1. 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

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

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

4. 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

5. 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 NRBC 76% MCV MCH43 platelet
Bilirubin 13.6/ /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

6. 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?

7. 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--

8. Case 2

9. Case 2

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

11. 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

12. HDN

13. HDN Anti c

14. Fetomaternal bleeding

15. Infantile piknocytosis

16. Neonatal jaundice with osteomatocytosis