Non RhD isoimmunization causing severe hemolytic disease of fetus and newborn in Rh positive pregnancies: report of 2 cases with review of literature
Keywords:Anti-c antibody, Hemolytic disease, Hyperbilirubinemia, Isoimmunization
Anti D immunoprophylaxis widespread use in antenatal patients has led to dramatic reduction in the rates of alloimmunization due to anti D, which is the most common Rh antibody causing severe Hemolytic Disease of Fetus and New born (HDFN). However, there has been increase in the rates of non Rh D antibodies causing alloimmunization in pregnant women and leading to moderate to severe HDFN. We hereby report two cases of neonates presenting with moderate to severe HDFN with strongly positive DAT due to Rh anti-c antibody in Rh-positive mothers. Thus, antenatal antibody screening should be done in all Rh-positive pregnant women to prevent the diagnostic delay of HDFN occurring due to Non anti-D isoimmunization in the fetus.
Harmening D. Modern blood banking & transfusion practices. 6th ed. Philadelphia: F.A. Davis; Chapter 19 Hemolytic Disease of the Fetus and Newborn (HDFN); 2012:672.
Levine P, Burnham L, Katzin EM, Vogel P. The role of iso-immunization in the pathogenesis of erythroblastosis fetalis. JAMA 1941;113:126-7.
Poole J, Daniels G. Blood group antibodies and their significance in transfusion medicine. Transfus Med Rev. 2007 Jan;21(1):58-71.
Basu S, Kaur R, Kaur G. Hemolytic disease of the fetus and newborn: Current trends and perspectives. Asian J Transfus Sci. 2011 Jan;5(1):3-7.
Daniels G, Bromilow I. Essential guide to blood groups. 3rd ed. West Sussex: Wiley; Chapter 4, The Rh blood group system; 2016:35-48.
Pahuja S, Gupta SK, Pujani M, Jain M. The prevalence of irregular erythrocyte antibodies among antenatal women in Delhi. Blood Transfus. 2011 Oct;9(4):388-93.
Lurie S, Eliezer E, Piper I, Woliovitch I. Is antibody screening in Rh(D)- positive pregnant women necessary? J Mater Fetal Neo-natal Med. 2003;14:404-6.
Adeniji AA, Fullar I, Dale T, Lindow SW. Should we continue screening Rhesus D positive women for the development of atypical antibodies in late pregnancy? J Matern Fetal Neonatal Med. 2007;20:59-61.
Astrup J, Kornstad L. Presence of anti-c in the serum of 42 women giving birth to c positive babies: serological and clinical findings. Acta Obstet Gynecol Scand. 1977;56(3):185-8.
Hardy J, Napier JA. Red cell antibodies detected in antenatal tests on rhesus positive women in South and Mid Wales, 1948-1978. Br J Obstet Gynaecol. 1981 Feb;88(2):91-100.
Bowell PJ, Brown SE, Dike AE, Inskip MJ. The significance of anti-c alloimunization in pregnancy. Br J Obstet Gynecol. 1986;93:1044-8.
Koelewijn JM, Vrijkotte TG, Van der Schoot CE, Bonsel GJ, De Haas M. Effect of screening for red cell antibodies, other than anti‐D, to detect hemolytic disease of the fetus and newborn: a population study in the Netherlands. Transfusion. 2008 May;48(5):941-52.
Hackney DN, Knudtson EJ, Rossi KQ, Krugh D, O’Shaughnessy RW. Management Of Pregnancies Complicated By Anti-C Isoimmunization. Obstet Gynecol. 2004;103(1):24-30.
Thakral B, Agrawal SK, Dhawan HK, Saluja K, Dutta S, Marwaha N. First report from India of haemolytic disease of newborn by anti-c and anti-E in Rh (D) positive mothers. Hematology. 2007;12:377-80.
Singla S, Kumar S, Roy KK, Sharma JB, Kachhawa G. Severe hydrops in the infant of a Rhesus D-positive mother due to anti-c antibodies diagnosed antenatally: a case report. J Med Case Rep. 2010 Feb 18;4:57.
Murki S, Kandraju H, Devi SA. Hemolytic disease of the newborn- anti c antibody induced hemolysis. Indian J Pediatr. 2012 Feb;79(2):265-6.
Sheeladevi CS, Suchitha S, Manjunath GV, Murthy S. Hemolytic Disease of the Newborn Due to Anti-c Isoimmunization: A Case Report. Indian J Hematol Blood Transfus. 2013 Sep;29(3):155-7.
Rao SPR, Vujhini SK. Alloimmunisation in Rh “c” negative mother causing severe fetal hemolysis. Int J Contemp Pediatr. 2015;2:454-5.
Mina SS, Bhardwaj R, Gupta S. Hemolytic disease of newborn: Can think beyond Rh (D) and ABO incompatibilities. J Clin Neonatol 2017;6:37-9.
McCall AJ, Race RR, Taylor GL. Rhesus antibody in Rh-positive mother causing hemolytic disease of newborn. Lancet. 1944;i:214-5.
Hackney DN, Knudtson EJ, Rossi KQ, Krugh D, O'Shaughnessy RW. Management of pregnancies complicated by anti-c isoimmunization. Obstet Gynecol. 2004 Jan;103(1):24-30.