Iranian Society of Gynecology Oncology

Document Type : Case Report Article


1 Department of Obstetrics and Gynecology, Baqyiatallah Hospital, Baqyiatallah University of Medical Sciences, Tehran, Iran

2 Departemtn of Feto-Maternal, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Obstetrics and Gynecology, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran


As widespread prophylaxis with anti-D Antibodies has dramatically diminished anti-D-associated hemolytic disease of the newborn (HDN), other antibodies-associated HDN has become relatively more significant. Two genes encode Rh proteins: the RhD gene coding for the D and the Rh CcEe gene coding for Cc Ee Antigens. D is a rare Rh phenotype in which RBCs lack Cc/Ee antigens while D antigen is strongly expressed. Anti R17 antibodies are important monomorphic antibodies acting against all previously mentioned antigens. It can pass through the placenta as a G immunoglobulin, leading to fetal or neonatal hemolysis. Here, we reported an immunized pregnant female with D- - phenotype and a history of intrauterine fetal death who had high titer of anti-Rh17 antibodies in her subsequent pregnancy. We would discuss our management strategy which led to good perinatal outcomes. To the best of our knowledge, this is the second case of HDN reported in English written literature in Iran.


Main Subjects

1. Flegel WA. The genetics of the Rhesus blood group system. Blood Transfus. 2007;5(2):50-7.
2. Chou ST, Westhoff CM. The Rh and RhAG blood group systems. Immunohematology. 2010;26(4):178-86. [DOI:10.21307/immunohematology-2019-217]
3. Jacqueelyn D, Chaote MD. ABO & Rh blood groups. In Principles of transfusion medicine. 2018.
4. Huang CH, Reid ME, Chen Y. Identification of a partial internal deletion in the RH locus causing the human erythrocyte D--phenotype [see comments]. Blood. 1995;86(2):784-90. [DOI:10.1182/blood.V86.2.784.bloodjournal862784] [PMID]
5. Hwang JY, Suh IB, Shim JY, Cho JS, Lee DH. A case of fetal hydrops associated with maternal -D-/-D- phenotype. Korean J Obstet Gynecol. 2006;49(6):1378-82.
6. Um TH, Cho CR, Whang JH, Whang DH, Yoon MS, Han KS. A Case of D--/D-- Phenotype Associated with Moderate Hemolytic Disease of the Newborn. Korean J Blood Transfus. 2007;18(1):61-5.
7. De Vooght KMK, Demir AY, Folman CC, Schutgens REG, van Solinge WW, Kemperman H. Successful transfusion care for a patient with the Rhesus -D- phenotype and antibodies against Rh17 and two additional alloantibodies. Ann Hematol. 2012;91(6):963-4. [DOI:10.1007/s00277-011-1344-7] [PMID] [PMCID]
8. Brumit MC, Carnahan GE, Stubbs JR, Storry J, Reid ME. Moderate hemolytic disease of the newborn (HDN) due to anti-Rh17 produced by a black female with an e variant phenotype. Immunohematology. 2002;18(2):40-2. [DOI:10.21307/immunohematology-2019-507] [PMID]
9. Hirose M, Nakanishi K, Kaku S, Moro H, Hodohara K, Aotani H, et al. Fetal Hemolytic Disease due to Anti-Rh17 Alloimmunization. Fetal Diagn Ther. 2004;19(2):182-6. [DOI:10.1159/000075147] [PMID]
10. Biswas A, Bajaj A, Philip J, Kushwaha N. A rare case of immune hydrops in an'Elevated D'pregnancy. Glob J Transfus Med. 2020;5(2):221-4. [DOI:10.4103/GJTM.GJTM_89_20]
11. Dajak S, Ipavec N, Cuk M, Golubic Cepulic B, Mratinovic-Mikulandra J, Milardovic J, et al. The Outcome of Hemolytic Disease of the Fetus and Newborn Caused by Anti-Rh17 Antibody: Analysis of Three Cases and Review of the Literature. Transfus Med Hemother. 2019;47(3):264-71. [DOI:10.1159/000503012] [PMID] [PMCID]
12. Klein H, Anstee D. The Rh blood group system (and LW). In: Klein H, Anstee D, editors. Mollison's Blood Transfusion in Clinical Medicine. 11 ed. London: Blackwell 2005. p. 163-208. [DOI:10.1002/9780470986868]
13. Rh DG. RHAG blood group systems. Human blood groups. 185. 3 ed. Oxford (UK): Wiley-Blackwell; 2013.
14. Salamat N, Bhatti FA, Hussain A. Anti-Rh17 [Anti-Hr0]: a rare diagnostic and management problem. J Pak Med Assoc. 2004;54(4):215-8.
15. Abolhassan Choobdar F, Milani H, Behrouzi K, Khalesi N, Haghighi B, Manafi A, et al. Anti-Rh17 Alloimmunization: A Rare Case of Severe Hemolytic Disease of the Newborn and Review of the Literature. J Pediatr Rev. 2020;8(1):29-34. [DOI:10.32598/jpr.8.1.29]
16. Deitenbeck R, Tutschek B, Crombach G, Stannigel H. Successful management of pregnancy and hemolytic disease of the newborn due to anti-HrO in a woman of the D--phenotype. Transfusion. 1999;39(10):1151-2. [DOI:10.1046/j.1537-2995.1999.t01-1-39101150.x] [PMID]
17. Diao Y, Song N, Guan Z, Zhang L, Wang Y, Wan M. A case of hemolytic disease of the newborn caused by anti-Hro and anti-e. Proc Chin Acad Med Sci Peking :union: Med Coll. 1990;5(1):58-60.
18. Mimura K, Endo M, Takahashi A, Doi Y, Sakuragi M, Kiyokawa T, et al. Successful management of fetal hemolytic disease due to strong anti-Rh17 with plasma exchange and intrauterine transfusion in a woman with the D-- phenotype. Int J Hematol. 2020;111(1):149-54. [DOI:10.1007/s12185-019-02735-6] [PMID]