Maternal anti-M induced hemolytic disease of newborn followed by prolonged anemia in newborn twins

Abstract

Allo-anti-M often has an immunoglobulin G (IgG) component but is rarely clinically significant. We report a case of hemolytic disease of the fetus and newborn along with prolonged anemia in newborn twins that persisted for up to 70 days postbirth. The aim was to diagnose and successfully manage hemolytic disease of newborn (HDN) due to maternal alloimmunization. Direct antiglobulin test (DAT), antigen typing, irregular antibody screening and identification were done by polyspecific antihuman globulin cards and standard tube method. At presentation, the newborn twins (T1, T2) had HDN with resultant low reticulocyte count and prolonged anemia, which continued for up to 70 days of life. Blood group of the twins and the mother was O RhD positive. DAT of the both newborns at birth was negative. Anti-M was detected in mothers as well as newborns. Type of antibody in mother was IgG and IgM type whereas in twins it was IgG type only. M antigen negative blood was transfused thrice to twin-1 and twice to twin-2. Recurring reduction of the hematocrit along with low reticulocyte count and normal other cell line indicated a pure red cell aplastic state. Anti-M is capable of causing HDN as well as prolonged anemia (red cell aplasia) due to its ability to destroy the erythroid precursor cells. Newborns with anemia should be evaluated for all the possible causes to establish a diagnosis and its efficient management. Mother should be closely monitored for future pregnancies as well.

Prevalence and associated factors of anemia among full-term newborn babies at University of Gondar comprehensive specialized hospital, Northwest Ethiopia: a cross-sectional study

“…Anemia in newborn babies has a complex problem and has a unique blood picture due to variation in hematological profiles [6]. It can be severe to the acute life-threatening event [7]. It also causes impairment in brain development, delay in brain maturation, poor school performance and work capacity in later years, stunted growth, tissue and organ hypoxia, poorer cognitive, motor, and social-emotional development [2,8].…”

Hemolytic disease and reticulocytopenia of the newborn attributable to maternal immunoglobulin G anti‐M reacting optimally at cold temperatures

“…19 Several reports have described HDFN attributable to IgG anti-M with typical reactivity at 37°C. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Furthermore, M glycophorin is expressed on EPCs. 18 Hinchliffe et al 18 reported HDFN with pure RBC aplasia, negative neonatal DAT, reticulocytopenia, and reduced (though morphologically normal) EPCs on neonatal bone-marrow biopsy.…”

Anti-M Alloimmunization: Management and Outcome at a Single Institution

“…In addition to the review by Yasuda et al, 13 studies were identified in the literature with reports of severe hemolytic disease of the newborn based on a requirement for neonatal IVIG, red blood cell transfusion, or exchange transfusion. 4 12 16 17 18 19 20 21 22 23 24 25 26 Conversely, several studies report pregnancies complicated by anti-M alloimmunization without associated HDFN. 2 15 27 28 29 30 Notably, HDFN did not occur in approximately 400 patients with anti-M antibodies in the Netherlands and our previously reported 115 pregnancies in the United States.…”