Kathy, a 30-year-old patient, was in her last trimester of pregnancy with her first child. Her medical reports showed that she had received a blood transfusion previously during a minor surgery after an accident. Grouping tests performed in the blood transfusion laboratory confirmed that her blood group was A negative and the child’s father A positive. From a genetic analysis, the fetus was most likely to be Rhesus positive. The laboratory went ahead to an indirect Antiglobulin Test (IAT) on the mother’s sample. The results were positive, meaning that there were anti-D antibodies in Kathy’s serum, which could harm the unborn child. According to Yousuf et al. (2012) , the antibodies can cross the placenta causing Hemolytic Disease of The Fetus and Newborn (HDFN). The patient confirmed that she had received RhoGAM during pregnancy, but these findings implied that the dose was not adequate.
Kathy underwent a caesarian section due to complications in pregnancy. Before the surgery, the laboratory performed coagulation and blood count tests. The results indicated that she had an elevated prothrombin time (INR of 2.3) and a low hemoglobin count of 10.1 g/dL. Therefore, the blood bank prepared two bags of Fresh Frozen Plasma (FFP) and one bag of packed red blood cells. The technicians in the blood transfusion unit cross-matched Kelly’s blood with A negative donor blood to ensure 100% compatibility. They were keen to avoid infusing more Rhesus antigens that could cause her body to produce more anti-D antibodies.
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Before the surgery, Kathy received the two bags of FFP to supply her with the much-needed clotting factors. The procedure was a success, and she did not bleed too much; hence she did not need the packed red cells. However, the patient started showing symptoms of febrile, non-hemolytic transfusion reaction shortly after surgery. She had a fever (100.5 o F), chills, nausea, and a headache. According to Maramica (2019), pre-formed cytokines in the FFP are the most common causes of this condition. The doctor managed it by giving the patient paracetamol.
After delivery, the nurse collected a sample of blood from the umbilical cord blood. The technician in the blood transfusion laboratory performed a blood group test on the sample and reported that the baby was A positive. A repeat test on the mother’s blood indicated that she was Rhesus negative, prompting the nurse to inject Kathy with RhoGAM. This shot is critical for all rhesus negative mothers who give birth to Rhesus positive babies. According to Li et al. (2017) , the drug stops the production of anti-D antibodies in the mother, which can harm the fetus in subsequent pregnancy. Failure to administer RhoGAM could also exacerbate HDFN as the antibodies can cross freely in breast milk, as described by Li et al. (2017) .
A Direct Antiglobulin Test (DAT) on the newborn’s blood came back positive. These results indicate that anti-D antibodies from the mother crossed the placental and got into the baby’s bloodstream. The antibodies coat Rhesus antigens found on red blood cells, causing hemolysis . This condition is called hemolytic disease of the fetus and newborn. It causes accumulation of excess bilirubin in the skin and eyes, causing yellow pigmentation (jaundice). In this case, the newborn showed these symptoms. Liver function tests confirmed an elevated level of serum bilirubin ( 11 mg/dL), indicating HDFN. However, the disease was not too severe to cause detrimental hemolysis, as the hemoglobin was 6.5 g/dL. The blood bank prepared two paints of A positive packed red cells, which was infused in the baby to replace the ones being destructed by the anti-D antibodies. The doctors put the bay under phototherapy to treat jaundice.
References
Li, M., & Blaustein, J. C. (2017). Persistent hemolytic disease of the fetus and newborn (HDFN) associated with passive acquisition of anti‐D in maternal breast milk. Transfusion , 57 (9), 2121-2124.
Maramica, I. (2019). Febrile Non-hemolytic Transfusion Reactions. In Transfusion Medicine and Hemostasis (pp. 385-388). Elsevier.
Yousuf, R., Aziz, S. A., Yusof, N., & Leong, C. F. (2012). Hemolytic disease of the fetus and newborn caused by anti-D and anti-S alloantibodies: a case report. Journal of medical case reports , 6 (1), 71.
