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Abstract
Hemolytic disease of the newborn caused by maternal isoimmunization has been decreasing
over the past 10 years because of prophylactic treatment with anti-RH1 (anti-D) immunoglobulin.
Nevertheless, there is an increase in the incidence of both relative and absolute
numbers of non-RH1 red-cell maternofetal isoimmunizations, essentially anti-RH4 (anti-c),
anti-RH3 (anti-E), and anti-Kell. In 8 to 14% of cases, multispecificity antibodies
are present, the most common combination being the association of anti-RH3 and -4.
Despite absence of specific prophylactic therapy, anti-RH4 isoimmunization could be
as severe as anti-RH1 ; as for anti-RH3, it is usually associated with mild to moderate
clinical manifestations. Nevertheless, there are few publications on anti-RH3, -4
maternofetal isoimmunization with a bias toward the most severe cases being reported.
We report here a case of nonsevere maternofetal anti-RH3, -4 isoimmunization complicated
with severe hyperbilirubinemia and delayed profound anemia. Hyperbilirubinemia was
controlled using intensive phototherapy. Although anemia was absent at birth, it appeared
progressively with a nadir at 7.8 g/dL at 1-month postnatal age. Blood counts were
monitored for 3 months but the patient did not require red blood cell transfusion.
This report underlines the need for a prolonged and rigorous pediatric follow-up of
children born in the context of maternofetal isoimmunization after the acute neonatal
period. Furthermore, it stresses the necessity of DAT testing in all pregnant women,
even those who are RH1-positive.