Hemolytic disease of the newborn associated with anti-Jra alloimmunization in a twin pregnancy: The first case report in Korea

  • Kim H
  • Park M
  • Sung T
 et al. 
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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.

Author-supplied keywords

  • Anti-Jra
  • Fetal erythroblastosis
  • Hematologic pregnancy complications
  • Neonatal jaundice

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Authors

  • Hyungsuk Kim

  • Min Jeong Park

  • Tae Jung Sung

  • Ji Seon Choi

  • Jungwon Hyun

  • Kyoung Un Park

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