SEVERE HYPERBILIRUBINEMIA IN A NEWBORN DUE TO ABO INCOMPATIBILITY
MILDA INAYAH,LANDELINA LANY,TIKA ADILISTYA
RSUD DR KANUJOSO DJATIWIBOWO BALIKPAPAN
Background : Hemolytic disease of the newborn (HDN) is the result of red cell alloimmunization in which IgG antibodies passage from the maternal circulation across the placenta into the circulation of the fetus where they react with fetal red cells and lead to their destruction. ABO incompatibility , is the most frequent cause of HDN, in which A or B blood-type newborn react with O blood-type mother. We describe a case of a newborn demonstrating severe symptom of hemolytic anemia and hyperbilirubinemia caused by ABO incompatibility.
Case Presentation Summary : A term female newborn, with the birth weight 2540grams, spontaneous labor delivery, and AS 7/9. Routine blood test 6 hours after birth showed she has anemia with hemoglobin level 9.9 g/dl and nucleated RBC 611.6%. Less than 24 hours after birth she was jaundice, with total bilirubin level 21.43 mg/dl and reticulocyte 22.6%. Peripheral blood smear demonstrated anisopoikilocytosis, polychromasia, and increased nucleated RBC. The newborn’s red cells typed B/Rh positive, while the mother’s red cells typed O/Rh positive. The patient was diagnosed as HDN due to ABO incompatibility. Intensive phototherapy and double volume exchange transfusion were performed using fresh type O/Rh positive whole blood. The newborn was discharged on day 5 in good condition with total bilirubin 12.80 mg/dl.
Learning Points/Discussion : All newborn with jaundice in the first 24 hours of life should suspicion of hemolytic process, especially with A or B blood type newborn and O blood type mother, diagnosis of ABO incompatibility is very likely. We describe a case of B/Rh positive term newborn to an O/Rh positive mother showing aggressive hemolysis within hours after delivery. This case demonstrated that HDN due to ABO incompatibility is not always a mild condition, because it may need exchange transfusion along with phototherapy to decrease the level of bilirubin that enter the toxic range to prevent bilirubin encephalopathy.
Keywords: hemolytic disease of newborn ABO incompatibility hyperbilirubinemia anemia
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