ISSN - 0973-0958

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Hyperbilirubinemia due to minor blood group incompatibility (anti C) in a newborn: Case report from a tertiary care teaching hospital.
Avani Duggirala1, Krishna Chaitanya2.
1Mallareddy Institute of Medical Sciences, Suraram, Hyderabad, India,
2Ankura Children's Hospital, Lb nagar, Hyderabad, India.
Abstract
Maternal alloantibodies against erythrocyte antigens Rh (D) usually cause clinically significant hemolysis in neonatal period. Anti-c is the next most common cause of severe HDNB after anti-D. We present In this article, a case of HDNB due to anti-c antibody incompatibility, which is a rare cause of anemia. A Preterm 35 weeks GA male baby with birth weight 2240 grams, Bilirubin total was 28.9 mg/dl, DCT was positive, Hb 10.5 gm/dl. Then minor blood group incompatibility was suspected and sent for analysis. Meanwhile baby was given IVIG @1gm/kg over 6hrs. Extended Rh phenotyping turned out to be Anti-c antibody positive in mother’s serum causing alloimmune hemolytic anemia in baby. Anti-c antibodies may occur due to prior exposures such as blood transfusions, abruptio placenta, spontaneous abortion, previous cesarean section. In newborns presenting with evidence of neonatal jaundice due to hemolysis not due to Rh and ABO incompatibilities, possibility of minor blood group incompatibility should be considered. There is a necessity for introduction of antibody screening for pregnant woman as a part of antenatal care in order to reduce burden of HDNB.
Why this article important?
Screening in India needed antenatally for minor blood groups Anti c antibodies may occur due to prior exposures such as blood transfusions, abruptio placenta, spontaneous abortion, previous cesarean section. (10) In our case, mother had history of blood transfusion during First pregnancy, probably when allosensitization might had occurred. HDNB due to minor blood group incompatibility may have wide clinical presentation ranging from hydrops fetalis to subclinical hemolysis. (11) Our case had active hemolysis and hyperbilirubinemia requiring phototherapy and Intravenous immunoglobulins. DCT positivity is not directly proportional to severity of disease and is usually positive only in 30% of minor group incompatibilities Pediatricians should consider minor blood group incompatibility while dealing with non ABO/Rh mismatch hemolytic jaundice in newborns. Universal screening for antibodies should be encouraged antenatally in order to prevent mortality and morbidity in newborns due to minor blood group incompatibility hemolytic jaundice.
Summary of article
Minor group incompatibility is very rare and important in countries like India Maternal alloantibodies against erythrocyte antigens Rh (D) usually cause clinically significant hemolysis in neonatal period. Anti-c is the next most common cause of severe HDNB after anti-D. We present In this article, a case of HDNB due to anti-c antibody incompatibility, which is a rare cause of anemia. A Preterm35weeks GA male baby with birth weight 2240grams, Bilirubin total was 28.9mg/dl ,DCT was positive ,Hb 10.5gm/dl. Then minor blood group incompatibility was suspected and sent for analysis. Meanwhile baby was given IVIG @1gm/kg over 6hrs. Extended Rh phenotyping turned out to be Anti-c antibody positive in mother’s serum causing allo immune hemolytic anemia in baby. Anti c antibodies may occur due to prior exposures such as blood transfusions, abruptio placenta, spontaneous abortion, previous cesarean section. In newborns presenting with evidence of neonatal jaundice due to hemolysis not due to Rh and ABO incompatibilities, possibility of minor blood group incompatibility should be considered. There is a necessity for introduction of antibody screening for pregnant woman as a part of antenatal care in order to reduce burden of HDNB.

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