Case presentation 1 Full term newborn baby Admitted to NICU because mild tachypnea She developed jaundice at 20 hours after birth She is second child of mother with AB negative group and AB positive father Hx of rhogam injection immediate after first delivery and she has a 3.5 years old child without history of jaundice In this pregnancy :Hx of vaginal bleeding at 17th week gestation she admitted in hospital for 5 days and has taken one dose of rhogam during hospital stay and at 28th week gestation Intensive phototherapy and investigation for etiology of jaundice were started

Case presentation 1 Lab result: Blood group A+ Hb 13.2 Bil 9.5 direct 0.9 Retic 19% Combs + WBC 20800 NRBC 50/100WBC Polychromasia and spherocte were seen What are the next tests to be needed?

Case presentation 1 Anti D 1/1024 Anti C 1/32 Anti E 1/64 Anti IgG 3d + Anti IgG + Anti c3d weakly positive

Case 1 Which one is responsible for hemolysis in this baby? antiD antibody? Or multiple antibody? Why anti D antibody was produced despite several injection of rhogam in mother at previous and current pregnancy

Case presentation 2 A term neonate with meconium aspiration (mild) and APGAR scor 7/8 under observation in NICU. Pallor ,tachycardia, hepatomegaly She is the first child of the family .no previous HX of abortion Jaundice was developed at 6 hours after birth Hb 6.7 WBC 21600 NRBC 76% MCV167 MCH43 platelet 199000 Bilirubin 13.6/0.9 15/3.2 retic 32% combs positive IV antibiotic intensive phototherapy were started No match blood was found after a several attempts of blood bank Hb was dropped to 5.2 gr/dl

Case 2 Mothers blood group: A+ Infants blood group: A+ What is your recommendation? 1- Emergency antibody screening 2-transfusion of least incompatible blood O negetive?

Immunohematology Reference Laboratory of the IBTO Infant Mother Test Result Test Result ABO A ABO A Rh(D) Positive Rh(D) Positive Anti-IgG, C3d Positive Antibody screening test Positive Anti-IgG Positive(3+) Antibody type Anti-Rh17(Anti-Hro) Anti-C3d Positive(1+) Anti-IgG, C3d Negative Auto Antibody Negative RBC phenotype C Negative c Negative E Negative e Negative BLOOD GROUP: D--

Case 2

Case 2

Case presentation 2 One unite Anti Rh-17 from frozen unites was released and transfused 2th day : Hb 8gr/dl Bil 13.5 direct 2.5 IVIG 2.5 gram transfused

case2 6,7 th day Hb: 7.2 , 4.5 retic 9% bil 10 ,8 40 cc packed cell transfused from brugerd Second dose IVIG 2.5 gr Transferred from NICU to the ward 8th day Hb :8gr /dl 9th day Hb 9gr/dl 11th day discharged

HDN

HDN Anti c

Fetomaternal bleeding

Infantile piknocytosis

Neonatal jaundice with osteomatocytosis