Korean J Lab Med.  2007 Oct;27(5):373-376. 10.3343/kjlm.2007.27.5.373.

A Case of Severe Hemolytic Disease of the Newborn Due to Anti-Di(a) Antibody

• Lee SM
• Im SJ
• Park SE
• Lee EY
• Kim HH

• KMID: 1781538
• DOI: http://doi.org/10.3343/kjlm.2007.27.5.373

Abstract

Here we report a severe case of hemolytic anemia of the newborn with kernicterus caused by anti-Di(a) antibody. A full term male infant was transferred due to hyperbilirubinemia on the third day of life. Despite single phototherapy, the baby's total bilirubin had elevated to 30.1 mg/dL. After exchange transfusion, total bilirubin decreased to 11.45 mg/dL. The direct antiglobulin test on the infant's red cells was positive. The maternal and infant's sera showed a negative reaction in routine antibody detection tests, but were positive in Di(a) panel cells. The frequency of the Di(a) antigen among the Korean population is estimated to be 6.4-14.5%. Anti-Di(a) antibody could cause a hemolytic reaction against transfusion or hemolytic disease of the newborn. We suggest the need for reagent red blood cell panels to include Di(a) antigen positive cells in antibody identification test for Korean.

Keyword

Anti-Di(a); Kernicterus; Hemolytic disease of the newborn; Antibody screening test

MeSH Terms

Alleles
Bilirubin/blood
Erythroblastosis, Fetal/*diagnosis/*immunology
Humans
Infant, Newborn
Isoantibodies/*analysis
Male
Polymerase Chain Reaction
Rh-Hr Blood-Group System/*analysis/blood

Figure

• 

  Fig. 1. Antibody screening test results of serum from patient (A), his mother (B) and father (C). All reactions to ID-DiaCell I+II panel cells (DiaMed AG, Switzerland) were negative but the sera of patient and his mother reacted to Dia+ cells (ID-DiaCell Dia+) while the sera of father did not.

• 

  Fig. 2. Allele specific PCR of SLC4A1 gene: lane 1-3, with primer set for DI1 allele; lane 4-6, for DI2 allele. Patient's father (lane 1 and 4) and patient (lane 3 and 6) have both SLC4A1 gene DI1 allele and DI2 allele, but his mother has the only DI2 allele (lane 2 and 5). The upper arrow indicates that the 427 bp fragments of HGH were amplified as an internal control. The lower arrow indicates 139-bp PCR products of SLC4A1 DI1 allele.

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