Get access

Successful management of severe hemolytic disease of the fetus due to anti-Jsb using intrauterine transfusions with serial maternal blood donations: a case report and a review of the literature

Authors

  • Arwa Z. Al Riyami,

    1. Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
    2. Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
    3. Department of Obstetrics and Gynecology, Royal Hospital, Muscat, Oman
    4. Department of Hematology, Royal Hospital, Muscat, Oman
    Search for more papers by this author
  • Moza Al Salmani,

    1. Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
    2. Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
    3. Department of Obstetrics and Gynecology, Royal Hospital, Muscat, Oman
    4. Department of Hematology, Royal Hospital, Muscat, Oman
    Search for more papers by this author
  • Sabria Al Hashami,

    1. Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
    2. Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
    3. Department of Obstetrics and Gynecology, Royal Hospital, Muscat, Oman
    4. Department of Hematology, Royal Hospital, Muscat, Oman
    Search for more papers by this author
  • Sabah Al Mahrooqi,

    1. Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
    2. Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
    3. Department of Obstetrics and Gynecology, Royal Hospital, Muscat, Oman
    4. Department of Hematology, Royal Hospital, Muscat, Oman
    Search for more papers by this author
  • Sumaiya Al Hinai,

    1. Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
    2. Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
    3. Department of Obstetrics and Gynecology, Royal Hospital, Muscat, Oman
    4. Department of Hematology, Royal Hospital, Muscat, Oman
    Search for more papers by this author
  • Halima Al Balushi,

    1. Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
    2. Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
    3. Department of Obstetrics and Gynecology, Royal Hospital, Muscat, Oman
    4. Department of Hematology, Royal Hospital, Muscat, Oman
    Search for more papers by this author
  • Nihal Al Riyami,

    1. Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
    2. Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
    3. Department of Obstetrics and Gynecology, Royal Hospital, Muscat, Oman
    4. Department of Hematology, Royal Hospital, Muscat, Oman
    Search for more papers by this author
  • V. Gowri,

    1. Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
    2. Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
    3. Department of Obstetrics and Gynecology, Royal Hospital, Muscat, Oman
    4. Department of Hematology, Royal Hospital, Muscat, Oman
    Search for more papers by this author
  • Tamima Al Dughaishi,

    1. Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
    2. Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
    3. Department of Obstetrics and Gynecology, Royal Hospital, Muscat, Oman
    4. Department of Hematology, Royal Hospital, Muscat, Oman
    Search for more papers by this author
  • Saif Al Hosni,

    1. Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
    2. Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
    3. Department of Obstetrics and Gynecology, Royal Hospital, Muscat, Oman
    4. Department of Hematology, Royal Hospital, Muscat, Oman
    Search for more papers by this author
  • Murtadha Al-Khabori,

    1. Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
    2. Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
    3. Department of Obstetrics and Gynecology, Royal Hospital, Muscat, Oman
    4. Department of Hematology, Royal Hospital, Muscat, Oman
    Search for more papers by this author
  • Khalil Al-Farsi,

    1. Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
    2. Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
    3. Department of Obstetrics and Gynecology, Royal Hospital, Muscat, Oman
    4. Department of Hematology, Royal Hospital, Muscat, Oman
    Search for more papers by this author
  • Mohammed Al Huneini,

    1. Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
    2. Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
    3. Department of Obstetrics and Gynecology, Royal Hospital, Muscat, Oman
    4. Department of Hematology, Royal Hospital, Muscat, Oman
    Search for more papers by this author
  • Salam Alkindi

    Corresponding author
    1. Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
    2. Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
    3. Department of Obstetrics and Gynecology, Royal Hospital, Muscat, Oman
    4. Department of Hematology, Royal Hospital, Muscat, Oman
    • Address reprint requests to: Salam Alkindi, Hematology Department, Sultan Qaboos University Hospital, PO Box 35, Muscat 123, Oman; e-mail: sskindi@squ.edu.om.

    Search for more papers by this author

Abstract

Background

The management of pregnant women with anti-Jsb is challenging due to the paucity of antigen-negative blood for fetal and neonatal transfusion.

Case Report

A 29-year-old woman with anti-Jsb was referred for assessment of recurrent fetal losses. With the presence of the sister as a historically matched donor, she was planned for active surveillance for fetal anemia during pregnancy.

Study Design and Methods

The fetus remained well until 21 weeks of gestation when signs of fetal anemia and early hydrops fetalis were noted. Anti-Jsb titer was at 128. The sister's red blood cells (RBCs) were cross-match incompatible. Urgent intrauterine transfusion (IUT) was performed with washed irradiated maternal RBCs, donated after cessation of heparin. The mother was given intravenous iron (IV-Fe) and continued on weekly recombinant human erythropoietin (rHu-EPO).

Results

Repeated IUTs were needed every 1 to 3 weeks. Throughout a 7-week period, three maternal donations were performed with total donated whole blood volume of 1250 mL, supporting four IUTs. At 29 weeks of gestation, the procedure was complicated by umbilical cord hematoma necessitating urgent cesarean section. A male newborn was delivered, transfused at birth, and subsequently treated with phototherapy and five top-up transfusions.

Conclusion

This case represents a successful example of managing hemolytic disease of the fetus due to a rare antibody using maternal blood. It also supports previous data on safety of maternal donations during pregnancy and the use of combination of rHu-EPO and IV-Fe as a supportive measure.

Get access to the full text of this article

Ancillary