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KMID : 0981820100300050511
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Korean Journal of Laboratory Medicine
2010 Volume.30 No. 5 p.511 ~ p.515
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Hemolytic Disease of the Newborn Associated with Anti-Jra Alloimmunization in a Twin Pregnancy: The First Case Report in Korea
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Kim Hyung-Suk
Park Min-Jeong
Sung Tae-Jung
Choi Ji-Seon
Hyun Jeong-Won
Park Kyoung-Un
Han Kyou-Sup
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Abstract
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Jra is a high-frequency antigen found in all ethnic groups. However, the clinical significance of the anti-Jra antibody has remained controversial. Most studies have reported mild hemolytic disease of the newborn and fetus (HDNF) in Jra-positive patients. Recently, fatal cases of HDNF have also been reported. We report the first case of HDNF caused by anti-Jra 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-Jra 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-Jra 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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KEYWORD
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Anti-Jra, Neonatal jaundice, Fetal erythroblastosis, Hematologic pregnancy complications
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