title: Successful management of anti-Jra alloimmunization in pregnancy: a case report.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Masumoto
authors.forename: Hisashi
authors.initials: H
authors.lastname: Masuyama
authors.forename: Yumi
authors.initials: Y
authors.lastname: Sumida
authors.forename: Tomonori
authors.initials: T
authors.lastname: Segawa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hiramatsu
mesh_terms: 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
chemical_list: D004921:Erythropoietin; D007501:Iron