Severe Hemolytic Disease of the Fetus and Newborn with Uncommon High Anti-D Titers and Prolonged Anemia

We report on two patients with severe hemolytic disease of the fetus and newborn. Both mothers showed anti-D antibodies with uncommon high titers (patient 1: 1 048 576, Patient 2: 16384) as well as further allo-antibodies and they were treated by intrauterine transfusions throughout pregnancy. Child 1 was born at 33rd week of gestation and had Apgar nisms are discussed as the cause of prolonged postnatal anemia: On the one hand persistent anti-D antibodies and intrauterine transfusions can lead to reduced erythropoiesis. This is to be distinguished from late hemolytic anemia with regenerating bone marrow and persistent immunohematological hemolysis. These cases demonstrate that hyporegenerative anemia can last for several weeks after birth and infants must be carefully monitored for signs of ongoing anemia. Besides hemoglobin level determination additional monitoring of reticulocytes and anti-D-titer will help to predict recovery of the bone marrow.