Afflicts newborns whose mothers are blood type is O, and who have a baby with type A, B, or AB.

In type O mothers, isoantibody is IgG and is capable of crossing the placental membranes Transplacental transport of maternal isoantibody results in an immune reaction with the A or B antigen on fetal erythrocytes causing hemolysis

A1 antigen in the infant

Of the major blood group antigens, the A1 antigen has the greatest risk of symptomatic disease

Elevated isohemagglutinins
Antepartum intestinal parasitism or third-trimester immunization with tetanus toxoid or pneumococcal vaccine may stimulate isoantibody titer to A or B antigens.

Birth order is not considered a risk factor. Maternal isoantibody exists naturally and is independent of prior exposure to incompatible fetal blood group antigens. First-born infants have a 40-50% risk for symptomatic disease. Progressive severity of the hemolytic process in succeeding pregnancies is a rare phenomenon.

Jaundice
onset is usually within the first 24 h of life

Anemia

Blood type and Rh factor in the mother and the infant Increased reticulocyte count Direct Coombs' test (direct antiglobulin test)
Because there is very little antibody on the red blood cell (RBC), the direct Coomb's test is often only weakly positive at birth and may become negative by 2-3 days of age.

Blood smear
microspherocytes, polychromasia proportionate to the reticulocyte response, and normoblastosis above the normal values for gestational age.

Indirect hyperbilirubinemia

Phototherapy Exchange transfusion IVIG

By blocking neonatal reticuloendothelial Fc receptors, and thus decrease hemolysis of the antibody-coated RBCs, high-dose IVIG (1 g/kg over 4h) has been shown to reduce serum bilirubin levels and the need for blood exchange transfusion with ABO or Rh hemolytic diseases.

BABY BLOOD TYPE A (weak expression of Antigen A)

ABO incompatibility: Transfer of Anti-A and Anti-B from the Mother who is Blood Type O

Baby now has Anti-A and Anti-B

HEMOLYSIS

What type of Blood to transfuse in anemic patients with ABO incompatibility?

Transfuse Adult Blood that is Blood Type A (contains strong expression of Antigen A)

Transfuse Blood Type O (contains Anti-A and Anti-B) (does not contain antigens)

Since Baby has Anti-A and Anti-B in ABO incompatiblity

RESULT: No further hemolysis of the transfused blood

RESULT: HEMOLYSIS of the transfused blood