title: Hemolytic disease of the fetus and newborn caused by an antibody to a low-prevalence antigen, anti-SARA.
abstract: BACKGROUND
  The first case describing the SARAH (SARA) antigen occurred in 1990, in an Australian blood donor. Hemolytic disease of the fetus and newborn (HDFN) due to anti-SARA has not been previously described.
  
  
  METHODS
  We report a case of HDFN in a multiparous female. The pregnancy was unremarkable except that she was involved in a seemingly minor motor vehicle accident at 25 weeks' gestation. Routine prenatal antibody screening was negative throughout the pregnancy. She presented at 37 weeks' gestation because of decreased fetal movements. Labor was induced and a 2702-g infant male was delivered. The infant's hemoglobin was 49 g/L and the bilirubin was 153 µmol/L.
  
  
  RESULTS
  Blood samples from the parents and infant were referred to Canadian Blood Services National Immunohematology Reference Laboratory and subsequently to the Australian Red Cross Red Cell Reference Service. The father's and infant's red blood cells were confirmed to be SARA positive, and the mother's plasma contained anti-SARA.
  
  
  CONCLUSIONS
  The infant was successfully treated with a double-volume exchange transfusion. This is the first example of HDFN associated with this antibody.
authors.affiliation: Medical, Scientific, and Research Affairs, Canadian Blood Services, Calgary, Alberta, Canada. dale.towns@blood.ca
authors.forename: Dale
authors.initials: D
authors.lastname: Towns
authors.forename: Judith
authors.initials: J
authors.lastname: Hannon
authors.forename: Julia
authors.initials: J
authors.lastname: Hendry
authors.forename: Janet
authors.initials: J
authors.lastname: Barnes
authors.forename: Mindy
authors.initials: M
authors.lastname: Goldman
mesh_terms: D004899:Erythroblastosis, Fetal / Q000209:etiology* / Q000276:immunology* / Q000628:therapy; D005260:Female; D005333:Fetus; D006801:Humans; D007231:Infant, Newborn; D007518:Isoantibodies / Q000276:immunology*; D007519:Isoantigens / Q000276:immunology*; D008297:Male; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000209:etiology* / Q000276:immunology* / Q000628:therapy
chemical_list: D007518:Isoantibodies; D007519:Isoantigens; C090667:SARAH antigen