Grand Rounds

A case report of minor blood group incompatibility (anti c) in a neonate - Is there a need for routine maternal antibody screening?

S. Nithyalakshmi1, P. Kumar2, V. Anurekha2, K.S. Kumaravel3, S. Gobinathan4, P. Sampathkumar3
1Junior Resident, Department of Pediatrics, Govt. Mohan Kumaramangalam Medical College, Salem, 2Assistant Professor, Department of Pediatrics, Govt. Mohan Kumaramangalam Medical College, Salem, 3Professor, Department of Pediatrics, Govt. Mohan Kumaramangalam Medical College, Salem, 4Associate Professor, Department of Pediatrics, Govt. Mohan Kumaramangalam Medical College, Salem

Address for Correspondence: Dr. K. S. Kumaravel, 191A, Shankar Nagar, Salem, Tamil Nadu - 636007, India. Email:

Keywords: Hemolysis, incompatibility, blood group.

Clinical Problem:
A female baby with term delivery and a birth weight of 2 kilograms was born to a 27 years old G2P1L1A0 mother by normal vaginal delivery. There was no history of blood transfusion in the motherand no history of neonatal jaundice in the first sibling. Jaundice was noticed at 23 hours of life, for which the baby was referred to our hospital. On examination, icterus was seen up to palms and soles and there was hepatomegaly of 2 cm below the right costal margin and splenomegaly of 2 cm below the left costal margin. There were no signs of bilirubin encephalopathy.
Investigations were taken on admission (Table 1) and the baby was kept under Intensive double surface phototherapy. Double volume exchange transfusion (DVET) was done at 25 hours of life and due to increasing serum bilirubin levels, DVET was repeated again at 43 hours of life. Thereafter, serial bilirubin values showed a decreasing trend.
As the neonate had a picture of immune hemolytic disease without ABO or Rh (D) incompatibility, blood group phenotyping and antibody screening of the parents were done (Table 2). Antibody identification revealed Anti-c antibody in mother and baby. A diagnosis of hyperbilirubinemia due to minor blood group incompatibility was made, the sensitizing antigen being c antigen in the neonate and antibody being anti-c antibody in the mother. The phenotyping for the baby could not be done as the baby had undergone DVET. Double surface phototherapy was discontinued at 96 hours of life at serum bilirubin of 11.9 mg% and the baby was discharged on the 7th day of life with the serum bilirubin of 8.2 mg%.

Table 1. Hematological and biochemical profile of the baby.
Hemoglobin 8.9 gms%
Total leukocyte count 16,000/
Platelet count 2,00,000 per
Total serum bilirubin 19.4 mg%
Indirect bilirubin 19 mg%
Direct bilirubin 0.4 mg%
Sr. LDH 1181 U/Lit
Reticulocyte count 13.5%
Sr. Uric acid 11 mg%
C Reactive Protein Negative
Peripheral smear Nucleated Red Blood Cells, polychromasia, and normoblasts
Mother's Blood Group O Positive
Father's Blood Group A1 Positive
Baby's Blood Group O Positive

Table 2. Result of phenotypic analysis and antibody screening in parents and the neonate.
Antigen detection: Father Mother
D 4+ 4+
C 0 4+
c 4+ 0
E 4+ 4+
e 0 4+
Indirect Coomb’s Test (Mother) 3+
Direct Coomb’s Test (Baby) 2+
Antibodies responsible for hemolysis Anti-c antibody in mother and baby

Is there a need for routine maternal antibody screening?

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