Hemolytic disease of the fetus and newborn caused by anti-E
A male neonate was delivered via spontaneous vaginal delivery (SVD) at 30 weeks of gestation by a 33 year-old Malay lady G7P7. The mother had a history of premature deliveries in all but one of her previous pregnancies. Her blood group was O RhD positive and was Rh-subtyped as R1R1 (DCe/DCe). Post-SVD antibody screen test in her serum was positive with antibodies identified as anti-c and anti-E. The neonate's birth weight was 1.8 kg. He was transferred to NICU. He was noticed to have jaundice (serum bilirubin 138 μmol/L) at 14 h after birth. His blood group was B RhD positive with Rh-subtype R1R2 (DCe/DcE). DAT was positive (2+). As in the first case, the Rh-subtype results may be interpreted with caution in light of the DAT being positive. A possibility of the ABO HDFN was opened but was ruled out with an extent that the eluate preparation from the baby's red cells showed anti-E only (not anti-c). The neonate became moderately anemic on day 5, with a hemoglobin level of 10.2 g/dL. No evidence of hemolysis was seen on the blood film. The patient was managed with phototherapy, IVIG, and transfusion of 30 cc of red cell concentrate. In light of underlying coagulopathy noticed at 6 h of life (with activated partial thromboplastin time 93.70 s, prothrombin time 20.8 s, and INR 1.80), a dose of 20 cc of fresh frozen plasma was also administered. He was discharged on day 14 of life as requested by the parents. His follow-up visit showed normal developmental milestones with consistent increase in body weight.