Haemolytic Disease of the Newborn Due to Anti‐G

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Abstract
Mrs P. presented at 13 weeks of gestation with apparent anti‐C+D. At week 34, with antibody levels of 168 IU/ml, a D‐negative (r′r) baby was delivered with a strongly positive DAT and an Hb of 3.0 g/dl. Anti‐G in maternal serum was isolated by adsorption and elution from R2R2 cells and shown, using flow‐cytometric and chemiluminescence assays, to sensitize r′r cells at levels of cell‐bound IgG consistent with fetal haemolysis. In an analysis of 28 sera from alloimmunized women with over 5 IU/ml anti‐C+D, 2 sera were shown to contain levels of anti‐G consistent with moderate or severe haemolytic disease of the newborn (HDN). Thus HDN due to anti‐G may not be rare. An analysis of 187,037 blood donors in the south‐west of England showed the r′ gene frequency to be 0.005897 suggesting that approximately 2.9% of matings of rr women with D‐negative fathers can produce an r′r baby. These findings highlight the need for the continuous non‐invasive monitoring of D‐negative fetuses of women with apparent anti‐C+D.