Successful outcome of a pregnancy complicated by anti-e and anti-Di^b

The e antigen is the highest prevalence antigen commonly encountered in the Rh blood system, while Di^b has a prevalence of nearly 100% in most populations studied. The immune response to these antigens is clinically significant with respect to hemolysis (hemolytic disease of the fetus/newborn and hemolytic transfusion reactions).

A 33-year-old G6P4 pregnant woman presented for an initial prenatal visit. Anti-e was detected at the time of delivery of her 5th baby. Initial blood bank testing for her 6th pregnancy revealed strong pan-reactivity that proved to be anti-e and anti-Di^b. A combined antibody titer of 16 led to pregnancy monitoring using serial fetal middle cerebral artery Doppler sonography. All results were in the normal range, indicating a low risk for severe fetal anemia. The patient donated 3 units of blood for autologous and/or neonatal transfusion. She ultimately had a vaginal delivery at ~37 weeks gestational age with minimal blood loss. Her neonate had a normal hemoglobin/hematocrit at delivery and no clinical evidence of jaundice even though he had a strongly reactive DAT, typed positive for both e and Di^b, and had both antibodies eluted from his red cells. On close follow-up, he developed mild jaundice but did not require treatment.

Though this pregnant patient had 2 clinically significant antibodies to high prevalence blood group antigens, they did not affect the neonate adversely. This case demonstrates that close collaboration between obstetricians, neonatologists, and transfusion medicine specialists is essential for positive patient outcomes in cases like this.