Hemolytic Disease of the Newborn Associated with Anti-Jr(a) Alloimmunization in a Twin Pregnancy: The First Case Report in Korea.
10.3343/kjlm.2010.30.5.511
- Author:
Hyungsuk KIM
1
;
Min Jeong PARK
;
Tae Jung SUNG
;
Ji Seon CHOI
;
Jungwon HYUN
;
Kyoung Un PARK
;
Kyou Sup HAN
Author Information
1. Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea. kshanmd@snu.ac.kr
- Publication Type:Case Report
- Keywords:
Anti-Jr(a);
Neonatal jaundice;
Fetal erythroblastosis;
Hematologic pregnancy complications
- MeSH:
Adult;
Blood Group Antigens/immunology;
*Blood Group Incompatibility;
Diseases in Twins/diagnosis/*immunology;
Erythroblastosis, Fetal/*diagnosis/immunology;
Female;
Gestational Age;
Humans;
Infant, Newborn;
Isoantigens/immunology;
Jaundice, Neonatal/complications/immunology/therapy;
Male;
Phenotype;
Phototherapy;
Pregnancy;
Pregnancy Complications, Hematologic/diagnosis/*immunology;
Twins
- From:The Korean Journal of Laboratory Medicine
2010;30(5):511-515
- CountryRepublic of Korea
- Language:English
-
Abstract:
Jr(a) is a high-frequency antigen found in all ethnic groups. However, the clinical significance of the anti-Jr(a) antibody has remained controversial. Most studies have reported mild hemolytic disease of the newborn and fetus (HDNF) in Jr(a)-positive patients. Recently, fatal cases of HDNF have also been reported. We report the first case of HDNF caused by anti-Jr(a) alloimmunization in twins in Korea. A 33-yr-old nulliparous woman with no history of transfusion or amniocentesis was admitted at the 32nd week of gestation because of vaginal bleeding caused by placenta previa. Anti-Jr(a) antibodies were detected in a routine laboratory examination. An emergency cesarean section was performed at the 34th week of gestation, and 2 premature infant twins were delivered. Laboratory examination showed positive direct antiglobulin test and Jr(a+) phenotype in the red blood cells and the presence of anti-Jr(a) antibodies in the serum in both neonates. The infants underwent phototherapy for neonatal jaundice; this was followed by conservative management. They showed no further complications and were discharged on the 19th postpartum day. Preparative management to ensure the availability of Jr(a-) blood, via autologous donation, and close fetal monitoring must be performed even in cases of first pregnancy in Jr(a-) women.
