Management of a pregnant woman with multiple erythrocyte alloantibodies – Case report

Abstract

Background: Hemolytic disease of the fetus and newborn (HDFN) is caused by erythrocyte allo‑antibodies present in the maternal plasma dur‑ing pregnancy, which cross the placental barrier and enter the fetal bloodstream, bind to fetal erythrocyte antigens and cause destruction of fetal erytrhocytes. Hemolysis leads to fetal anemia, which can cause fetal death if not treated. Case report: We report a case of HDFN in a multiparous female with multiple erythrocyte alloantibodies of anti‑C+G, anti‑E, anti‑Kp(a) and anti‑Kn(a) specificity. In her third preg‑nancy we found erythrocyte alloantibodies of anti‑C+G and anti‑Kp(a) specificity for the first time. Erythrocyte alloantibodies titers were low and fetal hemolysis was not expected. However, in the 30th week of pregnancy obstetricians observed rapid development of fetal anemia, which was due to hemolysis. The pregnancy was ter‑minated. Despite an exchange transfusion, the newborn died a few days after birth because of HDFN. In the following pregnancy, titers of al‑ready known erythrocyte alloantibodies were high and very severe hemolysis was predicted. In the 22nd week obstetricians found fetal hydrops. Despite intrauterine transfusion (IUT), the preg‑nancy ended with intrauterine fetal death. The fifth pregnancy ended with miscarriage in the 11th week of pregnancy. In the last pregnancy, titers of known erythrocyte alloantibody were high and again very severe hemolysis was predicted. In the 17th and 20th week of pregnancy, erythrocyte alloantibody titers increased. In the 22nd week of pregnancy, obstetricians observed fetal anemia and decided to perform an IUT. The fetus received seven IUTs. After the second IUT, additional erythrocyte alloantibodies of anti‑E and anti‑Kn(a) specificity were found in the ma‑ternal plasma. In the 34th week of pregnancy, ob‑stetricians terminated the pregnancy with elec‑tive caesarean section. The child was born with no signs of hemolytic anemia. Conclusion: HDFN is still considered an unpredictable disease. By the help of modern pro‑cedures for monitoring of immunised pregnant women also those pregnant women with mulip‑le, clinically significant erythrocyte alloantibod‑ies can be successfully managed in the course of pregnancy.