Hemolytic Disease Of Fetus Research Articles

Hemolytic disease of fetus due to multiple alloantibodies (anti-D, anti-C, and anti-s) requiring intrauterine transfusions: A case report and review of Indian literature

Abstract Immune hemolytic disease of fetus (HDF) and newborn is a serious complication in pregnancy and is associated with perinatal mortality and morbidity. Intrauterine transfusion (IUT) is performed for the treatment of fetal anemia caused by red cell alloimmunization. Here, we present the case of a 28-year-old multiparous pregnant female, with a history of bad obstetric outcomes. At 24 weeks gestation, she was referred to our center requesting one unit of irradiated leuco-depleted packed red cells (LDPRC) for 2nd IUT due to difficulty in finding a compatible unit elsewhere. A detailed immunohematology (IH) workup revealed the presence of anti-D, anti-C, and anti-s antibodies. The patient received O RhD Negative and C, and s red cell phenotype negative, crossmatch compatible, irradiated LDPRC unit for IUT. She received a total of three episodes of IUT at 24, 29, and 33 weeks of gestation and delivered a healthy female child at 36 weeks. Managing HDF with multiple antibodies requires coordination between interdisciplinary teams and an advanced IH lab along with trained staff and active involvement of transfusion medicine specialists to support early interventions and reduce HDF-related mortality.

Hemolytic disease of the fetus and newborn: pregnant person's and fetal immune systems interaction.

There exists a need to research new diagnostic and therapeutic approaches that consider hemolytic disease of fetus and newborn (HDFN)'s physiopathology and focus not only on the pregnant person's immune system but also on the fetal immune system. This implies, in the final sense, to view the fetus as our patient. In spite of having found a safe and efficient method of prevention of HDFN more than 50 years ago, HDFN continues to be a relevant cause of perinatal morbidity and mortality, due to lack of access to immunoprophylaxis. In light of the above, we should strive to prevent sensitization and HDFN by ensuring certain health policies across the globe, especially in countries and regions of high morbidity and mortality.

HEMOLYTIC DISEASE OF THE NEWBORN DUE TO UNRECOGNISED ANTI-Kpa ANTIBODY

Background: Kpa occurs in less than 2 percent of the Caucasian population. Antibody to this low frequency antigen causes mild to moderate delayed hemolytic transfusion reactions and hemolytic disease of fetus and newborn. Screening for antibodies to low frequency antigens such as Kpa is not routine, so sensitization is more difficult to diagnose. Case report: We present a case of hemolytic disease of the newborn due to anti-Kpa antibody unrecognised during regular considered first pregnancy. Results: Newborn, blood group 0 RhD positive, has been diagnosed with neonatal jaundice and positive direct antiglobuline test. Mother's screening test for irregular antibodies was negative three times during pregnancy. Elution was negative with screening red blood cells, but in identification using gel technology with cell's panels, anti-Kpa has been identified. Conclusion: Screening for antibodies to low frequency antigens such as Kpa is not routine, so immunisation to low incidence antigens is hard to diagnose, but very important. This case should alert us that there really is potential of antibodies to low incidence antigens to cause severe reactions. Keywords: Kell blood group system; Hemolytic disease of newborn; red cell alloimmunisation

A rare case of hemolytic disease-associated thrombocytopenia mimicking alloimmune thrombocytopenia: Salvaging a precious baby

Abstract: Thrombocytopenia associated with hemolytic disease of fetus and newborn (HDFN) is usually mild-to-moderate severity. Neonatal alloimmune thrombocytopenia (NAIT) is one of the leading causes of severe thrombocytopenia in neonates. We describe a rare case of very severe thrombocytopenia (5 g/L) with bleeding manifestations associated with HDFN mimicking NAIT. The baby was a preterm female, born to a 34-year-old multiparous mother with a bad obstetric history and multiple alloantibodies (anti-D, anti-C, anti-E, and anti-Jka). She was managed with phototherapy, exchange transfusion with phenotype-matched packed red blood cells, random donor platelets and intravenous immunoglobulin as platelet crossmatching could not provide compatible platelets. NAIT was ruled out with human platelet antigen (HPA) genotyping of the baby, the mother, and the father. It was concluded that the very severe thrombocytopenia might be due to HDFN after ruling out the other causes. HDFN can rarely cause very severe thrombocytopenia. However, when a newborn presents with severe/very severe thrombocytopenia, NAIT is to be ruled out with HPA genotyping, even in resource-limited settings, to plan out subsequent pregnancies.

PREVALENCE OF KELL BLOOD GROUP SYSTEM IN BLOOD DONORS ATTENDING A TERTIARY CARE CENTRE IN NORTHWESTERN INDIA

Objective: The Kell blood group system is amongst one of the clinically significant blood group system in blood transfusion, consisting of different types of antigens with high immunogenicity which can be a potential cause of serious transfusion reactions and hemolytic disease of fetus and newborn. Knowledge of the antigenic frequency is crucial to assess the risk of alloimmunisation and to guide the probability of finding antigen-negative donor blood, which can be useful for a patient with corresponding or multiple red cell alloantibodies. Methods: This is a retrospective study which was done at Department of Immunohematology and Transfusion medicine, SMS Medical College, Jaipur over a period of one year from 1st Jan to 31st Dec 2020. During the study period, blood both voluntary donors as well as replacement donors were typed for Kell antigens by automated red cell antigen typing by capture-R technology in neo immucor. Results: A Total of 9677(Nine Thousand Six Hundred Seventy Seven) Blood donors were typed for Kell Antigens. Out of these 9677 samples, 288 were Positive for Kell positive (K+) resulting in overall frequency of Kell (K) Antigen as 2.9%. Conclusion: This is the first study that set out to determine the prevalence of Kell antigens among Blood Donors in Northwestern India. These results appear to be useful in providing better care for patients by implementing tests that should become a routine in blood banks. The Kell system is very important in Transfusion medicine practice.

“Block D” Phenomenon in Hemolytic Disease of Fetus and Newborn: The Immunohematological Implications

ABSTRACT Background and Objectives: “Block D” in hemolytic disease of the fetus and newborn (HDFN) is quite rare and should be evaluated meticulously. We analyzed “Block D” phenomenon in neonates with HDFN due to rhesus (Rh) incompatibilities. The objective of this study was to identify the blocking phenomenon in HDFN by simple, sensitive methods so that they can be implemented in routine practices. Methods: The study was conducted over 10 years, and written informed consent was taken from each participating parent/guardian. Detailed immunohematological workup for “Block D” was done on 11 samples. Complete patient details were obtained from the hospital information system. All laboratory parameters of neonates were observed till discharge from the hospital. Results: All mothers were Rh-D negative with a median age of 28 years. All of them revealed anti-Rh-D antibodies in their serum with titer ranging from 256 to 1024. All neonatal red cells were direct antiglobulin test (DAT) positive and initially Rh-D negative. Rh-D typing on eluted red cells confirmed the presence of D antigen. Strong positive and negative correlations were observed between newborn anti-D immunoglobulin G titer and newborn DAT (r = +0.71, P = 0.031) and newborn DAT and newborn hemoglobin (Hb) (r = −0.78, P = 0.032), respectively. While all neonates received phototherapy, four of them also received exchange transfusion. Gradual increase in mean Hb and decrease in both total serum bilirubin and DAT were observed from day 0 to day 7 (P < 0.05). Conclusion: “Block D” though uncommon signifies the severity of HDFN. Often this phenomenon is missed due to a lack of standard protocol. Through detailed immunohematological characterizations, we could develop a diagnostic pathway to confirm “Block D” in HDFN which can be easily established in the resource-constrained laboratories.

Management of Fetal Hemolytic Disease Due to Anti-Rh17 With the D−Phenotype [ID 2683500

INTRODUCTION: The rare blood D− haplotype produces multiple Rh antibodies against red blood cell antigens such as anti-Rh17 or anti-Hr0 antibodies if a patient is sensitized to Rh antigens. METHODS: This report discusses successful management of a pregnancy in a 28-year-old woman with high anti-Rh17 titers leading to hemolytic disease of the fetus (HDFN). The combination of a D− allele and the weak D 45 allele has not been reported previously, and it may be that the hybrid allele expresses D antigen epitopes such that the D antigen is not weakened. During the studied pregnancy, the patient received plasmapheresis and intravenous immunoglobulin (IVIG) infusions along with intrauterine transfusions (IUTs) when absolutely necessary. She underwent uncomplicated repeat cesarean delivery at 32 5/7 weeks of gestation resulting in a female infant weighing 2,020 g. Patient informed consent was obtained for this case report. CONCLUSION: This patient with the D−/D− blood phenotype leading to anti-Rh17 antibodies after her first pregnancy was managed successfully. Her baby with HDFN and several instances of hydrops fetalis, was successfully managed and treated. The patient’s blood donations for IUTs and maternal plasma exchange therapies promoted efficiency and favorable outcomes for the baby, but did put the mother in an anemic blood range.

A rare presentation of severe alloimmune hemolytic disease of newborn pertaining to minor blood group ‘c’ incompatibility: a case report and review of literature

Hyperbilirubinemia is one of the most widely seen causes of neonatal morbidity. Haemolytic disease of fetus and newborn is caused by maternal alloantibodies to the fetal RBCs. It is responsible for incompatibility between maternal and fetal blood groups, which results in destruction of fetal red blood cells causing hyperbilirubinemia. ABO and Rh incompatibility are the most common causes of severe indirect hyperbilirubinemia. Besides ABO and Rh isoimmunization, minor blood group incompatibilities such as anti-Kell, anti-C, anti-c, anti-E, anti MNS, Duffy, KIDD, P, Lutheran and Lewis have also been identified as causes of severe neonatal jaundice with an incidence of 385/1,00,000 live births in South-East Asia. We, hereby report a rare case of a full term 2.2 kg newborn presented with severe anemia with reticulocytosis and neonatal hyperbilirubinemia at second hour of life. In view of strongly positive DCT and no Rh negative or ABO setting, minor blood group incompatibility screening test was performed in the mother which revealed presence of multiple alloantibodies; however, the red cell phenotyping confirmed the presence of anti-c antibodies in maternal sera responsible for neonatal alloimmune haemolytic anemia. The baby was offered intensive phototherapy with intravenous immunoglobulin.

Characterization of novel Rh variant (CETW) associated with haemolytic disease of fetus and newborn using recombinant technology

Characterization of novel Rh variant (CETW) associated with haemolytic disease of fetus and newborn using recombinant technology

Prevalence of Kell Blood Group Antigens among Blood Donors & Impact of its Alloimmunization in Multi-transfused Thalassemia & Sickle Cell Disease Patients with Recommendation of Transfusion Protocol—Need of the Hour

Background: The aim of the study was to analyze the prevalence of Kell antigen and its correlation to major blood groups, ABO & Rh system in Eastern India. There was simultaneous retrospective analysis of Kell alloimmunization to find out the implication and recommendation of transfusion protocols in multi-transfused thalassemia and sickle cell patients. Methods: The study was a prospective observational conducted on 3000 donors for KELL and ABO grouping. Retrospective analysis was made to identify common alloantibodies in multi-transfused patients. Results: The overall prevalence of Kell antigen was 2.6% (80) in 3000 donors. Among male, it was highly prevalent i.e. 2.77% and in females 0.65%. Kell antigen was highly prevalent among AB donors, i.e. 5.1%. It was 2.5% in A, 2.9% in B, 1.9% in Blood Donors. Kell prevalence was high in Rh D positive donors, i.e. 2.72% and was 1.72% among Rh D negative donors. Anti-K was the 3rd most common alloantibody detected in 638 cases of multi-transfused thalassemia and sickle cell (SCD) patients (9.25%). Anti-E (42.6%)was most common entity followed by anti-c (24.0%). Conclusion: The higher incidence of Kell prevalence in AB & Rh D Positive Blood groups and also in male persons indicate that there should be a donor database and knowledge of red cell antigen prevalence in a population. This will help blood centers in providing antigen negative compatible blood units to patients with corresponding alloantibodies. Hemolytic transfusion reactions due to Kell alloimmunization are of a significant severity. Prevalence of Kell alloantibody is high among multi-transfused patients and is next to anti E & anti c. Kell sensitized mothers may also cause serious consequences like hemolytic disease of fetus and newborn. Therefore, it is suggested that extended phenotyping including Kell blood group antigen should be implemented in cases of multi-transfused patients. Keywords: Blood donors, Extended phenotyping, Kell, Multitransfused thalassemia patients, Multitransfused sickle cell disease patients

COVID-19 mimicked fetal hemolytic disease: a case report

The pandemic of COVID-19 changed the traditional approaches to the management of gestational complications. Today there is still a lack of information about the impact of COVID-19 on the pregnancy course, in particular, about its role in relation to Rh-conflict during pregnancy.The paper focused on a rare presentation of Rh-conflict pregnancy and COVID-19. 32 years old G3 P2 pregnant women with Rh-negative had a third pregnancy. The injection of anti-D immunoglobulin after the first abortion was not performed. The second pregnancy finished with a term delivery and the birth of a fetus with hemolytic disease. During the third pregnancy, the woman fell ill with COVID-19 in the 26th week. The bilateral pneumonia was diagnosed.The treatment included antibiotics, antiviral, antithrombotic, and anti-inflammatory drugs. No signs of fetal hemolytic disease were found via ultrasonography. But the abnormal level of anti-D antibodies – 1:1024 was detected. From the 28th weeks of pregnancy till the delivery the test for anti-D antibodies was constant – 1:4. The variables of utero-placental, fetal (blood flow velocity in a middle cerebral artery), and umbilical hemodynamics were normal during the third trimester. But fetal moderate hepato- and splenomegaly were found at 36 weeks of gestation. The patient delivered at 38 weeks of gestation a female newborn 3100 g, 52 cm with a 7→8 Apgar score. The laboratory investigation detected a hemoglobin value of 202.6 mg/dL in a child. The blood analysis showed total bilirubin of 44.2 mg/dL, direct bilirubin of 1.0 mg/dL, and a negative result on the direct Coombs test. The baby received phototherapy for 3 days. Total bilirubin was decreased (15.2 mg/dL). The newborn was discharged from a hospital with the mother on the fifth day.COVID-19 could change the placental permeability and increase the titer of anti-D antibodies. But it did not contribute to fetal and newborn hemolytic disease.

Extended red blood cell phenotyping among regular donors in Fayoum, Egypt. Red Blood Cell Inventory Plan

Abstract Background Antibodies to clinically significant red cell antigens contribute to hemolytic transfusion reactions and hemolytic disease of fetus and newborn. The aim of the study was to estimate the prevalence of extended red cell antigen phenotypes among regular donors in Fayoum, Egypt, and to create an emergency model database for chronic transfusion patients. Similar data in Egypt is rare to find in the literature. Patients and methods The study was carried out over 1 year from December 2020 until November 2021in Fayoum University Hospital Blood Bank. In all, 1834 healthy known blood donor samples were analyzed for major Rh phenotypes (D, C, c, E, e) and for other clinically significant systems including Kell, Kidd, MNS, and Duffy. Results Phenotypic frequencies of Rh system were D+ (84.4%), e+ (79.6%), and C+ (63.9%). The K antigen frequency was 4.3%, Jka 79.4%, Jkb 62.37%, Fy a 33.2%, Fy b 44.4%, M antigen 88%, N antigen 38.6%, and the S and s antigens 48.2 and 85.3%, respectively. Conclusion Determination of red cell antigen phenotyping in Fayoum, Egypt, plays an important role in setting a routine phenotyping strategy for multiple transfused patients by keeping the donor database for rare phenotypes to prevent hemolytic transfusion reaction.

Racial Disparity in Antibody Against High Prevalence Antigen; Anti-U

Abstract Introduction/Objective Anti-U is an IgG antibody directed against the U antigen, which usually forms after exposure to U antigen via blood transfusion and/or pregnancy. U antigen is located on glycophorin B (GYPB) as part of the MNS blood group system. Approximately 2% of the African American population lacks this antigen, making them prone to developing anti-U. Anti-U can cause hemolytic disease of fetus and newborn (HDFN) and hemolytic transfusion reactions (HTR). Methods/Case Report A 60-year-old African American male underwent aortic valve surgery. The patient was A Pos with a negative antibody screen. During surgery, the patient was transfused with 3 random units of packed red blood cells (PRBCs). The postoperative course was uncomplicated, and the patient was discharged home. 6 months later, the patient was admitted for another procedure and was expected to require blood products. Thus, a type and screen test was ordered, revealing pan reactivity on screening cells. This prompted further investigation. Antibody detection was performed with the solid-phase technique followed by the tube method with Polyethylene glycol (PEG) as an enhancement medium. PEG technique is the next choice of method if the solid phase requires extended antibody work up, which was the case in our patient. PEG tube method successfully identified Anti-U, and the patient's phenotype was confirmed to be U negative. Results (if a Case Study enter NA) N/A. Conclusion It is imperative to stress the importance of racial disparity while investigating antibodies against high prevalence. In our case, our suspicion was high for Anti-U, given that patient was of African American descent. Tube methods with PEG and Solid Phase techniques are usually used for antibody identification. It is recommended that patients with rare antibodies carry an Antibody ID card indicating the rare antibody they have to prevent further exposure.

ABO and Rh Antigen Distribution Among Pregnant Women in South Western Uganda.

IntroductionABO and Rh are the major blood group systems in Transfusion Medicine, the ABO system based on two red cell antigens (A, B) while the Rh has about 50 antigens of which five are highly clinically significant (D, C, c, E, e). These vary among races and ethnic groups. Blood type phenotype incompatibility between mother and fetus may result in antigen mismatch, triggering alloimmunization, and thus causing hemolytic transfusion reaction (HTR), which results in hemolytic disease of fetus and newborn (HDFN). This study aimed to determine the frequencies of ABO and rhesus blood group antigen in the pregnant women in South Western Uganda.MethodsA cross-sectional study was carried out on 1369 pregnant women who were recruited and provided consent to participate during their regular antenatal visits between August 2020 and July 2021. Four milliliters (4mL) of EDTA-anti-coagulated blood samples were collected and ABO and Rh-blood grouping including Rh antigen screening was done using the agglutination technology comprised of glass beads and reagent contained in a column of the Ortho Biovue ID Micro Typing System (Ortho Clinical Diagnostics, New Jersey, USA). The Rh antigen phenotypes and frequencies were then determined.ResultsThere was percentage distribution of 99.8%, c 99.3%, D 94.3%, C 19.2% and E 15.9%, with Rh cDe/cDe (65.1%) being the most common phenotype followed by cDe/CDe (15%), cDe/cDE (10.8%) and cDE/cDE 0.1% least common. The ABO grouping frequency was obtained as O 49.4%, A 29.5%, B 17.0% and AB 4.1%, with D positivity at 94.3%.DiscussionPopulation genetic variations result in varied expressions of red cell antigens that may have clinical complications. Knowledge of the presence of these Rh antigen distributions and phenotype frequencies during pregnancy help in rational management of the pregnancy, alloimmunization and better approach to safe blood transfusion.

Prevalence of Rhesus & Kell phenotypes among blood donors of Bangladesh

The Rhesus blood group system is one of the most polymorphic and highly immunogenic systems in humans. Because of its high and strong immunogenicity Rh D antigen testing is mandatory before issuing a compatible blood. There are five major antigens i.e. DCEce in the Rhesus (Rh) blood group system. On the other hand from the immunogenicity point of view Kell antigen is next to the Rh system. Both of them may cause severe hemolytic transfusion reaction and hemolytic disease of fetus and new born. Exposure of Rhesus negative individuals to Rhesus positive blood through transfusion or pregnancy is most likely to stimulate production of Rhesus antibodies. These antibodies may cause Hemolytic Disease of Fetus and Newborn (HDFN) and Delayed Hemolytic Transfusion Reaction (DHTR). Like Rhesus antibodies, Kell antibodies may also cause HDFN and DHTR. So far we know, there is not enough study regarding antigens C, c, E & e of Rh or K, k antigen of Kell blood group system regarding these antigens in the donors in Bangladesh, thereby exposing transfused patients to these antigens negative patients. To determine the phenotype prevalence of the Rh and Kell blood group systems in the blood donors in Bangladesh, a descriptive cross sectional study was done in the laboratory of Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University, during the period of 1st January 2020 to 31 December 2020. Rhesus Phenotype CCDee is highest (48.4%) & CCDEe & ccDEE both are lowest (0.4%). Most probable Rhesus Genotype CDe/CDe (R1R1) is highest (48.4%) and CDe/CDE (R1Rz) & cDE/cDE (R2R2) both are lowest (0.4%). Kell Genotype kk is highest (99.2%) and Kk is lowest (0.8%). BSMMU J 2021; 14(3): 38-42

Outcome predictors for maternal red blood cell alloimmunisation with anti-K and anti-D managed with intrauterine blood transfusion.

Red blood cell (RBC) alloimmunisation with anti-D and anti-K comprise the majority of cases of fetal haemolytic disease requiring intrauterine red cell transfusion (IUT). Few studies have investigated which haematological parameters can predict adverse fetal or neonatal outcomes. The aim of the present study was to identify predictors of adverse outcome, including preterm birth, intrauterine fetal demise (IUFD), neonatal death (NND) and/or neonatal transfusion. We reviewed the records of all pregnancies alloimmunised with anti-K and anti-D, requiring IUT over 27 years at a quaternary fetal centre. We reviewed data for 128 pregnancies in 116 women undergoing 425 IUTs. The median gestational age (GA) at first IUT was significantly earlier for anti-K than for anti-D (24·3 vs. 28·7 weeks, P = 0·004). Women with anti-K required more IUTs than women with anti-D (3·84 vs. 3·12 mean IUTs, P = 0·036) and the fetal haemoglobin (Hb) at first IUT was significantly lower (51.0 vs. 70.5 g/l, P = 0·001). The mean estimated daily decrease in Hb did not differ between the two groups. A greater number of IUTs and a slower daily decrease in Hb (g/l/day) between first and second IUTs were predictive of a longer period in utero. Earlier GA at first IUT and a shorter interval from the first IUT until delivery predicted IUFD/NND. Earlier GA and lower Hb at first IUT significantly predicted need for phototherapy and/or blood product use in the neonate. In the anti-K group, a greater number of IUTs was required in women with a higher titre. Furthermore, the higher the titre, the earlier the GA at which an IUT was required in both groups. The rate of fall in fetal Hb between IUTs decreased, as the number of transfusions increased. Our present study identified pregnancies at considerable risk of an unfavourable outcome with anti-D and anti-K RBC alloimmunisation. Identifying such patients can guide pregnancy management, facilitates patient counselling, and can optimise resource use. Prospective studies can also incorporate these characteristics, in addition to laboratory markers, to further identify and improve the outcomes of these pregnancies.

RhD-induced immunogenetic disparity between mother and fetus: medical importance and economic effect of using molecular genetic technology

Introduction. Here we discuss the problem of timely diagnostics and prevention of Rh-immunization of pregnant women as well as fetal hemolytic disease, which remains currently relevant, despite the existence of proven diagnostic, therapeutic and preventive methods.Aim: to assess the medico-economic efficiency of non-invasive prenatal diagnostics of using fetal Rh factor (rhesus D antigen, RhD) in maternal blood – a fetal RhD-genotyping.Materials and Methods. A retrospective observational study was conducted to analyze determining fetal Rh-factor in the blood samples from 4109 Rh-negative pregnant women observed in the 41 medical facilities of the Ulyanovsk region in the years 2018–2020. The fetal RhD level was determined by polymerase chain reaction at gestational age of ≥ 10 weeks. To assess testrelated medical effectiveness, there were examined sensitivity, specificity, predictive value of positive and negative data as well as diagnostic accuracy. The data collected during the study were compared with those obtained after delivery. To assess the economic efficiency, the difference between the cost of immunization and the cost of determining the fetal Rh factor level was determined.Results. A positive and negative fetal Rh-factor was detected in 67.26 % (n = 2793) and 32.74 % (n = 1316) cases, respectively. Diagnostic accuracy of the test system "Test-RhD" was 99.40 %, sensitivity – 99.84 %, specificity – 97.51 %, the prognostic value of a positive result was 99.43 %, the predictive value of a negative result – 99.28 % with low rate of false positive and false negative data. It was shown that our study allows to avoid unnecessary immunization costs for all Rh-negative pregnant women.Conclusion. Analysis of the diagnostic characteristics and cost-effectiveness of the RhD test evidences about high medical significance of the method described and allows to recommend its wider application.

Rh-D primigravida mother with anti Rh-17 antibodies causing mild haemolytic disease of foetus and newborn in baby: a case report

Rh-D is an unusual phenotype in Rh blood group system, lacking all Cc or Ee antigens but demonstrates a stronger D antigen expression. We describe here an extremely rare Rh-D phenotyped mother with first baby affected by haemolytic disease of foetus and newborn (HDFN). A 20-year-old pregnant lady, presented in active labour with foetal distress and planned for emergency cesarean section. Her blood group was A RhD positive, with positive antibody screening. Antibody identification demonstrated multiple antibodies against RhCc Ee polypeptide by the reference laboratory. Rh phenotype was -D-/-D- with no C/c and E/e antigen but strong D antigen. Crossmatch was incompatible with all A RhD positive units. Management of such patient is extremely difficult due to the scarcity of Rh-D- donor blood. In this case, reference laboratory had one frozen Rh-D- blood ready for use if indicated. Fortunately, patient underwent caesarean section without any complication. Baby was grouped as A Rh-D positive with probable Rh genotype as CDe/-D-. Baby’s DCT was positive and eluate showed antibodies of identical reactivity as mother. Baby developed mild jaundice at day-2 and managed with phototherapy. Clinically Rh-D- phenotype in pregnant women can cause mild to fatal HDFN. Routine antibody screening in pregnant women can detect such rare case that helps proper management of mother and baby. Prior arrangement of this rare blood is warranted to prevent the maternal and infant mortality and morbidity.
 Bangladesh Journal of Medical Science Vol.20(3) 2021 p.669-672

EXCHANGE TRANSFUION IN HEMOLYTIC DISEASE OF NEWBORN:EFFICACY OF WHOLE BLOOD RECONSTITUTED (WBR) OVER WHOLE BLOOD

INTRODUCTION: hemolytic disease of newborn; also known as erythroblastosis fetalis, is an preventable blood group disorder that occurs when the blood types of mother and fetus are incompatible. A prospective study was MATERIAL AND METHOD: carried out on the cases suffering with HDN in the year 2018-2020 in the Blood Bank of the Department of Pathology, G.R. Medical College, Gwalior. The affected cases were given double volume exchange transfusion by reconstituted blood or whole blood and the outcome was studied. 150 cases of HDN RESULT: were studied out of which RhD HDN was found to be the most common cause seen in 61.3% and exchange transfusion by reconstituted blood was found to be an effective therapy. The reconstituted blood is found to be immunologicall CONCLUSION: y much safer and better than whole blood for purpose of exchange transfusion in hemolytic disease of fetus and newborn because of its superiority in minimizing transfusion reactions and in achieving all the therapeutic effects of exchange transfusion in better way.

Pregnancy management tactics in fetal hemolytic disease. Literature review

Hemolytic disease of the fetus is one of the types of pathological abnormalities in the development of the fetus, the reason of which is isoimmune hemolytic anemia. Depending on the degree of severity of this pathology, it can influence the development of the fetus both in a mild form, practically leaving no trace and in a severe form, which can cause fetal death.
 When carrying out a timely diagnostic research to detect this pathology, tactics of pregnancy management should differ, that will allow maintaining of pregnancy and ensure normal development of the fetus just until the moment of childbirth. To determine the tactics, which will be used during pregnancy management, it is necessary to identify not only the symptoms of hemolytic diseases of the fetus but its degree as well. Depending on the degree of severity of this disease, the activities will differ. If the disease is developing in a mild form, a pregnant woman is thoroughly observed and repeatedly diagnosed; if it is a severe form, intrauterine fetal blood transfusions are regularly conducted. The tactics of managing pregnancy with the detected fetal hemolytic disease will differ from the standard one and its right choice will ensure normal development of the fetus and term labor with minimum risks for both a mother and a child.