Hemolytic disease of the newborn due to anti-Di: a case study and review of the literature.
BACKGROUND
The severity of hemolytic disease of the newborn (HDN) due to Diego(b) (Di(b)) mismatch ranges from no symptoms to severe jaundice that requires exchange transfusion (ET). The clinical significance of anti-Di(b) is incompletely recognized.


METHODS
A male newborn, referred with jaundice, was revealed to have HDN due to Di(b) mismatch and was treated successfully with phototherapy and high-dose intravenous gamma globulin (IVGG).


METHODS
The literature of HDN caused by Di(b) mismatch was reviewed. The cases were classified into three groups according to their severity: the mildest needed no therapy (NO), the moderate group received phototherapy alone (PHOTO), and the most severe was treated with ET and/or high-dose IVGG therapy plus phototherapy (ET/IVGG).


RESULTS
Among 27 cases of HDN due to Di(b) reported to date, 10, 6, and 11 cases required NO, PHOTO, and ET/IVGG, respectively. A significant correlation (p < 0.01) was found between the maternal anti-Di(b) titer and the severity of the disease when the ET/IVGG group was compared with the NO group. All mothers of the group that needed ET/IVGG had an anti-Di(b) titer of 64 or greater.


CONCLUSIONS
A maternal high titer (> or =64) of anti-Di(b) is associated with a higher risk of severe hyperbilirubinemia for mismatched newborns.
Mochizuki
Kazuhiro
K
Department of Pediatrics and the Division of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan. mochi-k@fmu.ac.jp
Ohto
Hitoshi
H
Hirai
Shigeru
S
Ujiie
Niro
N
Amanuma
Fumitaka
F
Kikuta
Atsushi
A
Miura
Saori
S
Yasuda
Hiroyasu
H
Ishijima
Ayako
A
Suzuki
Hitoshi
H
D004899:Erythroblastosis, Fetal / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage*; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000097:blood / Q000188:drug therapy*; D008297:Male; D012203:Rh Isoimmunization / Q000097:blood / Q000188:drug therapy*; D018029:Rho(D) Immune Globulin / Q000097:blood*
D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D018029:Rho(D) Immune Globulin