The presence of multiple Rhesus (Rh) antibodies causing hemolytic disease of the fetus and newborn (HDFN) may lead to a more severe disease state, according to findings from a case study recently published in Case Reports in Pediatrics.
Although the most common cause of HDFN is the anti-D antibody, several other antigens have been known to cause the disease. This case study describes a mother with both anti-C and anti-D antibodies who delivered male twins via Cesarean section at 31 weeks. One of the infants was born with severe complications requiring resuscitation at birth, and later developed hepatic failure and hyperbilirubinemia, also known as jaundice.
Upon delivery, this infant required intubation and chest compressions due to respiratory distress, slow heart rate, poor tone, and pallor. Upon examination, he was found to have an enlarged liver and displayed signs of disseminated intravascular coagulation, a condition that leads to excessive blood clotting.
The patient was also born with low hemoglobin levels and received four packed red blood cell transfusions during his admission due to persistent hemolysis.
Read more about HDFN causes and risk factors
To treat the patient’s hyperbilirubinemia, he was prescribed ursodiol for one month, along with phototherapy for 15 days. Although his liver remained enlarged throughout his hospital stay, the patient’s liver function recovered with treatment. At a follow-up appointment, the patient had stained teeth as a result of the hyperbilirubinemia. Excess bilirubin pigment in the blood can stain the teeth and other tissues in patients with the condition.
An ultrasound and follow-up MRI revealed the presence of a germinal matrix hemorrhage, a type of brain hemorrhage sometimes seen in premature infants. However, the patient did not display signs of long-term damage to the brain at the time of publication.
The patient’s twin had a much more mild disease course. He required only one packed red blood cell transfusion and also received phototherapy for hyperbilirubinemia. Neither child showed any delays or signs of bilirubin-induced neurologic dysfunction at 18 months of corrected age.
The authors emphasize that it remains unclear whether the coexistence of multiple Rh antibodies leads to a more severe case of HDFN. However, anti-C antibodies generally cause a more severe case, highlighting the need for early intervention.
“This case highlights the importance of early testing for isoimmunization, understanding which Rh antigens can trigger more severe isoimmunization, close monitoring of fetal hemoglobin levels, and prompt management to prevent long-term sequelae,” the authors wrote.
