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Korean J Lab Med. 2010 Oct;30(5):511-515. English. Case Report. https://doi.org/10.3343/kjlm.2010.30.5.511
Kim H , Park MJ , Sung TJ , Choi JS , Hyun J , Park KU , Han KS .
Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea. kshanmd@snu.ac.kr
Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea.
Department of Pediatrics, Hallym University College of Medicine, Seoul, Korea.
Department of Laboratory Medicine, National Cancer Center, Goyang, Korea.
Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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.

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