CLINICAL EXAMINATION OF ERYTHROCYTE HALF-LIFE AFTER EXCHANGE TRANSFUSION IN A NEWBORN WITH HEMOLYTIC DISEASE OF THE FETUS AND NEWBORN

Abstract

RhoD (+) fetuses or newborns of women with anti-D frequently show serious hemolytic disease. We report herein a RhoD(+) newborn from a RhoD(-) woman who developed hemolytic disease of the fetus and newborn and describe the time course of the ratio between RhoD(-) and RhoD(+) erythrocytes after exchange transfusion (ET). Her fetus showed no serious complications without treatment, despite markedly increased titers of anti-D in plasma up to 1: 2,048 at birth. However, because total bilirubin and hemoglobin levels deteriorated immediately after birth, high-dose immunoglobulin administration, phototherapy, and ET were performed and proved successful. We administered a mixture of O-type RhoD(-) red cell concentrate and AB-type RhoD(+) flesh frozen plasma for ET. Flow cytometric analysis showed that most erythrocytes in the newborn were substituted for transfused O-type RhoD(-) red blood cells immediately after ET. The ratio of RhoD(+) erythrocytes then increased daily, in contrast to RhoD(-) erythrocytes, which disappeared by 86 days after ET. The half-life of transfused erythrocytes was approximately 36 days, suggesting that manipulated erythrocyte products show a half-life comparable to that of erythrocytes in healthy adults.