<strong>Hemolytic disease of the newborn due to non-Rh(D) antibody in a single family affecting all siblings</strong>
Creators: name: Naqvi, Fizza
name: Linga, Vijay
name: Bhatt, Parth
name: Naqvi, Mubariz
Publisher: name: figshare
Year: 2023
Subjects: Neonatology
Paediatrics not elsewhere classified

description: <strong>Introduction:</strong> Hemolytic disease of the fetus and newborn (HDFN) is a cause of early neonatal jaundice. Alloantibodies associated with HDFN are towards the blood types Rh (D), Kell, Rh(c), Rh (E), Duffy, MNS, P, and ABO. Since the screening of Rh (D) antibodies and prophylaxis with Rh (D) immunoglobulin in 1970, the incidence of HDFN due to RhD has decreased. Now, most HDFN cases are due to ABO incompatibility or other red blood cell antibodies, such as anti-Kell, anti-Rh(c), anti-Rh (E) and others. The most common way of developing maternal alloantibodies are by blood product transfusion, fetomaternal bleeding, and needle sharing. Anti-c isoimmunization has been shown to cause significant HDFN with some studies showing that the severity of hemolysis matches that of Anti-D antibodies. Here we present a single family with all the siblings affected with jaundice and last two pregnancies have maternal anti-c antibodies documented. <strong>Case Report:</strong> A 30-year-old African American G5P4014 mother with blood type B+ and anti-Rh(c), anti-Lewis antibodies and hemoglobin C trait. Father’s blood group is unknown. The first pregnancy was a female; born at 38 weeks of gestation as per mother she had jaundice, but did not require phototherapy. The second pregnancy was a male who was O+ and DAT negative with hemoglobin C trait. He also had jaundice and required phototherapy for 4 weeks. The third pregnancy was a miscarriage at 6 weeks. The fourth pregnancy was a female born at 39 weeks by C-section; blood group was O+ and DAT positive with anti–c antibodies. She also required phototherapy for 4 days. Fifth pregnancy was a male born at 38 weeks gestation by C-section, O+ and DAT positive with anti-c antibodies and hemoglobin C trait. Maternal antibody titer for anti-c was not available and there was no anemia or features of hydrops. The baby required phototherapy for nearly 175 hours and responded to intensive quadruple phototherapy without requirement for exchange transfusion. <strong>Discussion:</strong> Prevention of HDFN due to antibodies other than Rh (D) remains a challenge at this time. In our case the severity of jaundice due to anti–c alloimmunization in successive pregnancy was increasing, implying availability of ready antibodies in the mother. Early identification and prevention of pregnancy remains the cornerstone in non-Rh (D) alloimmunizations. Pre-pregnancy counseling with blood typing of mother with antibody titers and potential father’s blood typing may prevent isoimmunization. Prevention of HDFN can be accomplished with in vitro fertilization, pre-implantation genetic diagnosis, use of gestational surrogate, and/or use of donor sperm. Prenatal care management can be done with monitoring maternal antibody titers and anemia in the fetus with noninvasive and invasive testing. Postnatal management may be achieved by aggressively monitoring the bilirubin levels and early initiation of phototherapy as in our case. Measures must be in place if the phototherapy is not effective, such as infusion of IVIG and exchange transfusion to prevent bilirubin induced neurological sequelae. <strong>Conclusion:</strong> There are several antibodies other than anti-Rh (D) and ABO subgroups that can cause hemolysis and subsequent jaundice in a newborn. Since these antibodies are not routinely screened for, they can cause severe hemolysis. When evaluating a newborn for jaundice, the presence of these antibodies should be considered. Furthermore, mothers should be counseled on the effects of these antibodies in her baby and subsequent pregnancies.