title: Successful management of severe hemolytic disease of the fetus due to anti-Jsb using intrauterine transfusions with serial maternal blood donations: a case report and a review of the literature.
abstract: BACKGROUND
  The management of pregnant women with anti-Jsb is challenging due to the paucity of antigen-negative blood for fetal and neonatal transfusion.
  
  
  METHODS
  A 29-year-old woman with anti-Jsb was referred for assessment of recurrent fetal losses. With the presence of the sister as a historically matched donor, she was planned for active surveillance for fetal anemia during pregnancy.
  
  
  METHODS
  The fetus remained well until 21 weeks of gestation when signs of fetal anemia and early hydrops fetalis were noted. Anti-Jsb titer was at 128. The sister's red blood cells (RBCs) were cross-match incompatible. Urgent intrauterine transfusion (IUT) was performed with washed irradiated maternal RBCs, donated after cessation of heparin. The mother was given intravenous iron (IV-Fe) and continued on weekly recombinant human erythropoietin (rHu-EPO).
  
  
  RESULTS
  Repeated IUTs were needed every 1 to 3 weeks. Throughout a 7-week period, three maternal donations were performed with total donated whole blood volume of 1250 mL, supporting four IUTs. At 29 weeks of gestation, the procedure was complicated by umbilical cord hematoma necessitating urgent cesarean section. A male newborn was delivered, transfused at birth, and subsequently treated with phototherapy and five top-up transfusions.
  
  
  CONCLUSIONS
  This case represents a successful example of managing hemolytic disease of the fetus due to a rare antibody using maternal blood. It also supports previous data on safety of maternal donations during pregnancy and the use of combination of rHu-EPO and IV-Fe as a supportive measure.
authors.affiliation: Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman; Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman; Department of Obstetrics and Gynecology, Royal Hospital, Muscat, Oman; Department of Hematology, Royal Hospital, Muscat, Oman.
authors.forename: Arwa Z
authors.initials: AZ
authors.lastname: Al Riyami
authors.forename: Moza
authors.initials: M
authors.lastname: Al Salmani
authors.forename: Sabria
authors.initials: S
authors.lastname: Al Hashami
authors.forename: Sabah
authors.initials: S
authors.lastname: Al Mahrooqi
authors.forename: Sumaiya
authors.initials: S
authors.lastname: Al Hinai
authors.forename: Halima
authors.initials: H
authors.lastname: Al Balushi
authors.forename: Nihal
authors.initials: N
authors.lastname: Al Riyami
authors.forename: V
authors.initials: V
authors.lastname: Gowri
authors.forename: Tamima
authors.initials: T
authors.lastname: Al Dughaishi
authors.forename: Saif
authors.initials: S
authors.lastname: Al Hosni
authors.forename: Murtadha
authors.initials: M
authors.lastname: Al-Khabori
authors.forename: Khalil
authors.initials: K
authors.lastname: Al-Farsi
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al Huneini
authors.forename: Salam
authors.initials: S
authors.lastname: Alkindi
mesh_terms: D000328:Adult; D001782:Blood Donors; D001805:Blood Transfusion, Intrauterine / Q000379:methods*; D004899:Erythroblastosis, Fetal / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007518:Isoantibodies / Q000009:adverse effects* / Q000097:blood; D007626:Kell Blood-Group System / Q000276:immunology*; D008297:Male; D009035:Mothers; D011247:Pregnancy; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D007518:Isoantibodies; D007626:Kell Blood-Group System