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Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Torreiter, PP; Macher, S; Matzhold, EM; Resch, B; Klaritsch, P; Kormoczi, GF; Polin, H; Neuhold, L; Schonbacher, M; Schlenke, P; Wagner, T.
Ethical Issues and Management of Fetal Hemolytic Anemia Caused by Anti-Rh17 in a Multipara with Rare -D- Phenotype
TRANSFUS MED HEMOTH. 2021;
Doi: 10.1159/000513124
[OPEN ACCESS]
Web of Science
PubMed
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- Leading authors Med Uni Graz
- Torreiter Patrick Paul
- Wagner Thomas
- Co-authors Med Uni Graz
- Klaritsch Philipp
- Macher Susanne
- Matzhold Eva-Maria
- Resch Bernhard
- Schlenke Peter
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- Abstract:
- Background: The development of allo-anti-Rh17 (anti-Hr0) in a -D- phenotype whose red blood cells (RBCs) lack CcEe antigens is most likely triggered by transfusion, transplantation, or pregnancy. Gene conversion is the predominating factor in generating RHD-CE-D and RHCE-D-CE hybrids like -D-. Methods: We report here immunohematological and obstetrical data from 2 of the 5 pregnancies of a 24-year-old woman presenting with the -D- phenotype with anti-Rh17. Blood group typing, antibody screening, antibody differentiation, direct antiglobulin test (DAT), and antibody titers were performed by routine gel technology and tube testing. Additionally, molecular genetic analysis was performed. Fetal surveillance was done by sonographic evaluation of the fetal middle cerebral artery peak systolic velocity (MCA-PSV). Results: Blood group typing showed O, C-c-D+E-e- and the DAT was negative. DNA sequencing revealed homozygosity for an RHCE-D(3-9)-CE null allele. Anti-Rh17 titers in the fourth pregnancy remained between 1:8 and 1:128, and no signs for a fetal anemia were observed. However, in the fifth pregnancy, the antibody titers increased up to 1:4,096. Signs of moderate fetal anemia were detected and cesarean section was performed at 34 + 6 weeks of gestation. The newborn presented with hemolytic anemia (cord blood hemoglobin [Hb] = 8.5 mg/dL). She received 2 compatible (small) packed RBC concentrates, phototherapy, and intravenous immunoglobulins. Conclusion: Our case shows that the risk for hemolytic complications increases with the number of pregnancies of sensitized women. Only people who also lack CcEe antigens are compatible as donors. The role of such rare donors as lifesavers, their freedom, and voluntariness conflict with the urgent need for compatible blood.
- Find related publications in this database (Keywords)
- Hemolytic anemia
- Anti-Rh17 (anti-Hr0)
- Maternal alloimmunization
- Hyperbilirubinemia
- Medical ethics