Late onset severe anemia due to rhesus isoimmunization

Hareesh Vardhan Jadala, Pooja V., Raghavendra K., Prithvish C. M., Srinivas B.


Rh isoimmunization usually presents with severe neonatal jaundice associated with anemia needing exchange transfusion and phototherapy. Sometimes babies who have mild or no symptoms at birth may present later with severe hemolytic anemia. In this case report we have described a newborn infant who had mild jaundice initially and presented with severe anemia in the fourth week of life. This case signifies the importance of regular follow up and close monitoring of Rh isoimmunized infants for the first two months for delayed onset anemia.


Anemia, Blood transfusion, Direct coombs test, HDN, Jaundice, Newborn, Phototherapy, Rh isoimmunization

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Bowman J. Rh-immunoglobulin: Rh prophylaxis. Best Pract Res Clin Haematol. 2006;19:27-34.

Kumpel BM, Elson CJ. Mechanism of anti-D-mediated immune suppression a paradox awaiting resolution? Trends Immunol. 2001;22:26-31.

Turner RM, Jones LM, Anumba DOC, Smith GCS, Spiegelhalter DJ. Routine antenatal anti-d prophylaxis in women who are Rh(d) negative: meta-analyses adjusted for differences in study design and quality. PLoS ONE. 2012;7(2):30711.

Gross S, Shurin SB, Gordon EM. Behrman’s neonatal-perinatal medicine: Diseases of the fetus and infant. 3rd editionn. St Louis: Mosby; 1983.

Fraser ID, Oppe TE, Tovey GH, Webb DA. Post-exchange anaemia in Rh haemolytic disease. Lancet. 1964;2:1309-11.

Ebbesen F. Late anaemia in infants with rhesus haemolytic disease treated with intensive phototherapy. Eur J Pediatr. 1979;130:285-90.

Hayde M, Widness JA, Pollak A, Kohlhauser-Vollmuth C, Vreman HJ, Stevenson DK. Rhesus isoimmunisation: increased haemolysis during early infancy. Pediatr Res. 1997;41:716-21.

Mentzer WC, Glader BE. Erythrocyte disorders in infancy. In: Taeusch WH, Ballard RA, Gleason CA, editors., eds. Avery’s Diseases of the Newborn. Eight Edition Philadelphia, PA: Elsevier, Mosby, Inc; 2005:1188-91.

9. Dallacasa P, Ancora G, Miniero R, et al. Erythropoietin course in newborns with Rh hemolytic disease transfused and not transfused in utero. Pediatr Res. 1996;40:357-60.

Mitchell S, James A. Severe late anemia of hemolytic disease of new born. Pediatric Child Health. 1999;4(3):201-3.