[Haemolytic disease of the newborn due to anti-Duffy (author's transl)].

Case Report Mrs. Vail is group 0, Rh-negative, Duffy-negative; her husband, group 0, Rh-negative, Duffy-positive. Mr. Vall is 0; MsNs; P+; cdE.cde; kk; Fy(a+); Le(a-). Mrs. Vall is 0; NsNs; P+; cde.cde; Kk; Fy(a-); Le(a-); Jk(a+). Baby is 0; NsNs; P+; cde.cde; kk; Fy(a+); Le(a-). Mrs. Vail's pregnancy record is as follows: (1) In 1949, normal. The mother was transfused immediately following this delivery, which was complicated, and two weeks later she received another blood transfuision. There was no clinically adverse reaction following either transfusion. (2) In 1952, anencephalic foetus. (3) In 1953, six months' gestation stillbirth. (4) In 1955, the present baby, a girl, was born at term on December 19, weighing 5 lb. 6 oz. The baby's colour appeared normal at birth. Jaundice was first noticed when she was 12 hours old. About the same time she began to pass brownish-red blood by rectum and to vomit swallowed blood. The jaundie deepened, and at 38 hours she was admitted to the Chikiren's Hospital, Winnipeg. Her general condition was good. There was marked jaundice and a congenital anomaly of the thoracic spine was apparent, but there were no other notable findings on physical exaimination. TIhe haemoglobin was 16 g.; reticlocytes 13-2%; total nucleated red cells 1,188/c.mm ; serum bilirubin, direct acting 0-5 mg., total 13-7 mg. %. The infant's blood grouping was 0, Rh-negative, Duffy-positive. The direct Coombs test was positive, the reaction, however, being weaker than that usually seen in Rh sensitization of any clinical degree. Immediate replacement transfusion was deemed unnecessary. The blood passed per rectum was shown by the alkali denaturation test to be adult blood which the foetus had swallowed in utero. The bilirubin level continued to rise, being 18-7 mg. at 52 hours and 21 mg. at 76 hours. At this point, fearing the possibility of kenikterus, a replamnt tansfusion was done, using blood that was Vall-negative, Fy(a-). The bilirubin was reduced thereby to 13-3 mg.; rose slowly to a peak of 22-8 mg. at 114 hours, then fell, reaching 10 8 mg. at 212 hours. The jaundice was gone by the fifteenth day and the baby was discharged, apparntly wel save for the congenital anomaly of the spine. Radiographs showed the latter to be a hemivertebral formation extending from C7 to T8. The diagnosis of haerolytic disease seems certain: the jaundice beginning within 12 hours of birth and progressing, the steady and marked rise in serum bilimbin, the high reticukocyte and normoblast count, and the positive direct Coombs test of the baby's blood on both days 2 and 4. The mother's serum did not react by the standard saline, trypsin saline or albumin methods with any group 0 cells, or by the indirect Coombs or trypsin indirect Coombs nmthods with cells that were Fy(a-) but contained the following antigens absent from her cells: M, C, C-, D, E, Jkb. Her serum did react strongly by the standard indirect Coombs method and weakly by the trypsin inirect Coombs nmtho with her husband's cells and with eight other Fy(a+) cells but not with seven Fy(a-) cells. The antibody is anti-Fr; the titre was 8. The Canadian Red Cross Blood Transfusion Servce provided 10 samples of group 0, Rh-negative blood from which a suitable donor was sekcted by an indirect Coombs cross-match with the mother's serum and by Duffy typing. No anti-Fr could be demonstrated in the baby's serum by saline, albumin or the indirect Coombs test, nor were we able to elute an antibody from the baby's cells taken at the start of the replacement trsfusion on the fourth day; the direct Coombs reaction, however, was still positive at that time. The mother was most probably sensitized by one or other of the earlier transfusions but we have so far been