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Persistent hemolytic disease of the fetus and newborn (HDFN) associated with passive acquisition of anti‐D in maternal breast milk
Author(s) -
Li Marissa,
Blaustein John C.
Publication year - 2017
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.14171
Subject(s) - breast milk , discontinuation , medicine , obstetrics , breast feeding , pregnancy , fetus , pediatrics , biology , biochemistry , genetics
BACKGROUND Anti‐D is a well‐documented, significant cause of hemolytic disease of the fetus and newborn (HDFN), but its presence in breast milk is not routinely described. Theoretically, breast milk containing anti‐D could have the potential to exacerbate HDFN if ingested by the affected infant. STUDY DESIGN AND METHODS This is a case report of a 28‐week premature male neonate with hydrops fetalis born to a 32‐year‐old woman (gravidity 3/parity 3) with anti‐D and anti‐G. The male neonate experienced prolonged HDFN due to passive acquisition of anti‐D in the mother's breast milk. RESULTS The mother's breast milk reacted strongly (4+) with the D‐positive cells in the antibody screen test. Discontinuation of breast milk feeding and addition of total parenteral nutrition led to the cessation of clinically significant HDFN. CONCLUSION Although anti‐D is a significant cause of HDFN through placental transfer of antibody, exacerbation of the condition through breast milk antibodies is rarely described. The current case highlights the possibility of this occurring. Discontinuation of maternal breast milk feedings should be considered in infants with HDFN who do not respond to standard treatment.