Hemolytic disease of the new-born due to ABO incompatibility


  • Vijaya S. Kattimani Department of Pediatrics, Mysore Medical College and Research Institute, Irwin Road, Mysore, Karnataka, India
  • Ushakiran C. B. Department of Pediatrics, Mysore Medical College and Research Institute, Irwin Road, Mysore, Karnataka, India




Direct coombs test, Hemolytic disease of the new-born, Phototherapy


Background: Better understanding of the clinical characteristics of HDN due to ABO incompatibility helps to optimise care. The objective of this study was to investigate the clinical manifestations and outcome of treatment modalities.

Methods:This study was a hospital based cross sectional study conducted in the neonatal unit of Cheluvamba hospital attached to Mysore Medical College and Research Institute. A total of 50 neonates with blood group A or B born to mothers with blood group O; with jaundice and or anemia were enrolled during the period from January 2015 to December 2015. The various maternal and neonatal parameter and their association with development of jaundice and or anemia was studied. The outcome of treatment modalities was studied.

Results: Out of 50 ABO Incompatible neonates 24 (48%) were male and 26 (52%) were female. The percentage of O–A and O–B incompatible neonates were 38% (19) and 72% (31), respectively. Jaundice was detected within the first 24 hours in 6% and 18% neonates had anemia. The mean age of presentation was 2.9±0.89 days. The various maternal and neonatal factors had no significant association with development of jaundice and or anemia due to ABO Incompatibility. The mean initial Indirect Bilirubin was 21.26±3.97, initial hemoglobin was 14.3±2.31 and the mean Reticulocyte count was 16.6±5.3. Total 22 (44%) neonates had laboratory evidence of hemolysis (microspherocytosis). DCT was positive in 4 (8%) neonates. The main clinical manifestation was jaundice and was treated with phototherapy in 49 (98%) of the cases. The mean duration of phototherapy was 53.84±9.82 hours. Only one infant required exchange transfusion and on follow up had no neurological sequelae. The mean total duration of stay was 3.6±1.2 days. There was no significant difference in the HDN due to either O–A or O–B incompatibility.

Conclusions:Early identification of high risk neonates with ABO Incompatibility, diagnosis and early intervention can reduce morbidity and mortality. 


Wang M, Hays T, Ambruso DR. Hemolytic disease of the newborn, caused by a high titre anti-group B Ig G from a group A mother. Pediatr Blood Cancer. 2005;45:861-2.

Omatade OO, Adeyemo AA, Kayode M, Falade SL, Ikpeme S. Gene frequencies of ABO and Rh (D) blood group Allelles in a healthy infant population in Ibadan, Nigeria. West Afr J Med. 1990;18(4):294-7.

Drabik-Clary K, Reddy VV, Benjamin WH, Bactor FN. Severe hemolytic disease of the newborn in a group B African-American infant delivered by a group O mother. Ann Clin Lab Sci. 2006;36(2):205-7.

Chen JY, Ling UP. Prediction of the development of neonatal hyperbilirubemia in ABO incomptability, Zhonghua yi xie za zhi (Taipei). 1994 Jan;53(1):13-8.

Palleau S, Le Tourneau C, Jrad I, Andreuy JP, Govin I. ABO incompatibility and newborn heamolytic disease: two cases with major erythroblastosis. Ann Biol Clin. 2004;62(3):344-8.

Neil A Murray, Irene AG Roberts. Hemolytic disease of the newborn. Archiv Dis Childhood Fetal Neonat 2007;92:f83-f88.

Fischer K, Poschmann A, Grundmann A. Hemolytic disease of the newborn due to ABO incompatibility (author’s transl). Z Geburtshilfe Perinato. 1977 Aug; 181(4):227-40.

Chintu C, Zipursky A, Blajchman M. ABO hemolytic disease of the newborn. East Afr Med J. 1979Jul;56(7).

Haare KM, Rahman M. An unusual case of ABO-HDN. Bangladesh Med Res Counc Bull. 2000Aug;26(2):61-4.

Dufour DR, Monoghan WP. ABO-Hemolytic disease of the newborn-A retrospective analysis of 254 cases. Am J Clin Pathol. 1980 Mar;73(3):369-73.

Wagle S, Deshpande Pr. Hemolytic disease of newborn. E Medicine. June 2006.

Bowman JM. Hemolytic disease (erythroblastosis fetalis). Creasy RK, Resnik R. Maternal-fetal medicine. 4th edition. Philadelphia: WB Saunders;1999:736-67.

Kumar A, Patel MK, Chavda B. Hemolytic disease of the newborn: A study of 50 cases. IJSS 2013 Oct-Dec;1(3):95-9.

Akgül S, Korkmaz A, Yiğit S, Yurdakök M. Neonatal hyperbilirubinemia due to ABO incompatibility: does blood group matter. Turk J Pediatr. 2013 Sep 1;55(5):506-9.

Shah A, Shah CK, Shah V. Study of hematological parameters among neonates admitted with neonatal jaundice. J Evol Med Dental Sci. 2012 Jul;1(3):203-8.

Preethi BP, Maitreyee DS, Khemka M. Correlation of cord bilirubin levels with hyperbilirubinemia in ABO Incompatibility. Int J Pharma Bio Sci. 2011 Apr-Jun;22(2):257-62.

Mantani M, Patel A, Renge R, Kulkarni H. Prognostic value of direct bilirubin in neonatal hyperbilirubinemia. Indian J Pediatr. 2007;79:819-22.

Sharma P, Chhangani NP, Meena KR, Jora R, Sharma N, Gupta BD. Brainstem Evoked Response Audiometry (BAER) in neonates with hyperbilirubinemia. Indian J Pediatr. 2006;73:413-6.

Maisels MJ, Kring E. Length of stay, jaundice and hospital readmission. Pediatrics. 1998;101:995-8.

Nepal D, Banstola D, Dhakal AK, Mishra U, Mahaseth C. Clinico-laboratory profile and immediate outcomes of hyperbilirubinemic babies admitted in Kanti children hospital. J Nepal Paediatr Soc. 2010 Jan-Jun;30(1):31-6.

Rasul CH, Hasan MA, Yasmin F. Outcome of neonatal hyperbilirubinemia in a tertiary care hospital in Bangladesh. Malaysian J Med Sci. 2010 Apr-Jun;17(2):40-4.

Irshad M, Muhammad A, Hussain M, Khan B, Ali N, Ahmad A et al. Prevalence of rhesus type and ABO incompatibility in jaundiced neonates. J Postgrad Med Inst. 2011; 25(3):233-9.

Kalakheti BK, Singh R, Bharra NK, Baral N. Risk of neonatal hyperbilirubinemia in babies born to ‘O’ positive mothers: a prospective cohort study. Kathmandu Univ Med J. 2009;7(25):11-5.

aks A, Vilhekar K, Jain M, Zade P, Atkari S, Verkey S. Prediction of development of neonatal hyperbilirubinema by increase umbilical cord blood bilirubin. Ind Medica. 2005;9(1):5-9.

Knudsen A. Prediction of the development of neonatal jaundice by increased cord blood bilirubin. Acta Paediatr Scand. 1989;78:217-21.

Rostami N, Mehrabi Y. Identifying the newborn at risk for developing significant hyperbilirubinemia by measuring cord blood bilirubin levels. J Arab Neonatal Forum. 2005;2:81-5.

Oral E, Gezee A, Cagdas A, Pakkal N. Oxytocin infusion in labor: the effect different indications and the use of different diluents on neonatal bilirubin levels. Archgynecol Obstet. 2003 Jan;267(3):117-20.

Awasthi S, Rehman H. Early prediction of neonatal hyperbilirubinemia. Indian J Pediatr. 1998;65:131-9

Bhat Y, Pavan Kumar C. Morbidity of ABO haemolytic disease in the newborn. Paediatr Int Child Health. 2012;32:93-6

McDonnell M, Hannam S, Devane SP. Hydrops fetalis due to ABO incompatibility. Arch Dis Child Fetal Neonatal Ed. 1998;78:F220-F1.

Stiller RJ, Herzlinger R, Siegel S, Whetham JC. Fetal ascites associated with ABO incompatibility: case report and review of the literature. Am J Obstet Gynecol. 1996;175:1371-2.

Adewuyi J, Gwanzura C. Racial difference between white and black Zimbabweans in the haemolytic activity of A, B, O antibodies. Afr J Med Med Sci. 2001;30:71.

Thakker B, Shah AA. Haemolytic conditions of newborn-A laboratory study. NHL J Med Sci. 2014 Jul 1;3(2).

Ella EE, Garba SA, Ogal WN. ABO Incompatibility and its role in neonatal jaundice in Zaria, Kaduna state of Nigeria. IJES. 2013;2(11):17-23.

Baker FJ, Silverton RE, Pallister CJ. Introduction to Medical Laboratory Technology. 7th ed. London: Bounty Press Ltd; 2001:348-419.

Sharma DC, Rai S, Mehra A, Kaur MM, Sao S, Gaur A, et al. Study of 25 cases of exchange transfusion by reconstitute d blood in hemolytic disease of newborn. Asian J Transfus Sci. 2007;1:56-8.






Original Research Articles