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Erythrokinetic mechanism(s) causing the “late anemia” of hemolytic disease of the fetus and newborn

Journal of Perinatology (2024)Cite this article

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Abstract

A transfusion-requiring “late anemia” can complicate the management of neonates convalescing from hemolytic disease of the fetus and newborn (HDFN). This anemia can occur in any neonate after HDFN but is particularly prominent in those who received intrauterine transfusions and/or double-volume exchange transfusions. Various reports describe this condition as occurring based on ongoing hemolysis, either due to passive transfer of alloantibody through breast milk or persistence of antibody not removed by exchange transfusion. However, other reports describe this condition as the result of inadequate erythrocyte production. Both hypotheses might have merit, because perhaps; (1) some cases are primarily due to continued hemolysis, (2) others are primarily hypoproductive, and (3) yet others result from a mixture of these two mechanisms. We propose prospective collaborative studies that will resolve this issue by serially quantifying end-tidal carbon monoxide. Doing this will better inform the assessment and treatment of neonates recovering from HDFN.

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Authors and Affiliations

  1. Women and Newborns Research, Intermountain Health, Murray, UT, USA

    Robert D. Christensen & Timothy M. Bahr

  2. Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    Robert D. Christensen, Timothy M. Bahr & Robin K. Ohls

  3. Transfusion Medicine, Department of Pathology, Intermountain Health, Murray, UT, USA

    Sarah J. Ilstrup

  4. Comprehensive Fetal Care Center at Dell Children’s Medical Center and Department of Women’s Health, Dell Medical School, Austin, TX, USA

    Kenneth J. Moise Jr.

  5. Division of Neonatology, Leiden University Medical Centre, Leiden, Netherlands

    Enrico Lopriore

  6. Division of Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    Jessica A. Meznarich

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Contributions

Conceptualization: RDC, TMB, KJM, and EL. Formal analysis: RDC, TMB, RKO, KJM, EL, SJI and JAM. Writing of the original manuscript draft: RDC. Writing – review and editing: RDC, TMB, RKO, KJM, EL, SJL and JAM. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Robert D. Christensen.

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Christensen, R.D., Bahr, T.M., Ohls, R.K. et al. Erythrokinetic mechanism(s) causing the “late anemia” of hemolytic disease of the fetus and newborn. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01872-z

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