Haemolytic disease of the newborn presenting in a term baby born to a mother with negative red cell serology screening.

摘要

Current British guidelines for red cell antibody testing in pregnancy suggest testing maternal serum at booking and at 28 weeks gestation. If no antibodies are detected at 28 weeks, no further testing is required: alloantibodies developing after 28 weeks rarely cause haemolytic disease of the newborn (HDN), (British Committee for Standards in Haematology (BCSH), 2006a). Guidance from the National Institute for Clinical Excellence, (NICE), recommends that RhD-negative women with no evidence of sensitization to the RhD antigen are given antenatal anti-D prophylaxis commencing at 28 weeks, (NICE, 2002). Further dosing is dependent on the amount of anti-D given at 28 weeks, (BCSH, 2006b). No further serologicaltesting is required as this could result in detection of prophylactic anti-D and therefore confusion with immune anti-D. However, despite routine antenatal and postnatal prophylaxis, sensitization to RhD antigen may still occur at a rate of 0.17-0.28%, (BCSH, 2006b), usually because of an unrecognized sensitizing event or failure to administer anti-D at the appropriate time. We report here a case of significant HDN developing in the third trimester in a women without detectable anti-D at 28 weeks prior to the administration of antenatal anti-D.