Anti-Ce in haemolytic disease of the foetus and newborn.

OBJECTIVES

To report a delayed case of severe haemolytic disease of the foetus and newborn (HDFN) due to Anti-Ce.

BACKGROUND

HDFN due to maternal antibodies is potentially fatal. As a result, antibody levels and foetal anaemia are periodically monitored and risk assessed throughout pregnancy. HDFN due to Anti-Ce is rare.

CASE REPORT: A 29-year-old Caucasian female with low titre Anti-Ce and Anti-e antenatally delivered a term baby girl that required multiple transfusions and hospital admissions early in life. The apparent clinical severity of HDFN resulted in investigative testing of a maternal admission sample at delivery for titre levels. Anti-Ce was identified as the cause of HDFN in this case, following an eightfold increase in titre levels from week 28 gestation (titre = 4) to term (titre = 32).

DISCUSSION: The severe HDFN outlined in this case was unexpected due to the antibody specificity and low titres antenatally. The Anti-Ce with a titre of 32 implicated in this study is on the threshold for specialist foetal team involvement and vigilant monitoring as per BSH guidelines.

CONCLUSION

Anti-Ce titre monitoring beyond 28 weeks gestation and specialist foetal team involvement early in pregnancy should be considered despite current BSH Guidelines, along with extended neonatal monitoring.