Original ResearchAnemic Disease of the Newborn With Little Increase in Hemolysis and Erythropoiesis Due to Maternal Anti-Jra: A Case Study and Review of the Literature
Section snippets
Case Report
Anti-Jra was identified in an untransfused 33-year-old Japanese woman, gravida 2, para 0, who presented at 10 weeks of pregnancy following in vitro fertilization embryo transfer. The maternal anti-Jra titer persisted at 64 by the indirect antiglobulin test (IAT) at 18 and 27 weeks but rose slightly to 128 at 13 days and 10 months after delivery. A 3415-g male infant, blood type A D+, was delivered at 38 weeks and 4 days of gestation. Laboratory results included complete blood count (hemoglobin
Serology
At the initial hospital, ABO and D blood typing, and antibody screening were performed using the beads column method (Ortho BioVue System ABO-Rh/Reverse Grouping Cassette and Poly/Neutral Cassette, Ortho Clinical Diagnostics, Tokyo Japan). A 6-cell reagent (Ortho BioVue Screen J, Ortho) was used for antibody screening. Subsequent antibody identification was carried out by the LISS-IAT and ficin-enzyme test using an 11-cell panel (Resolve Panel C, Ortho) per the manufacturer's instructions.
Time Course of Anti-Jra and Jra Expression in the Infant and Family Study
Routine antibody identification confirmed anti-Jra with a titer of 64 at 18 and 27 weeks of gestation in the maternal plasma with no coexistence of autologous or allogeneic antibody (Fig 1). Anti-Jra was detected with a titer of 4 in the plasma of the infant at 3 days of life, and the DAT was positive (1+). However, both IAT and DAT were negative by day 13 of life. The Jra antigen status of the infant's red cells was inconclusive when cells were untreated but was confirmed to be positive after
Discussion
Although anti-Jra is not commonly thought to cause severe transfusion reactions or HDFN, this antibody can cause fatal hemolytic reaction [43] and intrauterine fetal death [6], [7], [8], [9], albeit rare. As anti-Jra has been reported predominantly among Japanese, we searched case reports written in Japanese and/or English.
Among 400 000 screened blood donors at the Japan Red Cross Saitama Processing Center (donors mainly within 300 km north of Tokyo) in Japan, 238 (0.06%) were Jr. (a−), with no
Disclosure
Authors declare they have nothing to disclose.
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Three non-classical mechanisms for anemic disease of the fetus and newborn, based on maternal anti-Kell, anti-Ge3, anti-M, and anti-Jr<sup>a</sup> cases
2020, Transfusion and Apheresis ScienceCitation Excerpt :Because high titer anti-Jra serum (1024) from a woman delivered ADFN failed to demonstrate suppression of BFU-E and CFU-E, direct suppressive pathogenesis including apoptosis is unlikely [33]. In a case of anti-Jra-mediated ADFN, neonatal red cells were revealed to be Jr(a-), with only a fraction Jr(a+) after antibody-elution treatment at day 3 of life, becoming biphasic with Jr(a+) and Jr(a-) at 1 month, and totally Jr(a+) at 10 months [32]. This phenomenon, that recovery of Jr(a+) clones by 10 months of life, suggests that clonal escape from anti-Jra immune pressure was brought by epigenetic modification of nucleic acids (DNA and RNA).
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