Korean J Lab Med.  2010 Oct;30(5):511-515. 10.3343/kjlm.2010.30.5.511.

Hemolytic Disease of the Newborn Associated with Anti-Jr(a) Alloimmunization in a Twin Pregnancy: The First Case Report in Korea

• Kim H
• Park MJ
• Sung TJ
• Choi JS
• Hyun J
• Park KU
• Han KS

• KMID: 1022043
• DOI: http://doi.org/10.3343/kjlm.2010.30.5.511

Abstract

Jr(a) is a high-frequency antigen found in all ethnic groups. However, the clinical significance of the anti-Jr(a) antibody has remained controversial. Most studies have reported mild hemolytic disease of the newborn and fetus (HDNF) in Jr(a)-positive patients. Recently, fatal cases of HDNF have also been reported. We report the first case of HDNF caused by anti-Jr(a) alloimmunization in twins in Korea. A 33-yr-old nulliparous woman with no history of transfusion or amniocentesis was admitted at the 32nd week of gestation because of vaginal bleeding caused by placenta previa. Anti-Jr(a) antibodies were detected in a routine laboratory examination. An emergency cesarean section was performed at the 34th week of gestation, and 2 premature infant twins were delivered. Laboratory examination showed positive direct antiglobulin test and Jr(a+) phenotype in the red blood cells and the presence of anti-Jr(a) antibodies in the serum in both neonates. The infants underwent phototherapy for neonatal jaundice; this was followed by conservative management. They showed no further complications and were discharged on the 19th postpartum day. Preparative management to ensure the availability of Jr(a-) blood, via autologous donation, and close fetal monitoring must be performed even in cases of first pregnancy in Jr(a-) women.

Keyword

Anti-Jr(a); Neonatal jaundice; Fetal erythroblastosis; Hematologic pregnancy complications

MeSH Terms

Adult
Blood Group Antigens/immunology
*Blood Group Incompatibility
Diseases in Twins/diagnosis/*immunology
Erythroblastosis, Fetal/*diagnosis/immunology
Female
Gestational Age
Humans
Infant, Newborn
Isoantigens/immunology
Jaundice, Neonatal/complications/immunology/therapy
Male
Phenotype
Phototherapy
Pregnancy
Pregnancy Complications, Hematologic/diagnosis/*immunology
Twins

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