COE AND SOLOWAY
76
cedures. It is both rapid and error-free, and requires only about 5 minutes of operator training time.
2.
ADDENDUM
Source listings for this program will be made available upon request. References 1. Bull BS, Huse WM, Brauer FS, et al: Heparin therapy during extracorporeal circulation, II. The use of a dose-response
3.
4. 5.
A.J.C.P. • July 1979
curve to individualize heparin and protamine dosage. J Thorac Cardiovasc Surg 69:685-689, 1975 Bull BS, Korpman RA, Huse WM, et al: Heparin therapy during extracorporeal circulation, I. Problems inherent in existing heparin protocols. J Thorac Cardiovasc Surg 69:674-689,1975 Doty DB, Young JA, Kisker TC: Adequate anticoagulation during cardiopulmonary bypass determined by activated clotting time and the appearance of fibrin monomer. Presentation at the Society of Thoracic Surgeons, Orlando, Florida, 1978 Hattersley PG: Activated coagulation time of whole blood. JAMA 196:436-440, 1966 Vitez T: Unpublished data
Subclinical Hemolytic Disease of the Newborn DuetoAntl-e
Hanzlick, Randy L., Senhauser, Donald A.: Subclinical hemolytic disease of the newborn due to anti-e. Am J Clin Pathol 72: 76-79, 1979. A case of subclinical hemolytic disease of the newborn resulting in reticulocytosis and positive direct and indirect antiglobulin tests in an infant both ABO- and Rh(D)-compatible with its mother is reported. The antibody was an IgG, non-complement-binding molecule present in low titer with a low avidity for the antigen, acted optimally in enzyme systems, did not manifest dosage effect, and caused slight extravascular destruction of fetal erythrocytes. Routine antibody screening of all pregnant women should be performed and neonatal cord blood specimens analyzed to avoid unexpected infant morbidity and mortality, and to characterize hemolytic disease of the newborn due to rare atypical antibodies more fully. (Key words: Anti-e; Anti-hr"; Hemolytic disease of the newborn.) ANTI-e (hr") is stated to be a rare cause of hemolytic disease of the newborn, 7 1 3 1 4 and most reports of this antibody have dealt only with its low incidence. The few case reports that describe the biologic effects of anti-e on the fetus have all involved mothers who had multiple antibodies in addition to anti-e; thus, the specific biologic significance of anti-e in the fetus remains unclear. Therefore, we report a case of mild hemolytic disease of the newborn due solely to anti-e, to help clarify the biologic effects and clinical significance of this atypical antibody in hemolytic disease of the newborn. Received March 30, 1978; received revised manuscript and accepted for publication July 5, 1978. Presented at the Annual Meeting of the Ohio Association of Blood Banks, March 31, 1978, Dayton, Ohio. Address reprint requests to Dr. Hanzlick: Transfusion Service, Department of Pathology, The Ohio State University Hospitals, Columbus, Ohio 43210.
Transfusion Service, Department of Pathology, The Ohio State University Hospitals, Columbus, Ohio
Report of a Case A 28-year-old Caucasian woman, gravida 5, para 4, sought medical care in early labor at 40 weeks' gestation. Prenatal care had been minimal; maternal blood type was reported to be AB, Rh(D)positive, and prenatal screening of maternal serum for atypical antibodies was not performed. The mother had never received a blood transfusion, and obstetrical history was remarkable only in regard to the third child, who had been born with an "enlarged liver and spleen" that persisted for five weeks post partum. Labor and delivery were unremarkable except for meconiumstained amniotic fluid. During labor, blood typing confirmed that the mother's erythrocytes were AB, Rh(D)-positive. The antibody screen detected an antibody that reacted 2+ at 37 C in bromelin and 1+ in the indirect antiglobulin test. Multiple panels identified the antibody to have anti-e specificity, and the titer was 4 at 37 C with homozygous (ee) panel cells treated with bromelin. Cord blood was not obtained, presumably because the maternal blood type made fetal-maternal incompatibility unlikely. The 8 lb, 13 oz, male infant appeared normal, and Apgar ratings of 9/10 were obtained at both 1 and 5 min. Hemoglobin and hematocrit values were 19 g/dl and 58.6%, respectively, and the leukocyte count was 17,100/mm3 with 67% segmented neutrophils and 27% lymphocytes. Erythrocytic morphology showed minimal macrocytosis, polychromatophilia, and a few target cells. The reticulocyte count was 6.5% (normal
76
cedures. It is both rapid and error-free, and requires only about 5 minutes of operator training time.
2.
ADDENDUM
Source listings for this program will be made available upon request. References 1. Bull BS, Huse WM, Brauer FS, et al: Heparin therapy during extracorporeal circulation, II. The use of a dose-response
3.
4. 5.
A.J.C.P. • July 1979
curve to individualize heparin and protamine dosage. J Thorac Cardiovasc Surg 69:685-689, 1975 Bull BS, Korpman RA, Huse WM, et al: Heparin therapy during extracorporeal circulation, I. Problems inherent in existing heparin protocols. J Thorac Cardiovasc Surg 69:674-689,1975 Doty DB, Young JA, Kisker TC: Adequate anticoagulation during cardiopulmonary bypass determined by activated clotting time and the appearance of fibrin monomer. Presentation at the Society of Thoracic Surgeons, Orlando, Florida, 1978 Hattersley PG: Activated coagulation time of whole blood. JAMA 196:436-440, 1966 Vitez T: Unpublished data
Subclinical Hemolytic Disease of the Newborn DuetoAntl-e
Hanzlick, Randy L., Senhauser, Donald A.: Subclinical hemolytic disease of the newborn due to anti-e. Am J Clin Pathol 72: 76-79, 1979. A case of subclinical hemolytic disease of the newborn resulting in reticulocytosis and positive direct and indirect antiglobulin tests in an infant both ABO- and Rh(D)-compatible with its mother is reported. The antibody was an IgG, non-complement-binding molecule present in low titer with a low avidity for the antigen, acted optimally in enzyme systems, did not manifest dosage effect, and caused slight extravascular destruction of fetal erythrocytes. Routine antibody screening of all pregnant women should be performed and neonatal cord blood specimens analyzed to avoid unexpected infant morbidity and mortality, and to characterize hemolytic disease of the newborn due to rare atypical antibodies more fully. (Key words: Anti-e; Anti-hr"; Hemolytic disease of the newborn.) ANTI-e (hr") is stated to be a rare cause of hemolytic disease of the newborn, 7 1 3 1 4 and most reports of this antibody have dealt only with its low incidence. The few case reports that describe the biologic effects of anti-e on the fetus have all involved mothers who had multiple antibodies in addition to anti-e; thus, the specific biologic significance of anti-e in the fetus remains unclear. Therefore, we report a case of mild hemolytic disease of the newborn due solely to anti-e, to help clarify the biologic effects and clinical significance of this atypical antibody in hemolytic disease of the newborn. Received March 30, 1978; received revised manuscript and accepted for publication July 5, 1978. Presented at the Annual Meeting of the Ohio Association of Blood Banks, March 31, 1978, Dayton, Ohio. Address reprint requests to Dr. Hanzlick: Transfusion Service, Department of Pathology, The Ohio State University Hospitals, Columbus, Ohio 43210.
Transfusion Service, Department of Pathology, The Ohio State University Hospitals, Columbus, Ohio
Report of a Case A 28-year-old Caucasian woman, gravida 5, para 4, sought medical care in early labor at 40 weeks' gestation. Prenatal care had been minimal; maternal blood type was reported to be AB, Rh(D)positive, and prenatal screening of maternal serum for atypical antibodies was not performed. The mother had never received a blood transfusion, and obstetrical history was remarkable only in regard to the third child, who had been born with an "enlarged liver and spleen" that persisted for five weeks post partum. Labor and delivery were unremarkable except for meconiumstained amniotic fluid. During labor, blood typing confirmed that the mother's erythrocytes were AB, Rh(D)-positive. The antibody screen detected an antibody that reacted 2+ at 37 C in bromelin and 1+ in the indirect antiglobulin test. Multiple panels identified the antibody to have anti-e specificity, and the titer was 4 at 37 C with homozygous (ee) panel cells treated with bromelin. Cord blood was not obtained, presumably because the maternal blood type made fetal-maternal incompatibility unlikely. The 8 lb, 13 oz, male infant appeared normal, and Apgar ratings of 9/10 were obtained at both 1 and 5 min. Hemoglobin and hematocrit values were 19 g/dl and 58.6%, respectively, and the leukocyte count was 17,100/mm3 with 67% segmented neutrophils and 27% lymphocytes. Erythrocytic morphology showed minimal macrocytosis, polychromatophilia, and a few target cells. The reticulocyte count was 6.5% (normal
