Relapsing Coombs-negative haemolytic anaemia in pregnancy with haemolytic disease in the newborn.

625 Relapsing Coombs-negative haemolytic anaemia in pregnancy with haemolytic disease in the newborn A rare form of acquired haemolytic anaemia is Coombs-negative haemolytic disease restricted to the period of pregnancy.'-3 Unlike previously reported cases, in our patient transient haemolytic disease developed in the infant also, lending support to the assumption of an autoimmune mechanism. Case report The patient was first examined because of anaemia in March 1959 at the age of 25 in the 8th month of pregnancy. Anaemia had also been present during her first pregnancy, but no further investigations were done. During the third month of the second pregnancy weakness, palpitations, and exertional dyspnoea developed. She was pale. The liver and spleen were not palpable. Her haemoglobin was 7-0 g/dl, with 9% reticulocytes, anisocytosis, and poikilocytosis. A marrow aspirate showed considerable erythroid hyperplasia and a normal haemosiderin stain. Serum bilirubin was 8-5 ,umol/l (05 mg/100 ml), and the direct and indirect Coombs tests were negative. A healthy girl was delivered at term, and within two weeks the mother's haemoglobin rose spontaneously to 11-6 g/dl. Repeated blood counts in the next 11 years disclosed a haemoglobin level of 12-2-13 3 g/dl (see fig). One month after delivery anaemia of 7 g/dl was discovered in the infant. No further details of this anaemia are available, and by the age of four months the child's haemoglobin level had reverted to normal.