The frequency of neonatal hemolytic disease and indirect hyperbilirubinemia due to Rh sensitisation has decreased with the widespread use of anti-D gamma globulin. required a double volume exchange transfusion. On follow up, bilateral sensorineural hearing loss was seen in one of the patients. All three neonates were normally healthy, gaining excess weight and WP1066 developmentally normal. Keywords: antibody screening, hemolytic disease of newborn, minor blood group, neonatal hyperbilirubinemia, reddish cell allo-immunization 1.?Introduction The estimated global prevalence of haemolytic disease of the fetus and newborn (HDFN) due to Rh isoimmunisation is 276/100,000 live births per year (1). The prevalence of HDFN for developed counties like United States is estimated to be 3/100,000 to 80/100,000 while in developing regions like Latin America, North Africa/the Middle East, South Asia, sub-Saharan Africa, and Eastern Europe/Central Asia, the prevalence of HDFN due to Rh isoimmunisation is usually estimated at 252, 278, 385, 386, and 529/100,000 live births, respectively (1,2). The frequency of neonatal hemolytic disease and indirect hyperbilirubinemia due to Rh sensitisation has decreased with the widespread use of anti-D gamma globulin. Hence, the contribution of minor blood groups incompatibility other than Rh(D) antigen, such as Kell, c, C, E, e has gradually increased in HDFN (3,4). The prevalence of reddish cell antibodies other than anti-D with the potency to induce HDFN is about 1 in 500 pregnancies (5). Anti-c is usually described as the next most common cause of severe HDFN after anti-D (6). More and more cases of minor blood group incompatibility are now being diagnosed due to developments in investigation modalities. Neonates with minor blood group incompatibility may be asymptomatic or the clinical picture may range from moderate anemia, reticulocytosis, neonatal hyperbilirubinemia to fetal hydrops (4,7). The clinical presentation, diagnosis and management of three cases of neonatal hyperbilirubinemia due to minor blood group incompatibility and maternal allo-immunisation to anti-E and anti-c antigens is usually discussed here (Table 1). Table 1. Result of phenotypic analysis and Fshr antibody screening in parents and neonate
Mother’s Blood Group B+ AB+ A+ Father’s Blood Group O+ O+ A+ Baby’s Blood Group O+ B+ A+ DCT (Baby) 344Antigen detection: MotherFather MotherFather MotherBaby* D 4+3+ 4+4+4+4+C 4+-ve 4+3+ 4+4+c 4+3+ -ve4+ -ve4+ E -ve3+ 4+4+-ve4+ e 4+2+ 4+4+4+-veKell -ve-ve-ve-ve-ve-veICT(Mother) +ve +ve +ve Antibodies responsible for hemolysis Anti E antibody in mother and baby Anti c antibody in mother and baby Anti E and anti c antibodies in baby Open in a separate window *antigen detection in father could not be tested because father was not available for screening. 2.?Patients and Methods All neonates presenting with icterus were examined for pallor, organomegaly and indicators of bilirubin encephalopathy. Investigations including a complete blood count and peripheral smear (for hemolysis, spherocytes, atypical cells and reticulocyte count), serum bilirubin levels, ABO and Rh(D) typing of neonate and mother, direct coombs test and Glucose 6 phosphate dehydrogenase enzyme levels were carried out on all patients at admission. In all patients with a positive direct coombs test in the absence of ABO or Rh(D) setting, autoimmune and alloimmune causes were looked for including indirect coombs test, phenotypic analysis for minor blood groups (C, c, Kell, E, e), antibody screening and anti-nuclear antibodies. Treatment including phototheraphy and exchange transfusion was carried out as per the guidelines; and once the bilirubin was below the cut off and in a decreasing pattern, phototherapy was discontinued (8). All patients were monitored for rebound hyperbilirubinemia before discharge. After discharge, patients were kept under follow up for hearing screening, developmental assessment (9) and head circumference monitoring. 2.1. Case 1 A term 40-week gestation, female baby with birth excess weight 2,860 g was born to a 29-year-old G2P1L1 mother by an uneventful vaginal delivery in hospital. It was a booked pregnancy with regular antenatal visits and normal antenatal ultrasounds. Breast feeding was initiated within first hour of life and continued thereafter. Baby exceeded urine and stools around the first day of life and was discharged on second day WP1066 of life. There was no history of jaundice in the.
