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Severe Fetal Hemolytic Disease Due to Anti-M Alloimmunization: A Case Report and Literature Review Publisher



Golshahi F1 ; Sharbaf FR1 ; Shirazi M1 ; Sahebdel B1 ; Golshahi J2 ; Dadoun S3 ; Aalipour S3 ; Haddadi M4
Authors
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Authors Affiliations
  1. 1. Maternal, Fetal, and Neonatal Research Center, Yas Hospital, Tehran University of Medical Science, Tehran, Iran
  2. 2. Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan, Iran
  3. 3. Baylor College of Medicine, Houston, TX, United States
  4. 4. Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran

Source: Case Reports in Women's Health Published:2024


Abstract

Fetal hemolysis is caused by maternal antibodies that cross the placenta. Anti-M antibodies can rarely cause severe forms of alloimmunization in the fetus and newborn. We present a case of severe anti-M alloimmunization requiring a total of 8 intrauterine transfusions, in a patient with a prior poor obstetrical history. A 35-year-old Iranian pregnant woman with a prior obstetrical history of one abortion and two stillbirths was found to have had anti-M antibody titers 1:8 and accompanying elevated middle cerebral artery peak systolic velocity (MCA-PSV) of 1.9 MoM suggestive of severe fetal anemia at 17 weeks of gestation. Persistently elevated fetal MCA-PSV was noted despite intraperitoneal transfusion at 17, 19, and 22 weeks. Fetal blood sampling at 27 weeks confirmed severe fetal anemia (3 g/dL), which required additional intravascular and intraperitoneal blood transfusion. At 37 weeks, elective cesarean section was performed. Neonatal hemoglobin immediately after delivery was 10.1 g/dL. In addition to standard supportive care, the neonate required two additional transfusions and remained in the neonatal intensive care unit (NICU) for 23 days. Anti-M antibodies are a rare cause of severe alloimmunization. We present a case in order to improve management. © 2024