Cord Blood Hemoglobin Research Articles

Impact of maternal anemia on neonatal outcomes

Impact of maternal anemia on neonatal outcomes

Cord Blood Hemoglobin Levels in Full Term Neonates of Mothers with Iron Deficiency Anemia

Abstract Background Iron is a critical micronutrient for tissue oxygenation, cellular metabolism, energy generation, and the metabolism of toxins. Iron transfer from mother to fetus is a regulated process involving iron status in the maternal circulation, its transport across the placenta and subsequent transfer into the fetal circulation. Objective To evaluate cord blood Hemoglobin (Hb) levels in neonates of mothers with iron deficiency anemia (IDA). Patients and Methods This prospective case-control study was conducted at Ain Shams University Hospitals. It included 60 full terms newborn who were born at Obstetrics and Gynecology Hospital. The study population included full term neonates delivered at ≥ completed 37 weeks of gestation which was divided into two groups according to maternal risk factor: Case: full term neonates with maternal risk factor. Control: full term neonates without maternal risk factor. Thorough clinical examination and investigations were performed including cord blood samples collected for measurement of the level of complete blood count (CBC; (Hb, MCV and MCH). For the mothers, venous blood samples were withdrawn with standard precautions and strict sterile conditions for CBC, transferrin saturation and serum ferritin. Results In comparison between cases and controls as regard RBCS parameter, there was no significant difference between cases and controls regarding neonatal hemoglobin( 14.93±1.14 vs 15.44 ±1.35(g/dL), p = 0.12) and MCH (32.51±2.9 vs33.57 ±1.9 (pg), p = 0.10), but there was significantly lower MCV in cases compared to controls (104.07± 7.36 vs 109.60±4.93 (fL), p = 0.001). There was no significant difference between cases and controls as regard maternal clinical characteristics including (age, weight, height, maternal diseases, gravidity, consanguinity and mode of delivery, p > 0.05 for all). Also, there was no significant difference between cases and controls regarding neonatal weight, Z score for weight, length (cm), head circumference (cm) and gestational age by Ballord Score and Apgar Score in 1-minute and 5-minute score p > 0.05 for all). Conclusion There was no relation between the maternal Hb deficient levels and neonatal Hb. The first sign of iron deficiency in neonates reflected in lower MCV in cases, but not reached to decrease Hb levels in neonates.

Umbilical Cord Blood Hemoglobin as a Predictor of Significant Neonatal Hyperbilirubinemia in Term Newborns in a Tertiary Care Centre in North Kerala

Aims: Neonatal hyperbilirubinemia is one of the most common problems during first week of life and is the most common cause of readmission in early neonatal period. The present study aimed to predict the development of significant hyperbilirubinemia in term neonates using cord blood hemoglobin.
 Study Design: Prospective study.
 Place and Duration of Study: Department of Paediatrics, MMCH & RC, Kozhikode, Kerala from March 2021 to July 2022.
 Methodology: The prospective study enrolled 162 appropriate for gestational age term newborns, delivered at MMCH & RC. Cord blood hemoglobin was measured and bilirubin estimation was done at 48-72 hours of life. Hyperbilirubinemia was considered significant if serum bilirubin value was above standard as per American Academy of Pediatrics guidelines. Data was entered in Microsoft Excel and analysed using SPSS 20.0 version. The relationship between cord hemoglobin in predicting significant neonatal hyperbilirubinemia was studied using appropriate statistical tests. Sensitivity and specificity of the variables were defined using ROC curve and Pearson correlation coefficient to determine the correlation between the variables.
 Results: Out of the total 162 neonates enrolled, 86 were boys (53.1%) and 76 were girls (46.9%). The mean cord hemoglobin value was 15.3g/dl. 20 neonates (12.3%) had developed significant hyperbilirubinemia and required phototherapy while none of them needed exchange transfusion. Correlation between cord hemoglobin with serum bilirubin showed weak correlation (r=0.194) but the correlation was statistically significant (p<0.05). On ROC curve analysis, cord hemoglobin cut off value ≥14.9g/dl showed 75% sensitivity and 39.4% specificity to predict significant neonatal hyperbilirubinemia.
 Conclusion: There is significant correlation between umbilical cord blood hemoglobin level and neonatal hyperbilirubinemia. Cord hemoglobin ≥14.9g/dl can predict future development of significant neonatal hyperbilirubinemia. This will be useful in very low resource centres to plan early discharge of newborns without fear of hyperbilirubinemia.

Maternal Serum Ferritin Levels and its effect on Cord Blood Hemoglobin in patients with Gestational Diabetes Mellitus

Maternal Serum Ferritin Levels and its effect on Cord Blood Hemoglobin in patients with Gestational Diabetes Mellitus

Cord Blood Hemoglobin Levels in Full Term Neonates of Mothers with Iron Deficiency Anemia

Cord Blood Hemoglobin Levels in Full Term Neonates of Mothers with Iron Deficiency Anemia

Vascular Disorders of Pregnancy Increase Susceptibility to Neonatal Pulmonary Hypertension in High-Altitude Populations.

Preeclampsia and fetal growth restriction increase cardiopulmonary disease risk for affected offspring and occur more frequently at high-altitude (≥2500 m). Retrospective studies indicate that birth to a preeclampsia woman at high altitude increases the risk of pulmonary hypertension (PH) in later life. This prospective study asked whether preeclampsia with or without fetal growth restriction exaggerated fetal hypoxia and impaired angiogenesis in the fetal lung, leading to neonatal cardiopulmonary circulation abnormalities and neonatal or infantile PH. We studied 79 maternal-infant pairs (39 preeclampsia, 40 controls) in Bolivia (3600-4100 m). Cord blood erythropoietin, hemoglobin, and umbilical artery and venous blood gases were measured as indices of fetal hypoxia. Maternal and cord plasma levels of angiogenic (VEGF [vascular endothelial growth factor]) and antiangiogenic (sFlt1 [soluble fms-like tyrosine kinase]) factors were determined. Postnatal echocardiography (1 week and 6-9 months) assessed pulmonary hemodynamics and PH. Preeclampsia augmented fetal hypoxia and increased the risk of PH in the neonate but not later in infancy. Pulmonary abnormalities were confined to preeclampsia cases with fetal growth restriction. Maternal and fetal plasma sFlt1 levels were higher in preeclampsia than controls and positively associated with PH. The effect of preeclampsia with fetal growth restriction to increase fetal hypoxia and sFlt1 levels may impede normal development of the pulmonary circulation at high altitude, leading to adverse neonatal pulmonary vascular outcomes. Our observations highlight important temporal windows for the prevention of pulmonary vascular disease among babies born to highland residents or those with exaggerated hypoxia in utero or newborn life.

Maternal iron stores and its association with newborn iron dynamics and outcomes

Objectives: In pregnant women in developing nations iron deficiency anemia is common. The motherfetus homeostasis may be adversely affected by the demands in pregnancy. This can lead to adverse fetomaternal outcomes like intrauterine growth retardation ,premature delivery, and neonatal and perinatal death. Therefore it is important to understand the relation between maternal and fetal iron handling as this may help in further implementation of measures to prevent iron deficiency in pregnancy and infancy and improve outcomes. Thus, this study was conducted to explore the effect of maternal iron deficiency anemia on newborn iron stores. Methods: The study was conducted in the Department of Obstetrics and Gynecology, Smt. Sucheta Kriplani Hospital, New Delhi, India between November 2014 to March 2016. It was an observational cross sectional study with sample size of 100 antenatal women diagnosed with iron deficiency anemia.We divided the mothers into groups with mild, moderate and severe anemia respectively. The maternal serum ferritin levels were compared with the newborn hemoglobin and serum ferritin levels. Results: Between the three groups the baseline characteristics were comparable. The newborns of mothers with severe anemia had lower Apgar scores and a greater risk of admission. The birth weight did not differ among the groups. The severity of anemia increased with the parity.The cord blood hemoglobin between the groups was comparable, however the cord blood ferritin levels were directly related to maternal hemoglobin values . In those with severe anemia, a positive association was found between maternal ferritin and cord blood hemoglobin and maternal hemoglobin and cord blood serum ferritin. A positive association was also found between maternal hemoglobin and cord blood hemoglobin. Conclusion: The study supports the fact that fetal needs dictate the placental iron demand. With increasing severity of anemia the fetus starts showing decreased serum ferritin and this finally results in iron deficiency at birth. Although the fetal weight and haemoglobin are not compromised with increasing severity of anemia in our study, increased fetal risk manifested by worsening Apgar scores and increased newborn admissions occurred as anemia worsened. This study supports the fact that maternal deficiency of iron affects the newborn iron profile and this reiterates the imperative role of iron supplementation during pregnancy. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 620-625

Effect of maternal anaemia on status of iron stores in neonates and anthropometry

Objective: To evaluate the effect of maternal IDA on neonatal hemoglobin and iron stores and also to assess its correlation with neonatal anthropometric characteristics. Study Design: This was a cross-sectional study conducted at a tertiary care hospital for a period of 18 months. The study enrolled total 112 pregnant women who were diagnosed with IDA, and also included babies of enrolled women for correlation of neonatal iron status and anthropometric variables. Maternal prenatal blood samples, during the first stage of labour, and neonatal cord blood samples were collected for hemoglobin and serum ferritin analysis. Results: Mean age of enrolled pregnant women was 25.81 ± 4.67 years. Among all, 65.17% women had moderate to severe anemia. The mean hemoglobin and serum ferritin levels of pregnant women with IDA were 8.92 ± 1.46 g/dL and 12.63 ± 1.36 µg/L, respectively. The mean cord blood hemoglobin and serum ferritin levels were 15.24 ± 1.04 g/dL and 27.79 ± 4.37 µg/L, respectively. Only 15.18% neonates born from mother with IDA were anemic (Hb <14 g/dL).

Comparison of Middle Cerebral Artery Doppler and Cord Blood Hemoglobin in the Diagnosis of Fetal Anemia among Rh-negative Pregnant Women

Background: Most prevalent cause of fetal anemia is Rh incompatibility between the mother's and the fetus's blood types, where antibodies from the mother damage the fetus's red blood cells causing fetal hemolytic anemia. Objective: To compare the Doppler of the middle cerebral artery of the fetus and cord blood hemoglobin to diagnose fetal anemia among Rh-negative women in the last trimester of pregnancy. Methodology: This was a cross-sectional study conducted at the Gynecology & Obstetrics Department, Mercy Teaching Hospital Peshawar, from February 2020 to May 2021. A total of 126 Rh-negative blood group women were included who were in the last trimester of the pregnancy. Ethical approval was obtained from Ethics Committee and informed written consent was taken from the study participants. Middle cerebral artery Doppler peak systolic velocity was checked at 28th, 32nd, and 34th week of gestation. If middle cerebral artery Doppler peak systolic velocity changes were present, then patients were closely monitored and managed appropriately for post-delivery assessment of cord blood fetal anemia. A pre-designed structured proforma was used to collect patient details. Results: Mean age of 126 pregnant mothers was 28±7 years, and the mean parity was 4.57±2. The overall frequency of fetal anemia among Rh-negative women predicted by middle cerebral artery Doppler peak systolic velocity was 59 (46.8%), while anemia on cord blood sampling after delivery was found in 43 (34.1%) of babies. No anemia was found in 83 (65.8%) study participants. The sensitivity and specificity of middle cerebral artery Doppler were 100% and 84% respectively. Conclusion: Middle cerebral artery Doppler can be a simple noninvasive method to detect fetal anemia before the development of hydrops fetalis with high sensitivity and specificity.

Irregular erythrocyte antibodies among antenatal women and their neonatal outcome at a tertiary care hospital in Northern India.

Red blood cell alloimmunisation during the pregnancy is a significant cause for neonatal mortality and morbidity. This study was planned to determine the prevalence and specificity of irregular erythrocyte antibodies in antenatal mothers and their neonatal outcome. In this observational study, blood grouping and red cell antibody screening of mothers were performed at first visit and after 28 weeks of gestation and positive cases were identified and followed up monthly till delivery by repeating antibody titre and middle cerebral artery-peak systolic velocity. After delivery of alloimmunised mothers, cord blood haemoglobin, bilirubin and direct antiglobulin tests (DAT) were analysed and further outcome of neonate was recorded. Among 652 registered antenatal cases, 18 multigravida women were found to be alloimmunised, accounting to prevalence of 2.8%. Most common alloantibody identified was anti D (>70%) followed by anti-Lea, anti-C, anti-Leb, anti-E and anti-Jka. Only 47.7% Rh D negative women received anti-D prophylaxis during previous pregnancies or whenever indicated. DAT was positive in 56.2% of neonates. Among nine DAT positive neonates, two early neonatal deaths due to severe anaemia were observed following birth resuscitation. Four antenatal mothers required intrauterine transfusion in view of fetal anaemia while three neonates received double volume exchange transfusion and top up transfusions after birth. This study emphasises importance of red cell antibody screening for all multigravida antenatal women at registration of pregnancy and additionally at 28 weeks or later in high-risk cases irrespective of RhD status.

Irregular erythrocyte antibodies among antenatal women and their neonatal outcome at a tertiary care hospital in Northern India

BackgroundRed blood cell alloimmunisation during the pregnancy is a significant cause for neonatal mortality and morbidity. This study was planned to determine the prevalence and specificity of irregular erythrocyte antibodies...

Role of Cord Blood Albumin and Bilirubin for Prediction of Significant Neonatal Jaundice

Introduction: Nearly 60-80% of the term and preterm neonates are affected due to rise in bilirubin levels during early postnatal days, and causes readmission of the neonate sometimes with severe jaundice, which can be reduced if neonatal hyperbilirubinemia can be predicted early. The study was conducted to evaluate the predictive values of cord blood albumin and bilirubin for neonatal hyperbilirubinemia and to evaluate the better predictor between them. Method: In this hospital based observational study, 152 healthy term newborns with birth weight more than 2.5 kg were included. Assessment of cord blood haemoglobin, blood group, albumin and bilirubin levels was done. Follow-up for first consecutive five days after birth was done and assessed daily to look for evidence of jaundice, sepsis or any other illness. Serum bilirubin was evaluated at 72-96 hours of life in all neonates and was done early, if clinically indicated. Receiver’s Operating Characteristics curves were used for calculating the cut-off values of cord blood albumin and bilirubin in relation to hyperbilirubinemia. Result: The cut-off values obtained for albumin and bilirubin of cord blood was < 2.56 mg/dL and >2.33 mg/dL respectively at optimum sensitivity and specificity. Cord blood bilirubin was found to be highly sensitive for early recognition of significant neonatal hyperbilirubinemia as compared to cord blood albumin and can be used for screening purpose. Conclusion: Cord blood albumin and bilirubin can be used for negating the development of NNHB, but for screening purpose, cord blood bilirubin is more predictive of neonatal hyperbilirubinemia.

Maternal anaemia and neonatal outcome: An observational study on rural pregnant women

Anaemia in pregnancy is a public health problem in developing countries. An observational study of anaemic pregnant women was carried out at the Department of Obstetrics and Gynecology from 1st December 2015 to 30th may 2017, to determine the effects of maternal anaemia on the newborn babies according to the severity of anaemia. 314 pregnant women with anaemia were included in this study. Parameters studied were haemoglobin levels, neonatal birth weight, APGAR score, NICU admission and cord blood haemoglobin. Severity of anaemia is determined by additional cutoffs, with severe anaemia defined as a haemoglobin level of less than 7.0g/dl. Statistics 16.0 software was used. Out of 314 patients, 24 patients (7.6%), 39 patients (12.4%), 251 patients(79.9%) were in severe, moderate, and mild category respectively. Mean haemoglobin levels in present study was 8.65gm/dl. 219 newborns (69.7%) were low birth weight out of which 100% babies born to severely anaemic mothers were LBW which shows that with increase in severity of anaemia, birth weight decreases which is statistically significant. 91.7% babies born to severe category had less than 7 APGAR score. 91.7% newborn in severe anaemia were admitted to NICU. 87.5% babies born to severely anaemic women had neonatal anaemia. Anaemia during pregnancy and its management remains an important issue in perinatal medication. Correct diagnosis and treatment lead to effective management of fetal and maternal risks and improved perinatal outcome.

Relationship between Maternal Hemoglobin Concentration to the Newborn Cord Blood Hemoglobin and Serum Concentration

Objective: To determine the mean cord blood hemoglobin and ferritin concentration in newborn of anemic mothers. Study Design: Cross sectional Place and Duration: Gynae & Obs department of Dow University Hospital, a tertiary care hospital in Karachi, Pakistan during the period from January, 2018 to July, 2019. Methodology: A total of 100 anemic pregnant women as per inclusion and exclusion criteria were included in this study. Cord blood sample (5ml) was obtained by sterile needle puncture immediately after cord clamping. 2ml will collected in EDTA bottle for full blood count analysis and 3ml collected in plain bottle for serum ferritin analysis. Final outcome was recorded on approved proforma. Results: The average age of the patients was 29.33±3.23 years. Mean cord blood hemoglobin and ferritin concentration in newborn of anemic mothers was 14.78±1.62 g/dl and 94.10±67.47 u/ml. Conclusion: We found that average hemoglobin of the women recruited in our study was 9.59±0.815 g/dl however we could find no correlation between mean cord blood hemoglobin and ferritin concentration in newborn of anemic mothers. Key Words: Cord blood Hemoglobin, Ferritin, Anemic mothers

A comparative study of cord blood haemoglobin and ferritin in normotensive versus preeclamptic patients

A comparative study of cord blood haemoglobin and ferritin in normotensive versus preeclamptic patients

A randomized controlled clinical trial on peripartum effects of delayed versus immediate umbilical cord clamping on term newborns

ObjectivesTo compare the hemoglobin and serum bilirubin concentration of term newborn following delayed and immediate umbilical cord clamping. MethodsA randomized controlled trial of eligible parturients with singleton pregnancy delivered between July 1, 2019 and September 30, 2020 were randomly assigned (1:1 ratio) to either delayed clamping of umbilical cord (60 s after delivery) or immediate clamping (0−15 s) was done. The primary outcome measures included hemoglobin and bilirubin levels of the newborn measured at birth and 48 h of life. Intention-to-treat principle was applied to analysis (www.pactr.org: PACTR201906668876480). ResultsOne hundred and two newborns were randomized into each group and none was lost to follow-up. Participants in both groups had similar socio-demographic and clinical characteristics. At 0 h of birth, cord blood hemoglobin concentration and total bilirubin values were not significantly different between the two groups (p > 0.05). At 48 h of birth, mean hemoglobin concentration was significantly higher in delayed clamping group than immediate clamping group (16.51 ± 1.71 g/dl vs 15.16 ± 2.27 g/dl; p < 0.001) but total mean bilirubin concentration was not significantly different (3.88 ± 1.54 mg/dl vs 3.71 ± 1.20 mg/dl; p = 0.380). There was no significant difference in postpartum hemorrhage (p = 0.653), neonatal jaundice (p = 0.856), and need for phototherapy (p = 0.561) while respiratory symptoms, polycythemia and anemia were not reported. ConclusionDelayed cord clamping at childbirth is more advantageous for term infants in terms of more hemoglobin concentration compared to traditional immediate cord clamping. The maternal and perinatal complications were either not significantly different or absent.

A study on effect of maternal anaemia on anthropometric profile and haemoglobin of newborns

Background & Objectives: Anaemia is one of the major health problems among antenatal mothers. Most of the anaemias seen in pregnancy are largely preventable and easily treatable if detected on time. According to WHO, Haemoglobin level below 11gm/dl at any time during pregnancy is considered as anaemia. If the mothers are anaemic, the foetuses are at a risk of preterm deliveries, low birth weight, morbidity and perinatal mortality due to impairment of oxygen delivery to placenta and foetus. Methods: Data was collected from inborn neonates born to Anaemic and Non-anaemic mothers, selected by purposive sampling technique, within 48 hours of birth. Collected data was analysed using software SPSS v16. Results: Among 1016 neonates studied,it was found that 23.6% of newborns born to mother’s with hemoglobin 11gm%). Length of the babies born to anaemic mothers (<11gm%) was found to be lower than the babies born to non-anaemic mothers, 68.50% as compared to 49.4 % in controls .Head circumference of babies born to anaemic mothers (<11gm%) was found to be in the lower range,45.86% as compared to 9.25% in controls. Babies born to mother’s with haemoglobin<11 gm%had cord hemoglobin in the range 14-15 gm/dl, 58.2 % as compared to 36.8 % in controls. Interpretation & Conclusion: Comparison of all anthropometric parameters born to neonates of Mothers with Anaemia and no anaemia was statistically significant. It was also found that the cord blood haemoglobin done in neonates born to anaemic mothers was lesser than in neonates born to non-anaemic mothers.

Maternal and Cord Blood Hemoglobin as Determinants of Placental Weight: A Cross-Sectional Study.

Background: Both high and low placental weights are associated with adverse pregnancy outcomes. Maternal hemoglobin levels can influence placental weight, but the evidence is conflicting. Since maternal hemoglobin does not invariably correlate with fetal/neonatal blood hemoglobin levels, we sought to determine whether cord blood hemoglobin or maternal hemoglobin status more closely associates with placental weight in women undergoing elective cesarean section at term. Methods: This was a cross-sectional study conducted at the Royal Alexandra Hospital, Edmonton, Canada, involving 202 women with term singleton pregnancies undergoing elective cesarean section. Maternal blood and mixed cord blood hemoglobin levels were analyzed using a HemoCue Hb201+ system. Birth weight, placental weight, one- and five-minute APGAR scores, American Society of Anesthesiologists physical state classification, maternal age, and maternal height were also recorded. Relationships between maternal and cord blood hemoglobin levels with placental weight, birth weight, and birth weight to placental weight ratio were the main outcome measures. Results: A total of 182 subjects were included in the analysis. Regression analysis showed that cord blood hemoglobin, but not maternal hemoglobin, was inversely related with placental weight (β = −2.4, p = 0.001) and positively related with the birth weight to placental weight ratio (β = 0.015, p = 0.001 and p = 0.63, respectively). Conclusions: Our findings suggest that measuring cord blood hemoglobin levels, rather than maternal hemoglobin levels, may provide important diagnostic information about in utero fetal adaptation to suboptimal placental function and neonatal health.

Role of Cord Blood Carboxyhemoglobin in Detecting Significant Hyperbilirubinemia in Term Neonates with ABO Alloimmunization.

This study aimed to assess whether cord blood carboxyhemoglobin (COHb) levels in jaundiced term neonates with and without a positive direct Coombs test (DCT) and in healthy controls could be used as a predictor of severe hyperbilirubinemia. The percentage of cord blood COHb should be higher among neonates with Coombs-positive ABO hemolytic disease than among those with Coombs-negative ABO incompatibility and higher than that of ABO-compatible control neonates. This cross-sectional descriptive study of 198 term neonates comprised three subgroups: group I featured 68 DCT-positive ABO-incompatible neonates (ABO + DCT), group II featured 60 DCT-negative ABO-incompatible neonates with hyperbilirubinemia (ABO-DCT), and group III featured 70 healthy controls. COHb was determined by an OSM3 hemoximeter. Group I differed from groups II and III for cord blood bilirubin, cord blood hemoglobin, and cord blood hematocrit. Groups I and II had higher mean total serum bilirubin (TSB) levels than group III, while there was no difference in the mean TSB levels between groups I and II. There was no significant difference between the COHb group means for groups I, II, and III (p = 0.98). The area under the receiver operating characteristic curve calculated for group I/group III and group II/group III were found to be 0.62 and 0.54, respectively. COHb levels did not prove to be superior to the DCT for predicting the risk of developing severe hyperbilirubinemia in term neonates. · COHb levels do not predict the risk of developing severe hyperbilirubinemia in term neonates.. · COHb levels may predict that ABO incompatibility in early life.. · COHb levels did not prove to be superior to the direct coombs test..

Ethical Issues and Management of Fetal Hemolytic Anemia Caused by Anti-Rh17 in a Multipara with Rare –D– Phenotype

Background: The development of allo-anti-Rh17 (anti-Hr0) in a –D– phenotype whose red blood cells (RBCs) lack CcEe antigens is most likely triggered by transfusion, transplantation, or pregnancy. Gene conversion is the predominating factor in generating RHD-CE-D and RHCE-D-CE hybrids like –D–. Methods: We report here immunohematological and obstetrical data from 2 of the 5 pregnancies of a 24-year-old woman presenting with the –D– phenotype with anti-Rh17. Blood group typing, antibody screening, antibody differentiation, direct antiglobulin test (DAT), and antibody titers were performed by routine gel technology and tube testing. Additionally, molecular genetic analysis was performed. Fetal surveillance was done by sonographic evaluation of the fetal middle cerebral artery peak systolic velocity (MCA-PSV). Results: Blood group typing showed O, C-c-D+E-e- and the DAT was negative. DNA sequencing revealed homozygosity for an RHCE-D(3–9)-CE null allele. Anti-Rh17 titers in the fourth pregnancy remained between 1:8 and 1:128, and no signs for a fetal anemia were observed. However, in the fifth pregnancy, the antibody titers increased up to 1:4,096. Signs of moderate fetal anemia were detected and cesarean section was performed at 34 + 6 weeks of gestation. The newborn presented with hemolytic anemia (cord blood hemoglobin [Hb] = 8.5 mg/dL). She received 2 compatible (small) packed RBC concentrates, phototherapy, and intravenous immunoglobulins. Conclusion: Our case shows that the risk for hemolytic complications increases with the number of pregnancies of sensitized women. Only people who also lack CcEe antigens are compatible as donors. The role of such rare donors as lifesavers, their freedom, and voluntariness conflict with the urgent need for compatible blood.