Fetal Hemolytic Disease due to Anti-Rh17 Alloimmunization

Abstract

Objective: To delineate clinical features of a case of fetal hemolytic disease due to anti-Rh17, along with a review of relevant studies published in English and Japanese. Methods: We present clinical features of a –D-/-D- phenotype woman with anti-Rh17 alloimmunization during pregnancy. Relevant English literature in the MEDLINE database was reviewed, while Japanese studies were searched in the Japana Centra Revuo Medicina database. Results: A Japanese –D-/-D- woman with anti-Rh17 (Hro) was treated during pregnancy. Serial ultrasonography, antibody titers, amniocenteses, and cordocenteses were conducted for perinatal management. Amniocentesis results demonstrated a high delta optical density level of 450 in the amniotic fluid, while cordocentesis revealed alloimmunization between the mother and the fetus as well as fetal hemolytic anemia. Blood flow velocity in the middle cerebral artery indicated a rapid development of fetal anemia. The newborn demonstrated severe anemia and hyperbilirubinemia, which were successfully treated with exchange transfusions. Two cases of prenatally diagnosed fetal hemolytic disease due to anti-Rh17 were found published in English and 5 in Japanese. Conclusion: A –D-/-D- phenotype patient with anti-Rh17 was successfully managed during pregnancy and a good outcome for the neonate was achieved. Our results and a review of related literature led to the following suggestions. The first pregnancy in a –D-/-D- woman may be affected, an anamnestic immune response can easily occur during pregnancy, the level of anti-Rh17 titer is indicative of the degree of fetal hemolysis, and appropriate intrauterine intervention is warranted for achievement of a good outcome.

Rare case of hemolytic death of the newborn due to anti‐hr0 and anti‐e

“…However, in our case, an absent history of blood transfusion allows for the assumption that the antibody was produced by the previous childbearing. Only three cases of neonatal hemolysis caused by anti‐hr0 antibodies have ever been reported in English‐speaking countries through 2004, while the occurrence tends to be higher with more than 40 cases reported in Japan, 2 all of which carried anti‐hr0 antibodies alone. In eight of the patients, childbearing was terminated premature, two cases had spontaneous delivery, and six cesarean sections were performed at a gestation age of 27 +1 –36 +5 weeks.…”

“…It is believed that the titer of blood‐type antibody is elevated in pregnant woman and the high risk intrauterine hemolysis as gestation advances, thus early termination of pregnancy should be considered if necessary 2 . Blood exchange transfusion therapy for Rh system neonatal hemolysis follows the principle that the transfused Rh blood must be the same as the mother and match her ABO type.…”

Rh and RHAG Blood Group Systems

“…Similar tests with D · · cells revealed an antibody, named anti -Dav (anti -RH47), in some D --sera [430] . Anti -Hr o in the sera of D --, Dc − , DC w − , and DIV(C) − mothers has been responsible for severe, and often fatal, HDFN [461,477,485,487,493,494] (reviewed in [493,494] ). Other antibodies to high frequency antigens, nonreactive with Rh null and D --cells, have been identifi ed in individuals with unusual Rh phenotypes, such as those homozygous for R N (anti -Rh46), or for genes producing partial e antigens (anti -Hr, -Hr B ) [335,442] .…”

Sensitization to Multiple Rh Antigens by Transfusion of Random Donor Platelet Concentrates in a -D- Phenotype Patient

“…In most cases, the factors that trigger sensitization in -D- individuals are known to be pregnancy or the transfusion of packed RBCs [2-6, 13-17]. To the best of our knowledge, there has been no reported case of a -D- individual sensitized by platelet transfusion.…”