title: Case report: Severe hemolytic disease of the fetus and newborn due to anti-C+G.
abstract: Anti-G is commonly present with anti-D and/or anti-C and can confuse serological investigations. in general, anti-G is not considered a likely cause of severe hemolytic disease of the fetus and newborn (HDFN), but it is important to differentiate it from anti-D in women who should be administered anti-D immunoglobulin prophylaxis. We report one woman with three pregnancies severely affected by anti-C+G requiring intrauterine treatment and a review of the literature. In our case, the identification of the correct antibody was delayed because the differentiation of anti-C+G and anti-D+C was not considered important during pregnancy since the father was D-. In addition, anti-C+G and anti-G titer levels were not found to be reliable as is generally considered in Rh immunization. Severe HDFN occurred at a maternal anti-C+G antibody titer of S and anti-G titer of 1 in comparison with the critical titer level of 16 or more in our laboratory. close collaboration between the immunohematology laboratory and the obstetric unit is essential. In previously affected families, early assessment for fetal anemia is required even when titers are low.
authors.affiliation: MD, PhD (corresponding author), Specialist in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, P.O. Box 140, 00029 HUS, Helsinki, Finland.
authors.forename: Riina
authors.initials: R
authors.lastname: Jernman
authors.affiliation: MD, PhD, Specialist in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Vedran
authors.initials: V
authors.lastname: Stefanovic
authors.affiliation: MSc, Laboratory Specialist.
authors.forename: Anu
authors.initials: A
authors.lastname: Korhonen
authors.affiliation: PhD, Laboratory Specialist.
authors.forename: Katri
authors.initials: K
authors.lastname: Haimila
authors.affiliation: MSc, Laboratory Specialist.
authors.forename: Inna
authors.initials: I
authors.lastname: Sareneva
authors.affiliation: MSc, Laboratory Specialist.
authors.forename: Kati
authors.initials: K
authors.lastname: Sulin
authors.affiliation: PhL, Biologist.
authors.forename: Malla
authors.initials: M
authors.lastname: Kuosmanen
authors.affiliation: MD, PhD, Specialist in Obstetrics and Gynecology, Finnish Red Cross Blood Service, Helsinki, Finland.
authors.forename: Susanna
authors.initials: S
authors.lastname: Sainio
mesh_terms: D000328:Adult; D003298:Coombs Test / Q000379:methods; D004899:Erythroblastosis, Fetal / Q000097:blood / Q000276:immunology* / Q000628:therapy; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D007231:Infant, Newborn; D007518:Isoantibodies / Q000276:immunology*; D008297:Male; D011247:Pregnancy
chemical_list: D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D007518:Isoantibodies; C051138:anti-c antibody