Perinatology.  2020 Sep;31(3):157-160. 10.14734/PN.2020.31.3.157.

Severe Late-onset Anemia Associated with Rhesus D Alloimmunization

  • 1Departments of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea


Rhesus D (RhD) alloimmunization is the most severe cause of hemolytic disease of the fetus and newborn (HDFN). However, owing to medical advances, pediatricians are likely to encounter only a few relatively mild cases. Therefore, although late-onset anemia is a well-recognized complication of HDFN, it may be overlooked in evaluations for post-discharge surveillance. Herein, we report a case of severe late-onset anemia associated with RhD HDFN. A 37-day-old male infant presented with a marked pale appearance. During the fetal period, he had received intrauterine transfusion six times for the treatment of severe anemia induced by RhD HDFN. However, during the neonatal period, he had no significant clinical manifestations, except mild jaundice. The laboratory findings on the day of presentation showed severe hemolytic anemia with reticulocytosis, which was treated with red blood cell transfusion. Our case report emphasizes that regardless of the initial disease severity during the neonatal period, regular follow-up visits and close monitoring for late-onset anemia in the first several weeks after birth are vital in infants with HDFN.


Rh isoimmunization; Hemolytic disease of the fetus and newborn; Late-onset anemia; Intrauterine blood transfusion
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