Hemolytic Disease of Newborn due to anti - c antibody in an RhD positive mother - A Case Report

Introduction Hemolytic disease of fetus and newborn (HDFN) is a condition in which the lifespan of an infants red blood cells (RBCs) is shortened by the action of specific maternal Immunoglobulin G (IgG) antibody. RhD hemolytic disease of the newborn is the prototype of maternal alloimmunisation and fetal hemolytic disease. Although rare, the other blood group antigens capable of causing alloimunisation and hemolytic disease are c, C, E, Kell and Duffy. We report a case of HDN due to anti-c in the maternal serum as a result of anamnestic response to Rh c antigen. Case Report A 5-day-old male child was admitted to the Neonatal Intensive Care Unit of a Tertiary care teaching hospital with the symptoms of neonatal jaundice which had progressed to acute bilirubin encephalopathy. Laboratory investigations of the neonates sample showed elevated serum bilirubin levels (Indirect), and low haemoglobin level. Neonates blood group was O RhD positive. Direct Antiglobulin Test (DAT) was positive. Mothers blood group was O RhD positive and antibody screen showed the presence of anti-c antibody. There was no previous history of blood transfusion or abortion. Father, first child and the neonates red blood cells were phenotyped and found to be c antigen positive. The neonate was treated in neonatal intensive care unit with phototherapy and double volume exchange transfusion with compatible blood, but the neonate succumbed to bilirubin encephalopathy. Conclusion This case report reflects the importance of antibody screening in antenatal women, which could assist in diagnosing and successfully treating the fetus and neonate with appropriate antigen negative crossmatch compatible blood.