Haemolytic disease of the newborn caused by anti-c, anti-E and anti-Fya antibodies: Report of five cases

Fetal haemolytic disease caused by irregular antibodies is discussed on the basis of three cases with maternal anti-c alone, one with anti-E along wit h anti-c, and one with anti-Fya sensitization. All fetuses suffering from m aternal c-allo-immunization alone were treated with intra-uterine transfusi ons and the newborns received exchange transfusions. These interventions we re also required in the case of simultaneous E and c-alloimmunization, and this was the most severe of the five cases. Delta OD450 results were consis tent with the severity of the fetal condition in the c and/or E allo-immuni zation cases, Maternal anti-Fya sensitization caused only mild jaundice of the neonate, but the results of amniotic fluid analysis were quite misleadi ng in that case. Antibody titres did not prove to have good prognostic valu es (though they were all above the critical level), and the direct antiglob ulin test from cord blood was negative in three cases. Regular sonographic evaluations were performed and fetal blood samplings were a cornerstone of management. Copyright (C) 1999 John Wiley & Sons, Ltd.