Three examples of Rh haemolytic disease of the newborn with a negative direct antiglobulin test

Heddle, NM; Wentworth, Paul; Anderson, David R.; Emmerson, D.; Kelton, John G.; Blajchman, MA

doi:10.1111/j.1365-3148.1995.tb00197.x

Cited by 8 publications

(5 citation statements)

References 12 publications

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“…Surprisingly, sonographic signs of hydrops were not observed in any of the severely anaemic cases in our series. Finally, the direct antiglobulin test on cord blood, which is considered to be an extremely reliable predictor of clinical disease, gave negative results in two cases of c-sensitization and that of Fya-iso-immunization, which is similar to the observations of Heddle et al (1995).…”

Section: Commentssupporting

confidence: 65%

Haemolytic disease of the newborn caused by anti-c, anti-E and anti-Fya antibodies: report of five cases

Babinszki

Berkowitz

1999

Prenat. Diagn.

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Fetal haemolytic disease caused by irregular antibodies is discussed on the basis of three cases with maternal anti‐c alone, one with anti‐E along with anti‐c, and one with anti‐Fya sensitization. All fetuses suffering from maternal c‐allo‐immunization alone were treated with intra‐uterine transfusions and the newborns received exchange transfusions. These interventions were also required in the case of simultaneous E and c‐allo‐immunization, and this was the most severe of the five cases. ΔOD450 results were consistent with the severity of the fetal condition in the c and/or E allo‐immunization cases. Maternal anti‐Fya sensitization caused only mild jaundice of the neonate, but the results of amniotic fluid analysis were quite misleading in that case. Antibody titres did not prove to have good prognostic values (though they were all above the critical level), and the direct antiglobulin test from cord blood was negative in three cases. Regular sonographic evaluations were performed and fetal blood samplings were a cornerstone of management. Copyright © 1999 John Wiley & Sons, Ltd.

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Section: Commentssupporting

confidence: 65%

Haemolytic disease of the newborn caused by anti-c, anti-E and anti-Fya antibodies: report of five cases

Babinszki

Berkowitz

1999

Prenat. Diagn.

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“…In the USA, anti-D + anti-C is the most common combination in women with multiple RBC antibodies, and they are more likely to develop significant HDN [22]. Rh HDN with negative DAT has also been reported in the literature [23]. We encountered one case of ABO incompatibility along with Rh HDN.…”

Section: Discussionmentioning

confidence: 74%

The Spectrum of Hemolytic Disease of the Newborn: Evaluating the Etiology of Unconjugated Hyperbilirubinemia Among Neonates Pertinent to Immunohematological Workup

Routray¹,

Behera²,

Mallick³

et al. 2021

Cureus

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Background and objectiveThe exact burden of hemolytic disease of the newborn (HDN) attributed to neonatal unconjugated hyperbilirubinemia (NUH) in developing nations is still unclear. Still, anti-D is reported to be the most common cause of HDN in India. ABO incompatibility has emerged as a leading cause of exchange transfusion (ET) in many countries. But many centers in our country rely on direct antiglobulin test (DAT) as a screening tool to evaluate immunological causes, whereas advanced immunohematological workup like antibody screening, identification, and elution tests are also required. Early identification of implicated antibodies resulting in HDN can aid in the proper selection of blood units when ET is indicated, and hence also in managing the subsequent pregnancy. This study focused on determining the causes of neonatal hyperbilirubinemia (NH), especially with respect to immunohematological evaluation. This cross-sectional study was conducted on 240 neonates requiring neonatal intensive care unit (NICU) support for NUH at a tertiary care hospital. Materials and methodsDemographic data, along with detailed history pertaining to the cause of hyperbilirubinemia, was collected. Clinical and laboratory evaluation and complete immunohematological work including DAT, heat elution, antibody screening, antibody identification, and Rh Kell phenotyping were performed from neonate blood samples. Data were analyzed using SPSS Statistics version 19 (IBM Corp., Armonk, NY). ResultsPathological jaundice was more common (62.1%) than physiological jaundice (37.9%). The various pathological causes identified were HDN (42.6%), sepsis (12%), cephalohematoma (5.4%), and idiopathic (1.7%). Among HDN cases, ABO incompatibility (39.2%) was the most prevalent cause, followed by Rh HDN and G6PD deficiency (1.7% each). DAT was positive in only 14 cases out of 94 ABO-incompatible cases. Elution revealed antibodies in four DAT-negative neonates with ABO incompatibility and more specificity to the OA setting. DAT was positive with 100% sensitivity in Rh HDN cases (n=4). Elution demonstrated the presence of anti-D (n=2), anti-D + anti-C (n=1) and anti-E (n=1), confirming Rh HDN. DAT strength was found to be significantly associated with hemoglobin (Hb) level (p=0.048). The majority of cases were treated with phototherapy only (94.1%), and 10 cases received both ET and phototherapy. Four neonates' condition improved without any intervention. ConclusionThis study highlighted the shift in the trend from Rh HDN to ABO incompatibility as the cause of hemolytic jaundice in NICU neonates. Elution tests can aid in the diagnosis of DAT-negative ABO-incompatible hemolytic anemia. Early diagnosis, along with timely intervention and appropriate measures, can prevent neonatal morbidity and mortality. Negative DAT does not rule out HDN. Sensitive techniques like elution must be used in the presence of clinical suspicion.

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“…Both of these antibodies are clinically significant and have been associated with haemolytic transfusion reactions and mild to moderate haemolytic disease of the newborn (HDN). [10–12] Anti-D (3.9%) was not frequent in the Thai population due to the low frequency of RhD negative (<1.0%) within the Thais population. [13] Although anti-D is rare in Thais, it often causes problems in clinical transfusion and severe haemolytic disease of the newborn because it is not well recognized by many clinicians.…”

Section: Discussionmentioning

confidence: 99%

Frequencies and specificities of red cell alloantibodies in the Southern Thai population

Promwong

Siammai

Hassarin

et al. 2013

Asian J Transfus Sci

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Context:Detailed reports of red cell alloantibody frequencies and specificities in the Thai population are limited. The aims of this study were to determine the specificity and compare the frequency of alloantibodies detected using column agglutination technology (CAT) and conventional tube techniques in blood donors and previously transfused patients.Settings and Design:We retrospectively reviewed antibody screening and identification records for two time periods: January-December 2006 during which conventional tube techniques were used and January 2008-December 2009 when CAT was used.Results:The overall prevalence of alloantibodies in both patients and donors when using conventional tube techniques was 0.7%, for patients only was 0.9% and donors 0.6%. The most frequent antibodies detected in both groups were anti-Lea, anti-Mia, anti-Leb, anti-P1 and anti-E. When using CAT, alloantibodies were found in 0.8% of patients and 0.13% of donors with the five most common alloantibodies found in patients were anti-Mia, anti-E, anti-Lea, anti-c and anti-Leb respectively. Similarly the common alloantibody specificities in donors were anti-Lea, anti-Mia, anti-Leb, anti-M and anti-D.Conclusions:One of the most commonly identified alloantibodies in the Thai population studied was anti-Mia suggesting that Mia positive red cells should routinely be included in antibody screening and identification in this population. For antibody screening and identification, CAT method detected immune and warm alloantibody (ies) more frequently than that associated with conventional tube techniques.

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Three examples of Rh haemolytic disease of the newborn with a negative direct antiglobulin test

Cited by 8 publications

References 12 publications

Haemolytic disease of the newborn caused by anti-c, anti-E and anti-Fya antibodies: report of five cases

Haemolytic disease of the newborn caused by anti-c, anti-E and anti-Fya antibodies: report of five cases

The Spectrum of Hemolytic Disease of the Newborn: Evaluating the Etiology of Unconjugated Hyperbilirubinemia Among Neonates Pertinent to Immunohematological Workup

Frequencies and specificities of red cell alloantibodies in the Southern Thai population

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