Hemolytic disease of newborn due to RhE and Rhc incompatibility in premature infant: a case report and literature review

doi:10.3877/cma.j.issn.1673-5250.2023.01.013

Objective

To investigate the clinical characteristics of hemolytic disease of newborn (HDN) caused by anti-RhE and anti-Rhc alloantibodies.

Methods

A premature infant with HDN caused by anti-RhE and anti-Rhc alloantibodies treated in the Seventh Affiliated Hospital, Sun Yat-sen University in December 2019 was chosen in study. The clinical data were retrospectively analyzed. Retrieved literature of study on clinical characteristics, treatment and prognosis of HDN children caused by anti-RhE and anti-Rhc alloantibodies were summarized based on domestic and foreign databases. This study followed the World Medical Association Declaration of Helsinki revised in 2013. The informed consents of the infant′s diagnosis and treatment were obtained from guardians.

Results

① Clinical data of this case: A female infant, G₅P₃, whose gestational age was 31^{+ 2} weeks, was born by cesarean section due to " premature rupture of membranes for 19 days and frequent deceleration of fetal heart rate" . After admission, the baby had fever, poor response, and developed jaundice and anemia at 14 h after birth. The blood culture result showed Escherichia coli (ESBL+ ), and the serum level of total bilirubin (TBil) was higher than exchange transfusion threshold. The baby′s blood group was O blood type Rh (CcDEe) and her direct antiglobulin test (DAT) was positive. Her mother′s blood group was O blood type Rh (CCDee). After treated by exchange transfusion, blood transfusion, intensive phototherapy, immunoglobulin intravenous infusion, antibacteria and other supportive treatments, the infant was cured and discharged at 37 d after birth. The main discharge diagnoses were HDN due to Rh blood group incompatibility (anti-RhE and anti-Rhc alloantibodies), neonatal sepsis (intrauterine infection), etc.. She was followed up to the age of 24 months and had no psychomotor developmental retardation. ② Literature retrieval results: a total of 14 pieces of related literature that meet the retrieval strategy, which involving 14 cases of HDN caused by anti-RhE and anti-Rhc alloantibodies. Their main clinical manifestations were early-onset and progressive jaundice and anemia, DAT positive. By timely phototherapy, exchange transfusion and other treatments, their jaundice resolved gradually, and no indicated neurodevelopmental disability according to some case reports.

Conclusions

Rare blood group incompatibility hemolytic disease should be screened if mother has serum irregular antibodies and infant develops anemia and jaundice at early life and progresses rapidly. Infants with HDN caused by anti-RhE and anti-Rhc alloantibodies have good prognosis if treated actively in the early stage.

Key words: Erythroblastosis, fetal, Blood group incompatibility, Rh isoimmunization, Hyperbilirubinemia, neonatal, Exchange transfusion, whole blood, Infant, premature

表1 患儿入院后不同时间点血常规、感染指标及胆红素检查结果

检查时间	白细胞计数(×10⁹/L)	中性粒细胞百分率(%)	红细胞计数(×10¹²/L)	Hb(g/L)	血小板计数(×10⁹/L)	CRP(mg/L)	PCT(ng/mL)	TBil(μmol/L)	IBil(μmol/L)
生后2 h	8.75	32.3	3.24	128	133	<5.00	0.29	91.74	91.74
生后14 h	11.97	83.0	3.04	88	213	17.12	228.63	221.33	206.27
生后42 h(换血后2 h)	6.66	59.7	6.21	200	97	6.21	107.03	135.27	135.27
生后50 h(换血后10 h)	5.67	61.2	5.12	165	81	4.52	—	133.37	126.41
生后5 d(换血后3 d)	8.12	50.3	5.70	181	149	1.61	0.43	163.16	148.30
参考值	5.00~11.00	40.0~75.0	3.80~5.10	180~190	125~350	<5.00	<0.05	0~23.00	0~19.00

表1 患儿入院后不同时间点血常规、感染指标及胆红素检查结果

检查时间	白细胞计数(×10⁹/L)	中性粒细胞百分率(%)	红细胞计数(×10¹²/L)	Hb(g/L)	血小板计数(×10⁹/L)	CRP(mg/L)	PCT(ng/mL)	TBil(μmol/L)	IBil(μmol/L)
生后2 h	8.75	32.3	3.24	128	133	<5.00	0.29	91.74	91.74
生后14 h	11.97	83.0	3.04	88	213	17.12	228.63	221.33	206.27
生后42 h(换血后2 h)	6.66	59.7	6.21	200	97	6.21	107.03	135.27	135.27
生后50 h(换血后10 h)	5.67	61.2	5.12	165	81	4.52	—	133.37	126.41
生后5 d(换血后3 d)	8.12	50.3	5.70	181	149	1.61	0.43	163.16	148.30
参考值	5.00~11.00	40.0~75.0	3.80~5.10	180~190	125~350	<5.00	<0.05	0~23.00	0~19.00

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