Haemolytic disease of the newborn caused by anti-c, anti-E and anti-Fya antibodies: report of five cases.

Fetal haemolytic disease caused by irregular antibodies is discussed on the basis of three cases with maternal anti-c alone, one with anti-E along with anti-c, and one with anti-Fya sensitization. All fetuses suffering from maternal c-allo-immunization alone were treated with intra-uterine transfusions and the newborns received exchange transfusions. These interventions were also required in the case of simultaneous E and c-allo-immunization, and this was the most severe of the five cases. Delta OD450 results were consistent with the severity of the fetal condition in the c and/or E allo-immunization cases. Maternal anti-Fya sensitization caused only mild jaundice of the neonate, but the results of amniotic fluid analysis were quite misleading in that case. Antibody titres did not prove to have good prognostic values (though they were all above the critical level), and the direct antiglobulin test from cord blood was negative in three cases. Regular sonographic evaluations were performed and fetal blood samplings were a cornerstone of management.