Haemolytic Anaemia and Thrombocytopenia due to Foeto-Maternal ABO Incompatibility: Case Report
Abstract
Since anti-D immunoglobulins are given to all RhD-negative pregnant women, the most common cause of haemolytic disease of the newborn is ABO feto-maternal incompatibility. Haemolysis of erythrocytes is caused by the antibodies anti-A or anti-B IgG class that cross the placenta and destroy the foetal and neonatal erythrocytes. The disease presents with haemolytic anaemia, severe early jaundice and splenomegaly. Since ABO antigens may also be expressed on platelets and other tissues, anti-A and anti-B antibodies may in rare cases also cause thrombocytopenia. In the article we describe a clinical case of a term newborn girl with blood group A, RhD positive, Kell negative, who presented with haemolytic anaemia and thrombocytopenia. The blood group of her mother was O, RhD positive, Kell negative. On admission the newborn girl was subicteric, the laboratory values at the age of 100 hours were as following: haemoglobin 152 g/L, platelets 44 x 109/L, bilirubin 254 μmol/L and direct bilirubin 10.6 μmol/L. Direct Coombs test was positive, antibodies anti-A IgG were present. Treatment with phototherapy lowered the levels of bilirubin. Because of a low platelet level, we obtained the mother’s platelet level, which was normal. We performed HPA genotyping in the mother and the newborn girl, and we did not find any mismatch. Direct test of the patient’s platelets for antibodies was negative. We did not con firm platelet-specific antibodies (HPA and HLA). Platelet number rose spontaneously. At the last check-up we noticed neutropenia, which was no longer present at 4 and a half months of age.
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