Fatal hemolytic disease of the newborn due to anti‐B Isohemagglutinin: An unfamiliar presentation of a familiar disease

Abstract

AbstractBackgroundHemolytic disease of the newborn (HDN) occurs in approximately 1 out of 3000 live births. Severe presentations are atypical but must be recognized and treated rapidly to avoid life‐threatening organ dysfunction.Case PresentationHere we report an unusual case of neonatal ABO HDN that illustrates the enormous inflammatory potential of maternal‐fetal blood group mismatch. Following an uneventful delivery notable only for HDN caused by maternal anti‐B IgG, our patient developed shock, DIC, and renal failure. Despite numerous interventions, she experienced a rapid clinical decline and died 10 days after birth. Treatment with whole blood exchange and a monoclonal antibody directed at complement component 5 (eculizumab) were attempted late in the disease course but were unsuccessful. Importantly, this patient had several known risk factors for severe ABO HDN, including the pentad of a group O mother with a group B neonate, high newborn red blood cell B antigen expression, presence maternal anti‐B isohemagglutinin in high titer, presence of a maternal IgG anti‐B isohemagglutinin, and African ancestry.ConclusionClinicians should be aware of the potential for severe ABO HDN and consider earlier diagnostic workup and more aggressive therapy in patients with high‐risk features.