A case of assisted reproductive technology-induced maternal alloimmunization: an emerging sensitizing factor to consider?

Red blood cell (RBC) alloimmunization can occur because of exposure to various sensitizing factors and poses a constant threat in transfusion. Assisted reproductive technology (ART) involves manipulation of sperm, ova, or embryos in vitro with the goal of producing a pregnancy. We present an interesting case of ART-induced maternal alloimmunization (AIMA) due to anti-c in a woman carrying a twin pregnancy. A 35-year-old primigravida, whose blood sample typed as group B, D+ and showed anti-c in her plasma, delivered twins by cesarean section. The spouse's blood group was also B, D+. The blood groups of twins I and II were confirmed to be B, D+ and AB, D+, respectively. The RBCs of twin I were c+, but those of twin II and the spouse were c-. On enquiry, history of ART with donor sperm insemination was noted. Because there were no previous sensitizations, antigenic inheritance from the sperm donor to twin I could be the possible sensitizing factor for maternal alloimmunization. To the best of our knowledge, this case is the first report of ART-induced maternal RBC alloimmunization in the literature. History of ART exposures should be documented, and appropriate RBC phenotyping of the parent as well as potential ART donors will help in timely detection or prevention of hemolytic disease of the fetus and newborn or other AIMA-related complications.