Selection of blood products for infants with hemolytic disease of the fetus and newborn (HDFN)

Alloantibody causing HDFN	Key characteristics for RBCs:
Rh(D)	Rh(D) negative Group O* or ABO compatible^¶ Cross-match compatible
ABO incompatibility	Group O* Rh(D) negative or Rh(D) compatible Cross-match compatible
Other blood group incompatibility (eg, anti-K, anti-E)	Negative for the offending antigen Group O* or ABO compatible^¶ Rh(D) negative or Rh(D) compatible Cross-match compatible

For an exchange transfusion, the RBCs described above are reconstituted with AB plasma (this plasma contains no anti-A or anti-B), or with ABO-compatible plasma.

Rh(D): Rhesus D; RBCs: red blood cells.
* At some institutions, group O RBCs are washed to remove any traces of anti-A or anti-B antibodies. This is most often used for preterm babies because trace amounts of antibodies represent a higher proportion of their blood volume.
¶ At some institutions, group O RBCs are used for all newborns and infants younger than 4 months old, rather than ABO-compatible RBCs. This simplifies and standardizes the blood bank protocol. If nongroup O RBCs are used, the newborn must also be tested for "passive" anti-A and anti-B (ie, anti-A or anti-B of maternal origin). These antibodies are detected by an indirect antiglobulin (Coombs) test, which can be done on the infant's plasma, serum, or eluate of baby's RBC, tested against A and B cells if a direct antiglobulin (Coombs) test is positive for immunoglobulin G. Cord blood can also be used for this purpose.

Courtesy of Jun Teruya, MD, DSc, FCAP

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