Repeated severe neonatal hemolysis due to Rhesus isoimmunization in a pregnant woman.
Rhesus (Rh) isoimmunization presenting as severe neonatal hemolytic disease is rare in RhD negative primigravidas of Chinese ethnicity. We report the case of a 32-year-old pregnant Taiwanese woman, RhD negative, who gave birth vaginally to two RhD-positive full-term fetuses 6 years apart. Antenatal follow-up was uneventful and there was no obvious fetal-maternal hemorrhage except at the performance of amniocentesis at the 19th week of the first pregnancy without anti-D immune globulin prophylaxis. Although anti-D immune globulins were administered to the mother within 1 hour after each birth, both of the newborns had severe neonatal hemolysis refractory to phototherapy and were rescued by exchange transfusions. Both of the children were well at age 7-years-old and one-year-old respectively In conclusion, with suspicion of fetal-maternal hemorrhage in RhD-negative pregnancies post amniocentesis, serial monitoring of indirect Coombs titer with appropriate management is mandatory.
Chen
Da-Chung
DC
Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Kung Road, Nei-Hu, Taipei, Taiwan 114.
Chang
Yeing-Kuan
YK
Chen
Wei-Hwa
WH
Liu
Jah-Yao
JY
D000328:Adult; D005260:Female; D006461:Hemolysis; D006801:Humans; D007518:Isoantibodies / Q000627:therapeutic use; D015514:Oncogene Proteins, Fusion; D011247:Pregnancy; D011993:Recombinant Fusion Proteins; D012203:Rh Isoimmunization / Q000150:complications*; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin
D007518:Isoantibodies; D015514:Oncogene Proteins, Fusion; C061961:RHO(D) antibody; D011993:Recombinant Fusion Proteins; D012204:Rh-Hr Blood-Group System; C117760:RhD fusion protein, human; D018029:Rho(D) Immune Globulin; C026410:Rho(D) antigen