the importance of structured perinatal strategies, including routine antibody screening, timely RhIg administration, multidisciplinary care, and infrastructure readiness for monitoring and intervention, especially in socioeconomically disadvantaged settings,” the authors wrote.
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