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help needed please !!!!

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Andy Battaglia:
Mickey,

Is this possibly related to Rh factor? It is the most common cause of hemolysis in newborns, and often does not manifest until a second pregnancy.

Andy Battaglia:
There is a good overview of Hemolytic Disease of Newborn at http://emedicine.medscape.com/article/974349-overview  If it is not Rh factor, it may be among the following issues. Please print this out and ask the doctors if any of these may apply and if testing is in order for any of these possibilities.


--- Quote ---Causes
In the absence of a positive direct Coombs test result, other causes of pathologic jaundice should be considered, including intrauterine congenital infections; erythrocyte membrane defects (eg, hereditary spherocytosis, hereditary elliptocytosis, hereditary pyropoikilocytosis); RBC enzyme deficiencies (eg, glucose-6-phosphate dehydrogenase [G6PD] deficiency, pyruvate kinase deficiency, triosephosphate isomerase deficiency); and nonhemolytic causes (eg, enclosed hemorrhages, hypothyroidism, gastrointestinal obstruction, and metabolic diseases).
 
Similarly, hydrops can occur from nonimmune hematologic disorders that cause anemia, such as hemoglobinopathies (eg, α -thalassemia major), cardiac failure due to dysrhythmia, congenital heart defects, and infections (eg, syphilis, cytomegalovirus [CMV], parvovirus).



Common causes of HDN
Rh system antibodies
ABO system antibodies
Uncommon causes - Kell system antibodies
Rare causes
Duffy system antibodies
MNS and s system antibodies
No occurrence in HDN
Lewis system antibodies
P system antibodies

--- End quote ---

To be honest, thalassemia alone would make no sense for this reaction. It could possibly be thal minor combined with another factor.

Narendra:
Mickey,

Also make sure the blood been given is washed blood, so the blood taken does not attack her. As Andy as mentioned, do print the list of the possibilities and show it to the doctor to see what is causing the hemolysis of the blood

Sharmin:
We are all praying for your family Mickey.  I think that the notes Andy gave you will be very helpful to your doctors in assessing her.  Is your wife's blood type B-?  That could explain a lot.  I wonder if the doctors have suspected thisas well because from the notes it appears that she was given IVIg. 

Sharmin

Zaini:
We are praying for you Micky,I hope she is feeling better now,please update us.

Zaini.

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