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Hemolytic disease and reticulocytopenia of the newborn attributable to maternal immunoglobulin G anti‐M reacting optimally at cold temperatures
- Source :
- Transfusion. 61:974-978
- Publication Year :
- 2021
- Publisher :
- Wiley, 2021.
-
Abstract
- Background Hemolytic disease of the fetus and newborn (HDFN) attributable to anti-M is rare, although case reports implicate anti-M in varying severities of HDFN, including fetal hydrops and intrauterine death. Case description We describe the case of a newborn with HDFN associated with an atypical immunoglobulin (Ig) G anti-M that reacted best at cold temperatures. The maternal antibody detected in pregnancy was not reactive at 37°C, and a direct antiglobulin test (DAT) on red blood cells (RBCs) from the newborn was negative, suggesting an anti-M that should not have been clinically relevant. However, the infant developed hyperbilirubinemia (bilirubin level, 17.6 mg/dL), hemolytic anemia (hemoglobin nadir, 5.5 g/dL), and reticulocytopenia. Laboratory testing demonstrated the presence of an IgG anti-M in maternal and neonatal samples reacting best at 4°C. This passively acquired IgG anti-M provoked hemolytic anemia in the infant and likely suppressed erythropoiesis, resulting in reticulocytopenia with prolonged anemia. He was treated for IgG anti-M HDFN with 10 intravenous Ig infusions and 10 days of oral prednisone followed by a taper. He required seven transfusions with M- RBCs. His hemoglobin level normalized at 3 months of age. Follow-up at 2 years revealed no hematologic or neuro-developmental concerns. Conclusion To our knowledge, this is the second report of HDFN attributable to an IgG anti-M reacting preferentially at cold temperature with no 37°C reactivity. Clinically relevant IgG anti-M may elude standard testing. Early recognition and testing for cold-reacting IgG anti-M should be considered for newborns with hemolysis, a negative DAT, and prolonged anemia.
- Subjects :
- Hemolytic anemia
biology
Anemia
business.industry
Immunology
Hematology
030204 cardiovascular system & hematology
medicine.disease
Immunoglobulin G
Hemolysis
03 medical and health sciences
0302 clinical medicine
biology.protein
medicine
Immunology and Allergy
Erythropoiesis
Hemoglobin
Reticulocytopenia
Antibody
business
030215 immunology
Subjects
Details
- ISSN :
- 15372995 and 00411132
- Volume :
- 61
- Database :
- OpenAIRE
- Journal :
- Transfusion
- Accession number :
- edsair.doi...........eb369bb5593a0198ea8c9b9ac14478d4