A Case of Severe Hemolytic Disease of the Newborn Due to Anti-Dia Antibody

Sun Min Lee; Sun Ju Im; Su Eun Park; Eun Yup Lee; Hyung Hoi Kim

doi:10.3343/kjlm.2007.27.5.373

Journal List > Korean J Lab Med > v.27(5) > 1011424

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee, Im, Park, Lee, and Kim: A Case of Severe Hemolytic Disease of the Newborn Due to Anti-Dia Antibody

Original Article

Korean J Leg Med 2007;27(5):373-376.

Published online: 14 February 2007

DOI: https://doi.org/10.3343/kjlm.2007.27.5.373

A Case of Severe Hemolytic Disease of the Newborn Due to Anti-Di^a Antibody

Sun Min Lee, M.D.¹, Sun Ju Im, M.D.², Su Eun Park, M.D.², Eun Yup Lee, M.D.¹, Hyung Hoi Kim, M.D.¹

¹Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea

²Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea

Received 9 May 200714 August 2007 Accepted 18 August 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Here we report a severe case of hemolytic anemia of the newborn with kernicterus caused by anti-Di^a antibody. A full term male infant was transferred due to hyperbilirubinemia on the third day of life. Despite single phototherapy, the baby's total bilirubin had elevated to 30.1 mg/dL. After exchange transfusion, total bilirubin decreased to 11.45 mg/dL. The direct antiglobulin test on the infant's red cells was positive. The maternal and infant's sera showed a negative reaction in routine antibody detection tests, but were positive in Di^a panel cells. The frequency of the Di^a antigen among the Korean population is estimated to be 6.4-14.5%. Anti-Di^a antibody could cause a hemolytic reaction against transfusion or hemolytic disease of the newborn. We suggest the need for reagent red blood cell panels to include Di^a antigen positive cells in antibody identification test for Korean.

Keywords: Anti-Di^a, Kernicterus, Hemolytic disease of the newborn, Antibody screening test

REFERENCES

1.Won CD., Kim SH., Shin HS. Transfusion and blood group. Korean Medicine. 1961. 4:363–71. (원종덕, 김석환, 신한수. 수혈과혈액형. 한국의약 1961;4: 363-71.).

2.Lee SY. Further analysis of Korean blood types. Yonsei Med J. 1965. 6:16–25.

3.Choi SY., Kim SI., Cho HI. Study on gene frequencies of blood groups in Koreans. Korean J Hematol. 1984. 19:63–75. (최성엽, 김상인, 조한익. 한국인의 혈액형 유전자 빈도에 관한 연구. 대한혈액학회지 1984;19: 63-75.).

4.Chae SL., Cho HI., Kim SI. A study on the frequencies of U, Diegoa, and Kell blood group antigens and anti-Dia and anti-K in Koreans. Korean J Hematol. 1988. 23:183–8. (채석래, 조한익, 김상인. 한국인의 U, Diegoa 및 Kell 혈액형항원 빈도와 항-K 및항-Dia 항체에대한조사연구. 대한혈액학회지 1988;23: 183-8.).

5.Sung NH., Jeon TY., Lee EY., Chung JS., Cho GJ., Kim HH. Prevalence and specificity of unexpected antibody using antibody screening test including Dia and Mia cells. Korean J Lab Med. 2005. 25:340–6. (성낙현, 전태용, 이은엽, 정주섭, 조군제, 김형회. Dia와 Mia 항원을포함한적혈구특이항원에대한비예기항체빈도및그특성에관한연구. 대한진단검사의학회지 2005;25: 340-6.).

6.Kim HO., Song KS., Lee SY. A case of anti-Diegoa. Korean J Clin Pathol. 1987. 7:357–61. (김현옥, 송경순, 이삼열. 다수수혈경험이있는환자에서의 anti-Diegoa (Dia) 검색1예. 대한임상병리학회지 1987;7: 357-61.).

7.Kim HK., Cho YJ., Kim YK., Oh YC., Choi BR., Cho MJ. A case of anti-Dia antibody. Korean J Hematol. 1989. 24:155–9. (김혜경, 조윤정, 김영기, 오영철, 최범열, 조명준. 항 Dia 항체검색 1예. 대한혈액학회지 1989;24: 155-9.).

8.Chung HR., Lee JW., Kim HO., Lee SY., Kim HJ. A case of delayed hemolytic transfusion reaction in a patient with anti-Diegoa and anti-Lewisa. Korean J Clin Pathl. 1989. 9:557–62. (정화령, 이정운, 김현옥, 이삼열, 김휘준. 항-Diegoa와 항-Lewisa 항체에 의한 지연성 용혈성수혈부작용1예. 대한임상병리학회지 1989;9: 557-62.).

9.Chung MA., Park EH., Lee CH., Oh CH., Namgung R., Kim HO, et al. A case of hemolytic disease in the newborn due to anti-Dia antibody. J Korean Soc Neonatol. 2001. 8:141–4. (정민아, 박은혜, 이창한, 오창희, 남궁란, 김현옥등. Anti-Dia에의한신생아용혈성질환 1예. 대한신생아학회지 2001;8: 141-4.).

10.Han KS, Park MH, editors. Transfusion medicine. 3rd ed.Seoul: Korea Medical Publishing Co.;2006. (한규섭, 박명희등. 수혈의학. 제3판. 서울: 고려의학, 2006.).

11.Alves de Lima LM., Berthier ME., Sad WE., DiNapoli J., Johnson CL., Marsh WL. Characterization of an anti-Dia antibody causing hemolytic disease in a newborn infant. Transfusion. 1982. 22:246–7.

12.Levine P., Robinson EA. Some observations of the new human blood factor Dia. Blood. 1957. 12:448–53.

13.Peng CS., Soong WJ., Hu HY., Huang B. Hemolytic disease of the newborn due to anti-Di(a): report of one case. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1996. 37:370–2.

14.Kusnierz-Alejska G., Bochenek S. Haemolytic disease of the newborn due to anti-Dia and incidence of the Dia antigen in Poland. Vox Sang. 1992. 62:124–6.

15.Ting JY., Ma ES., Wong KY. A case of severe haemolytic disease of the newborn due to anti-Di(a) antibody. Hong Kong Med J. 2004. 10:347–9.

16.Yung CH., Lin JS., Hu HY., Lyou JY., Chen YR., Chen CR, et al. Hemolytic disease of the newborn caused by maternal anti-Di(a): a case report in Taiwan. Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi. 1995. 28:146–50.

17.Kim DA., Kim TY., Choi TY. Genotyping of Diego blood group system by use of polymerase chain reaction and Nae I restriction enzyme. Korean J Clin Pathol. 1999. 19:246–51. (김덕언, 김신규, 최태열. 중합효소연쇄반응법과 Nae I 제한효소절단양상분석을이용한새로운 Diego 유전자형검사법. 대한임상병리학회지 1999;19: 246-51.).

18.Miyazaki T., Sato S., Kato T., Ikeda H. Human anti-Dia monoclonal antibodies for mass screening. Immunohematol. 2000. 16:78–81.

19.Park TS., Oh SH., Choi JC., Lee DD., Kim HH., Chang CL, et al. The clinical significance of antibody screening test including Di^a+ panel cell in Asian-Mongoloid populations. J Korean Med Sci. 2003. 18:669–72.

20.Lee SM., Lim YA., Oh JS. An experience of including ID DiaCell Dia cell in unexpected antibody screening test. Korean J Blood Transfus. 2005. 16:32–7. (이선민, 임영애, 오진숙. 비예기항체 선별검사시 IDDiaCell Dia 선별혈구사용경험. 대한수혈학회지 2005;16: 32-7.).

21.Oh DJ., Kim MJ., Seo DH., Song EY., Han KS., Kim HO. The frequency of unexpected antibodies in blood donors and transfusion candidates in Korea. Korean J Blood Transfus. 2003. 14:160–72. (오덕자, 김문정, 서동희, 송은영, 한규섭, 김현옥. 국내 헌혈자 및 수혈 예정자의비예기항체빈도. 대한수혈학회지 2003;14: 160-72.).

Fig. 1.

Antibody screening test results of serum from patient (A), his mother (B) and father (C). All reactions to ID-DiaCell I+II panel cells (DiaMed AG, Switzerland) were negative but the sera of patient and his mother reacted to Di^a+ cells (ID-DiaCell Di^a+) while the sera of father did not.

Fig. 2.

Allele specific PCR of SLC4A1 gene: lane 1-3, with primer set for DI1 allele; lane 4-6, for DI2 allele. Patient's father (lane 1 and 4) and patient (lane 3 and 6) have both SLC4A1 gene DI1 allele and DI2 allele, but his mother has the only DI2 allele (lane 2 and 5). The upper arrow indicates that the 427 bp fragments of HGH were amplified as an internal control. The lower arrow indicates 139-bp PCR products of SLC4A1 DI1 allele.

Table 1.

Laboratory findings of the patient with hemolytic disease of the newborn due to anti-Di^a

Days after birth	Hb (g/dL)	Hct (%)	Reticulocyte (%)	TB (mg/dL)	DB (mg/dL)	LDH (IU/L)	Management
Day 2				23.5			Phototherapy
Day 3	14.7	42.4		29.1	1.0	1,175	Transfer
Day 4	12.4	35.0		21.94	0.83	1,094	Exchange transfusion
				11.45^∗
Day 5	10.9	31.2	3.71	13.98^†	0.48	580	Phototherapy
Day 7	11.1	31.4		7.46^‡	0.33	847	Mechanical ventilation
Day 11	11.2	33.3		5.39^§	0.33	759	Vent weaning

^∗ After exchange transfusion, the level of total bilirubin was decreased to 11.45 mg/dL.

^† Next day morning, the total bilirubin was 13.98 mg/dL.

^‡ After phototherapy for three days, it was decreased to 7.46 mg/dL.

Abbreviations: Hb, hemoglobin; Hct, hematocrit; TB, total bilirubin; DB, direct bilirubin; LDH, lactate dehydrogenase.

Table 2.

Primer sequences used for Diego blood group gene SLC4A1 PCR

Primer	Sequence (5′-3′)	Gene (allele)	Size (bp)
F2	GTG CTG GGG TGT GAT AGG C	SLC4A1 (DI1)	139
AR	CAG GGC CAG GGA GGC CA
BF	GGT GGT GAA GTC CAC GCC	SLC4A1 (DI2)	129
R	CCA GGC AGC CAC TCA CAC
HGHF	GCC TTC CCA ACC ATT CCC TT	HGH	427
HGHR	TCA CGG ATT TCT GTT GTG TTT C

TOOLS

Similar articles