ABO incompatibility (ABOi), the most common cause of hemolytic disease of the newborn (HDN), is nearly always mild and treatable with phototherapy. Reports of ABOi HDN requiring neonatal exchange transfusion are extremely rare since the inception of modern guidelines. Here, a case of ABOi HDN clearly met criteria for exchange transfusion. An O-positive African American mother delivered a B-positive neonate that quickly developed hyperbilirubinemia. The neonatal DAT was positive from anti-B and anti-A,B, and maternal IgG titer was 1024. Double volume exchange transfusion resulted in a favorable outcome. Given early discharge of newborns, further understanding of factors predicting severe disease is needed.
*Department of Pathology, University of Utah, Salt Lake City, UT
†Department of Laboratory Medicine, University of Washington
§Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle WA
‡Departments of Pathology and Pediatrics, Stanford University, Palo Alto, CA
The authors declare no conflict of interest.
Reprints: Ryan A. Metcalf, MD, Department of Pathology, University of Utah, 50N Medical Drive, Salt Lake City, UT 84108 (e-mail: email@example.com).
Received March 12, 2018
Accepted May 27, 2018