Severe hemolytic disease of a newborn due to anti-E combined with anti-Mia, anti-Mur and anti-Hil

Background: Common alloantibodies leading to severe hemolytic disease of the fetus and newborn (HDFN) could vary among different ethnic groups. The MNS blood group hybrid glycophorin GP.Mur distributes with a high frequency in the regions of Southeast Asia. Alloantibodies against GP.Mur (anti-‘Mi a ’) often present as mixture of antibodies against several low frequency antigens. In this study, we first described a case of severe HDFN in Guangzhou, China, which was caused by alloantibodies of anti-E in combination with specificities to the GP.Mur including Mi a , Mur and Hil. Methods: Blood samples from the newborn boy and parents have been subjected to antibody screening and identification analysis followed by GYP*Mur genotyping. The direct antiglobulin test (DAT) and the eluate technique were also performed for the newborn. Results: The mother was group B, CCDee, Mur−, the father was group B, ccDEE, Mur+, and the newborn was group B, CcDEe, Mur+. Genotyping results showed the mother was absent for GYP*Mur , while the father and the newborn carried heterozygous GYP*Mur allele. DAT test of the newborn was strongly positive with anti-IgG. Anti-E and anti-‘Mi a ’ were detected in the maternal serum and the newborn’s eluate, whereas anti-E alone was detected in the newborn’s serum. The anti-‘Mi a ’ specificity was further identified as combination of anti-Mi a , anti-Mur and anti-Hil. Conclusions: Because alloantibodies to GP.Mur could cause severe HDFN, it is highly recommended to include GP.Mur red cells in antibody screening cells to avoid miss detection of the alloantibodies in the populations of Southeast Asia.