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HEMOLYTIC DISEASE OF THE NEWBORN CASE #3
SCENARIO Baby Girl Dae Two-day old
jaundiced newborn girl
Sample of her blood submitted for HDFN workup
WHAT WE KNOW ABOUT THE MOTHER
Doris Dae Mother's first pregnancy Pre-natal type and screen done at 2 months -
ADT negative Blood was tested again at 28 weeks
gestation - ADT negative Received prophylactic antenatal RhIg at 28
weeks Post-delivery specimen was submitted for an
RhIg retest
SEROLOGICAL RESULTS FOR BABY
Blood type - A pos
Test for Circulating Antibody (reverse type)
A B a b D [IS] Ctl [IS]
3+ - - - 3+ -
3+ - - - 3+ -
IS 37o AHG CCC
A1 cells - - 1+
B cells - - -/- +
BABY’S SEROLOGICAL RESULTS CONT.
Antibody Detection Panel
DAT
IS 37o AHG CCC
I - - -/- +
II - - -/- +
IS 37 o CCC
1+ 1+
ELUTION RESULTS ON BABY’S BLOOD
Elution results
At this stage we know that the baby has maternal ABO antibody coating her cells
Cells AHG CCC
A1 + cells 2+
A1 – cells 2+
B + cells -/- +
B – cells -/- +
O + cells -/- +
O – cells -/- +
SEROLOGICAL RESULTS FOR MOTHER
Post-delivery confirmation of blood type
Post-delivery antibody screen (ADT)
Antibody Detection Panel Most likely antibody: anti-D Can't rule out anti-C, -E, -Cw, -K
A B a b DIS
D37
o
DAHG
DCCC
CtlIS
Ctl37o
CtlAHG
CtlCCC
- - 3+
3+
- - -/- + - - -/- +
IS 37o AHG CCC
I - - 1+
II - - 1+
IS THERE A SEROLOGICAL PROBLEM IN EITHER THE MOTHER OR THE BABY?
Yes - baby is reacting to an antibody from the mother; the mother has tested positive for an antibody as well
DOES THE CHILD HAVE HDN? WHAT TYPE OF HDFN?
Yes - ABO HDN Antibody is coating the baby’s cells Baby is showing classic symptoms of a hemolytic
reaction Serological testing shows that it is an ABO
antibody, not Rh or non-Rh HDFN
WHAT LED YOU TO THE CONCLUSION OF HDN AND WHAT IS/ARE THE IMPLICATED ANTIBODIES?
DAT - shows that there is an IgG antibody coating the baby's RBCs
Back type and elution - shows that it is an ABO reaction, not Rh or non-Rh. Weak D reaction is negative
Clinical presentation and patient history also helps Jaundiced baby within 48 hours of delivery This is the mother's first pregnancy Mother is type O- and baby is type A+ Antibody present: most likely anti-A,B
HOW WOULD YOU EXPLAIN THE TESTING RESULTS TO THE PHYSICIAN? Discuss clinical presentation of ABO HDN,
both the mother and the newborn’s test results and common treatments ABO HDFN usually presents with milder hemolytic
symptoms; thus transfusion is rarely necessary Infant’s rising bilirubin levels are due to the liver’s
immaturity and inability to keep up with the breakdown excess free hemoglobin due to RBC lysis. In utero, the mother’s liver was clearing the bilirubin before it could accumulate.
Increasing levels of bilirubin can be treated with phototherapy using a blue light of a specific frequency that breaks down the bilirubin
TRANSFUSION INDICATED TREATMENT IN THE NEWBORN FOR HDN ABO
Rapidly increasing bilirubin levels not controlled by the phototherapy
Transfusion with group O Rh- RBC’s may be required
WHAT TYPE OF BLOOD PRODUCTS SHOULD BE GIVEN TO THE MOTHER?
Blood Products: RBC: O neg Plasma: O preferred, any type will be acceptable Platelets: O neg
NOTE: Rh matching is not required with plasma and cryoprecipitate Platelets must be selected according to the Rh status of
recipient.
WHAT TYPE OF BLOOD PRODUCTS SHOULD BE GIVEN TO THE BABY? Blood Products:
RBC: O neg Plasma: AB Platelets: O neg
NOTE: Baby should be transfused using cells that match
the mother’s blood type and Rh status. O neg is the universal donor type since it has no
antigens on the surface of the red cells
WERE THERE ANY UNNECESSARY TESTS DONE?
Back-typing the baby with B cells was not necessary Baby is not producing its antibodies yet If maternal ABO crossed the placenta it is most
likely anti-A,B (anti-A and anti-B are IgM unless the mother was immunized in some rare scenario)
Testing with A cells alone would be sufficient to detect anti-A,B or rare anti-A IgG
ARE THERE ANY ADDITIONAL TESTS THAT WOULD BE USEFUL IN SOLVING THIS PROBLEM?
Test baby's eluate or mother's serum for anti-A,B to confirm that it is the antibody causing the reaction
To finish the work-up you should try to rule out the additional antibodies from the mother's antibody panel
WHY IS BABY ONLY REACTING WITH A?
Cells have more A receptors than B receptors - the A response was already pretty weak so the B response may not have been detectable (not high enough titer of antibody?)
Mom could have been previously immunized and formed IgG anti-A (rare!)
SHOULD THIS MOTHER RECEIVE RHIG? WHY OR WHY NOT?
yes - mother is Rh neg and the baby is Rh pos and we want to prevent the mother from becoming immunized
the mother's pre-natal and 28 week ADT were both negative
post-natal ADT was positive but weak Baby RBC elution shows no anti-D positive post-natal ADT is due to residual
RhIg? from the prophylactic treatment at 28 weeks
QUESTIONS?