Clinical analysis of rare hemolytic disease of newborn and literature review

Zhu Lin; Liu Guiying

doi:10.3760/j.issn.1673-4777.2026.06.021

Abstract：Objective To explore the clinical characteristics of rare hemolytic disease of newborn(HDN),and improve the understanding of rare HDN.Methods The clinical data of 8 children diagnosed with rare HDN in the Department of Pediatrics,Beijing Anzhen Hospital,Capital Medical University from July 2021 to July 2025 were retrospectively analyzed,including 4 cases of Rh blood group incompatibility hemolysis caused by combined anti-c and anti-E antibodies,3 cases of MN blood group incompatibility hemolysis including 1 case complicated with ABO blood group incompatibility hemolysis,and 1 case of Duffy blood group incompatibility hemolysis.Their clinical manifestations,laboratory examinations,treatments and outcomes were analyzed.Results All 4 children with Rh incompatibility hemolytic disease induced by combined anti-c and anti-E antibodies presented with hyperbilirubinemia and anemia,among whom 2 suffered from severe anemia and 1 was complicated with circulatory disturbance,with positive direct and indirect antiglobulin tests in all 4 cases.Hyperbilirubinemia and anemia occurred in all 3 children with MN hemolytic disease,and severe anemia and circulatory disturbance were found in the case complicated with ABO blood group incompatibility hemolysis.All 3 cases showed negative direct antiglobulin test and positive indirect antiglobulin test.Pathological jaundice and mild anemia occurred in the child with Duffy blood group incompatibility hemolytic disease.None of the 8 children received exchange transfusion,and all were discharged with improved conditions.Delayed hemolysis occurred one month after birth in the child complicated with MN and ABO blood group incompatibility hemolysis.Serum cardiac injury biomarkers including cardiac troponin I,creatine kinase isoenzyme,creatine kinase and lactate dehydrogenase were elevated at the onset of HDN in all 8 children.Except cardiac troponin I,the other three indicators decreased significantly during recovery period(P＜0.05).All cardiac troponin I levels returned to normal within 2 weeks to 1.5 months during follow-up.Conclusions Active screening of maternal and neonatal serum antibodies should be performed for neonates with high hemolytic risk and hemolytic manifestations to reduce missed diagnosis.Delayed hemolysis may occur in neonates with MN blood group incompatibility hemolytic disease,so regular follow-up is necessary.Symptoms of Duffy blood group incompatibility hemolysis are generally mild.Myocardial injury induced by HDN is mainly manifested as elevated serum myocardial enzymes,and cardiac troponin I takes the longest time to recover.