Hydrops Fetalis Due to Blood Group BO Incompatibility
Brief Reports
Hydrops Fetalis Due to Blood Group BO Incompatibility
Sources: McDonnell M, et al. Hydrops fetalis due to ABO incompatibility. Arch Dis Child Fetal Neonatol Ed 1998;78:F220-F221; Vos GH, et al. A study of ABO blood group incompatibility and neonatal jaundice in black South African newborn infants. Transfusion 1981;21:744-749.
Abo incompatibility is the most common materno-fetal blood group incompatibility occurring in as many as 20% of pregnancies. However, unlike Rh incompatibility, ABO hemolytic disease of the newborn is almost always a problem of the neonate rather than the fetus. Neonatal anemia is unusual and the major clinical problem is jaundice during the first few days of life, which can usually be controlled by phototherapy. The low frequency of severe ABO hemolytic disease in the newborn is usually attributed to the fact that most natural ABO isohemaglutinins are of the IgM immunoglobulins, and these large molecules do not cross the placenta. Hydrops fetalis is extremely rare, and only three cases of neonatal survival have been reported. McDonnell and associates at the Kings College Hospital in London describe an African-Caribbean and a Nigerian woman who delivered infants with hydrops fetalis. Both infants had severe hemolytic anemia and became jaundiced and were successfully treated with a double-volume exchange transfusion. Both mothers were O positive and both infants were B positive. Both mothers had high anti-B titers of 1:1280, but, unfortunately, it is not mentioned whether these were IgG or IgM isohemagglutinins. The incidence of severe ABO hemolytic disease of the newborn is reported to be increasing in black South African newborns as opposed to other ethnic groups. I do not know whether there are similar studies in African-American women. Vos and colleagues concluded that early prenatal discharge may be risky for babies of group O women, especially black women with a high AB antibody titer or those with a history of ABO incompatibility in a previous baby.-rae
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