HDN_Case_3

Report
HEMOLYTIC DISEASE OF THE NEWBORN
CASE #3
SCENARIO
 Baby
Girl Dae
 Two-day old
jaundiced newborn
girl
 Sample of her
blood submitted for
HDFN workup
WHAT WE KNOW ABOUT THE MOTHER
Doris Dae
 Mother's first pregnancy
 Pre-natal type and screen done at 2 months ADT negative
 Blood was tested again at 28 weeks gestation ADT negative
 Received prophylactic antenatal RhIg at 28
weeks
 Post-delivery specimen was submitted for an
RhIg retest

SEROLOGICAL RESULTS FOR BABY


Blood type - A pos
A
B
a
b
D [IS]
Ctl
[IS]
3+
-
-
-
3+
-
3+
-
-
-
3+
-
Test for Circulating Antibody (reverse type)
IS
37o
AHG
A1 cells
-
-
1+
B cells
-
-
-/-
CCC
+
BABY’S SEROLOGICAL RESULTS CONT.


Antibody Detection Panel
IS
37o
AHG
CCC
I
-
-
-/-
+
II
-
-
-/-
+
DAT
IS
37 o
1+
1+
CCC
ELUTION RESULTS ON BABY’S BLOOD


Elution results
Cells
AHG
CCC
A1 + cells
2+
A1 – cells
2+
B + cells
-/-
+
B – cells
-/-
+
O + cells
-/-
+
O – cells
-/-
+
At this stage we know that the baby has
maternal ABO antibody coating her cells
SEROLOGICAL RESULTS FOR MOTHER

Post-delivery confirmation of blood type
A B
-


a
-
b
3+ 3+
D
D
I
S
37
-
-
D
D
Ctl
Ctl
Ctl
Ctl
AHG
CCC
-/-
+
AHG
CCC
IS
37o
-/-
+
-
-
o
Post-delivery antibody screen (ADT)
IS
37o
AHG
I
-
-
1+
II
-
-
1+
Antibody Detection Panel
Most likely antibody: anti-D
 Can't rule out anti-C, -E, -Cw, -K

CCC
IS THERE A SEROLOGICAL PROBLEM IN
EITHER THE MOTHER OR THE BABY?

Yes - baby is reacting to an antibody from the
mother; the mother has tested positive for an
antibody as well
DOES THE CHILD HAVE HDN? WHAT
TYPE OF HDFN?

Yes - ABO HDN
Antibody is coating the baby’s cells
 Baby is showing classic symptoms of a hemolytic
reaction
 Serological testing shows that it is an ABO antibody,
not Rh or non-Rh HDFN

WHAT LED YOU TO THE CONCLUSION OF HDN
AND WHAT IS/ARE THE IMPLICATED
ANTIBODIES?
DAT - shows that there is an IgG antibody coating the
baby's RBCs
 Back type and elution - shows that it is an ABO
reaction, not Rh or non-Rh. Weak D reaction is
negative
 Clinical presentation and patient history also helps

Jaundiced baby within 48 hours of delivery
 This is the mother's first pregnancy
 Mother is type O- and baby is type A+
 Antibody present: most likely anti-A,B

HOW WOULD YOU EXPLAIN THE TESTING
RESULTS TO THE PHYSICIAN?

Discuss clinical presentation of ABO HDN, both
the mother and the newborn’s test results and
common treatments
ABO HDFN usually presents with milder hemolytic
symptoms; thus transfusion is rarely necessary
 Infant’s rising bilirubin levels are due to the liver’s
immaturity and inability to keep up with the
breakdown excess free hemoglobin due to RBC lysis.
In utero, the mother’s liver was clearing the bilirubin
before it could accumulate.
 Increasing levels of bilirubin can be treated with
phototherapy using a blue light of a specific
frequency that breaks down the bilirubin

TRANSFUSION INDICATED TREATMENT IN
THE NEWBORN FOR HDN ABO
Rapidly increasing bilirubin levels not controlled
by the phototherapy
 Transfusion with group O Rh- RBC’s may be
required

WHAT TYPE OF BLOOD PRODUCTS
SHOULD BE GIVEN TO THE MOTHER?

Blood Products:

RBC: O neg
 Plasma: O preferred, any type will be acceptable
 Platelets: O neg
NOTE:

Rh matching is not required with plasma and cryoprecipitate
 Platelets must be selected according to the Rh status of recipient.

WHAT TYPE OF BLOOD PRODUCTS
SHOULD BE GIVEN TO THE BABY?

Blood Products:
RBC: O neg
 Plasma: AB
 Platelets: O neg


NOTE:
Baby should be transfused using cells that match the
mother’s blood type and Rh status.
 O neg is the universal donor type since it has no
antigens on the surface of the red cells

WERE THERE ANY UNNECESSARY TESTS
DONE?

Back-typing the baby with B cells was not
necessary
Baby is not producing its antibodies yet
 If maternal ABO crossed the placenta it is most likely
anti-A,B (anti-A and anti-B are IgM unless the
mother was immunized in some rare scenario)
 Testing with A cells alone would be sufficient to
detect anti-A,B or rare anti-A IgG

ARE THERE ANY ADDITIONAL TESTS THAT
WOULD BE USEFUL IN SOLVING THIS PROBLEM?
Test baby's eluate or mother's serum for anti-A,B
to confirm that it is the antibody causing the
reaction
 To finish the work-up you should try to rule out
the additional antibodies from the mother's
antibody panel

WHY IS BABY ONLY REACTING WITH A?
Cells have more A receptors than B receptors the A response was already pretty weak so the B
response may not have been detectable (not high
enough titer of antibody?)
 Mom could have been previously immunized and
formed IgG anti-A (rare!)

SHOULD THIS MOTHER RECEIVE RHIG?
WHY OR WHY NOT?
yes - mother is Rh neg and the baby is Rh pos
and we want to prevent the mother from
becoming immunized
 the mother's pre-natal and 28 week ADT were
both negative
 post-natal ADT was positive but weak
 Baby RBC elution shows no anti-D
 positive post-natal ADT is due to residual RhIg?
from the prophylactic treatment at 28 weeks

QUESTIONS?

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