SEVERE HEMOLYTIC-DISEASE OF THE NEWBORN CAUSED BY ANTI-GONZALES ANTIBODY

We report on a female infant with severe hemolytic disease of the newb orn (HDN) secondary to anti-Gonzales antibody (anti-Go(a)) necessitati ng an exchange transfusion within the first day of life. The infant wa s born to a mother known to be Gonzales-antigen negative and a father who was Gonzales-antigen positive. The mother had an anti-Go(a) titer of 1:256 at 35 weeks' gestation. The infant was noted to have jaundice shortly after birth, with a bilirubin of 17.8 mg/dl (total) and .05 m g/dl (direct) at 11 hours of life. Coombs' test was positive and cord cells were Gonzales-antigen positive. Eluate on cord cells demonstrate d anti-Go(a). Despite aggressive phototherapy, the total bilirubin rea ched 23.3 mg/dl by 24 hours of age and a double-volume exchange transf usion was performed. Following the exchange transfusion, phototherapy was continued for several days. The hemoglobin, which was 19.8 gm/dl a t 11 hours of age, remained stable through the hospitalization, and no further transfusions were required. History revealed that two prior p regnancies resulted in Gonzales-antigen positive infants. The first ch ild experienced mild jaundice requiring no therapy, and the second chi ld required phototherapy for prolonged hyperbilirubinemia. Previous re ported cases of anti-Go(a) suggest that this is not a cause of severe HDN. However, in view of the current case, it may be prudent to follow women with anti-Go(a) prenatally with amniotic fluid bilirubin studie s, serial antibody titers, and fetal hemoglobin levels.