Severe hemolytic disease of the newborn caused by anti-Gonzales antibody.
We report on a female infant with severe hemolytic disease of the newborn (HDN) secondary to anti-Gonzales antibody (anti-Go(a)) necessitating an exchange transfusion within the first day of life. The infant was born to a mother known to be Gonzales-antigen negative and a father who was Gonzales-antigen positive. The mother had an anti-Go(a) titer of 1:256 at 35 weeks' gestation. The infant was noted to have jaundice shortly after birth, with a bilirubin of 17.8 mg/dl (total) and .05 mg/dl (direct) at 11 hours of life. Coombs' test was positive and cord cells were Gonzales-antigen positive. Eluate on cord cells demonstrated anti-Go(a). Despite aggressive phototherapy, the total bilirubin reached 23.3 mg/dl by 24 hours of age and a double-volume exchange transfusion was performed. Following the exchange transfusion, phototherapy was continued for several days. The hemoglobin, which was 19.8 gm/dl at 11 hours of age, remained stable through the hospitalization, and no further transfusions were required. History revealed that two prior pregnancies resulted in Gonzales-antigen positive infants. The first child experienced mild jaundice requiring no therapy, and the second child required phototherapy for prolonged hyperbilirubinemia. Previous reported cases of anti-Go(a) suggest that this is not a cause of severe HDN. However, in view of the current case, it may be prudent to follow women with anti-Go(a) prenatally with amniotic fluid bilirubin studies, serial antibody titers, and fetal hemoglobin levels.
Leschek
E
E
Medical Center of Delaware, Newark 19718.
Pearlman
S A
SA
Boudreaux
I
I
Meek
R
R
D001663:Bilirubin / Q000097:blood; D004899:Erythroblastosis, Fetal / Q000097:blood* / Q000628:therapy; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D010789:Phototherapy; D012204:Rh-Hr Blood-Group System / Q000097:blood / Q000276:immunology*; D065227:Transfusion Reaction
D007518:Isoantibodies; C033242:RH-antibodies; D012204:Rh-Hr Blood-Group System; D001663:Bilirubin