A 1-Day-Old Neonate Presents With an Unexpected Antibody

Abstract

Patient: 1-day-old Caucasian male neonate. History of Present Illness: The neonate was born to a 26-year-old gravida 1 female at 37 weeks gestational age via Caesarean section, secondary to failure to progress in labor. The infant was delivered without complications. Routine blood work on the infant revealed an unexpected red cell antibody. A direct antiglobulin test (DAT) and antibody screen were both noted to be positive. Past Medical History: The mother received routine prenatal care throughout her pregnancy. She has a past medical history of chronic hypertension, an anti-E antibody, a pan-reactive autoantibody to red cell antigens, and mild intermittent asthma. The anti-E was discovered upon prenatal screening in the mother, but was not identified in subsequent auto-absorbed specimens. No previous transfusions were documented. Social History: Non-contributory. Family History: Non-contributory. Physical Exam: The neonate’s APGAR scores were 8 at 1 minute and 9 at 5 minutes. An exam showed the neonate to be in no acute distress and with essentially normal physical findings. Principal Laboratory Findings: See Table 1, Table 2, Table 3, and Table 4. 1. What are the mother’s most striking laboratory findings? 2. The mother and neonate share the same antibody identification panel in Tables 3 and 4. Why? 3. What autoimmune conditions of pregnant women have been observed to produce transplacental antibodies resulting in neonatal disease? 4. What additional workup is necessary …