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Background
Antibodies with anti-M are detected in 10% of pregnant women with a positive antibody screen. It is the most frequently encountered antibody of the MNS blood group system but anti-M is rarely associated with haemolytic anaemia in the fetus or newborn. We report a case of a newborn with anti-M antibody immune haemolysis presenting with severe hyperbilirubinaemia requiring exchange transfusion and a previous sibling death due to intrauterine immune hydrops.
Prompt and early diagnosis with aggressive management would result in good outcome of these newborns.
Case presentation
A preterm male infant (35 weeks) appropriate for gestational age with birth weight of 2.20 kg, was born to a 28-year G2 P0 mother. The mother's blood group was A positive and the father's blood group was B positive. This pregnancy was complicated by gestational diabetes mellitus which was controlled on diet. Her first pregnancy was an intrauterine fetal death due to immune hydrops. The mother's blood was positive for indirect Coomb's test (ICT) with 1:32 dilution and anti-M antibodies. In this pregnancy too, the mother's ICT was positive. Antenatal scans showed polyhydramnios (amniotic fluid index-18) but no hydrops, Doppler ultrasound of middle cerebral artery (MCA) revealed peak systolic velocity in zone B of Marie's curve. Pregnancy was induced at 35 weeks of gestation. The baby cried immediately at birth and had Apgar's of 8/9/9 at 1, 5 and 10 min, respectively. Investigations from the cord blood revealed A positive blood group, positive direct Coomb's test (DCT), haematocrit of 41.4%, reticulocyte count of 5.3% and total serum bilirubin (TSB) of 2.7 mg/dL. On examination the infant was healthy with no pallor, no splenomegaly and was started on breastfeeding. Intensive compact fluorescent tube light phototherapy was started at 27 h of life for visible jaundice...