Emergence of additional anti-C with amplification of anti-D titer post-Rh-Kell phenotype-matched intrauterine transfusions in severe hemolytic disease of fetus.

Transplacental ultrasound-guided intrauterine transfusion (IUT) acts as a lifesaving therapy to prevent fetal anemia or even to reverse fetal hydrops. IUTs are generally initiated after 22-24 weeks of gestation and repeated every 2-4-week period of gestation. Although Rh-Kell phenotype-matched, fresh irradiated leukoreduced donor-packed red cells help to increase fetal hemoglobin level, this invasive procedure can increase fetal complications by fetomaternal hemorrhage. Women receiving IUTs are noted to be high allo-responders to red cell antigens, which can cause enhanced antibody titer or the formation of additional antibodies which might complicate future pregnancies. Hereby, we are reporting the case of a multiparous woman who underwent three sessions of IUTs between 24 weeks and 31+-week period of gestation and developed an additional anti-C antibody which was incidentally detected during compatibility testing at 34 weeks, along with raised anti-D immunoglobulin G titer of 1024 from initial titer of 128.