Abstract :
Abstract
Background: A male neonate born at 37 4 weeks of gestation with a birth weight of 2.94 kg, cried immediately at birth, and was admitted to the Neonatal intensive care unit (NICU) soon after birth in view of antenatally detected positive indirect coombs test (ICT). At admission, baby had normal vital signs and systemic examination. The baby was pink without pallor and icterus. Cord blood investigations for hemolysis workup revealed elevated total bilirubin with low hemoglobin, elevated retic count and positive direct coombs test. The mother’s and baby’s blood group were B negative and AB positive, respectively. Double volume exchange transfusion was performed under strict aseptic condition and intensive phototherapy was given. A repeat haemolytic workup done at 36 hours of life reported positive DCT, low hemoglobin and elevated retic count and significant rise of bilirubin. Two doses of Intravenous immunoglobulin (IVIG) was administered in view of ongoing hemolysis and worsening hyperbilirubinemia. In view of persistent hemolysis, the baby’s blood was tested for minor blood group incompatibility which revealed strongly positive anti-C antibodies. On day 8 of life, hemolytic workup was repeated which reported positive DCT (2 compared to previous 4 ), improved hemoglobin and normal bilirubin levels. On day 12 of life, hemolytic workup was normal. This established the diagnosis of anti-C hemolytic disease. On day 29 of life, hemolytic workup done on OPD basis reported low hemoglobin (8.2 g/dL) and positive DCT for which the infant was admitted, IVIg and PRBC transfusion was done in view of anaemia (Hb-8.2 g/dL). Subsequently, the parameters were normal. Currently, the infant is on follow-up and asymptomatic. Anti-C minor blood group incompatibility should be considered in the setting of hemolysis and persistent hyperbilirubinemia due to isoimmunization in neonates. Timely diagnosis and management can avert morbidity and mortality.
Keyword :
Neonate, Hemolytic disease, Hyperbilirubinemia, Minor group incompatibility, Exchange transfusion