Successful management of anti-Jra alloimmunization in pregnancy: a case report.
BACKGROUND
Hemolytic disease of the fetus/newborn due to Jr(a) immunization is very rare and considered to be mild, and only routine obstetrical care is recommended for pregnant women sensitized to the Jr(a) antigen.


METHODS
A 20-year-old nulliparous woman was referred to our hospital for perinatal management. Her indirect Coombs test was positive for anti-Jr(a) antibody (1:64). At 33 weeks' gestational age, we observed that fetal growth was mildly restricted and the peak systolic velocity of the fetal middle cerebral artery (PSV-MCA) was above the upper limit of the reference range (1.55 multiples of the median). Amniocentesis was also carried out and the DeltaOD450 value was in the lower mid-zone of the Liley curve. We continued to carefully observe the patient because we observed PSV-MCA values within 1.50-1.60 multiples of the median and no other findings of fetal anemia. She vaginally delivered a female infant weighing 2,136 g at 37 weeks' gestational age. The infant received treatment with both iron and recombinant erythropoietin without developing hyperbilirubinemia and blood transfusion.


CONCLUSIONS
PSV-MCA should be monitored for the detection of fetal anemia, even in pregnant women sensitized to some antigens for which only routine obstetrical care is recommended.
Masumoto
Akio
A
Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Masuyama
Hisashi
H
Sumida
Yumi
Y
Segawa
Tomonori
T
Hiramatsu
Yuji
Y
D001787:Blood Group Incompatibility / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D004899:Erythroblastosis, Fetal / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007501:Iron / Q000627:therapeutic use; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000000981:diagnostic imaging / Q000473:pathology*; D012203:Rh Isoimmunization / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D014463:Ultrasonography; D055815:Young Adult
D004921:Erythropoietin; D007501:Iron