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My sister had a baby yesterday at 3 am. Tested bilirubin since baby has A and sis has O blood type. It was a 5. Sis checked out of hospital AMA at 5 pm last night. Took baby back today and it was a 12 at less than 12 hours old. Now the baby is admitted to the hospital. On top of that, sis was GBS + and refused the abx.

 

I knew about Rh + and - but I never knew about ABO incompatibility. Anyone have experience with this?

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The links explain it better than I could (especially this late at night).

It's similar to Rh incompatibility, with a different red blood cell antigen (in this case, the incompatible antigen is the baby's A while the mom has anti-A in her blood). The mom's antibody attacks the baby's red blood cells.

 

http://www.pregnancy.com.au/resources/topics-of-interest/postnatal/abo-incompatibility-in-newborns.print.shtml

 

http://en.wikipedia.org/wiki/Hemolytic_disease_of_the_newborn_(ABO)

 

http://www.ncbi.nlm.nih.gov/books/NBK2266/

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I had an anti e antibody that was detected the last tree pregnancies. The first pregnancy ended in mc, the second was successful with the antibody titers becoming undetectable by the 30th week, and my last baby was born jaundiced. Thankfully my babies never had any of the other serious complications. Prayers and positive thought for your sister.

Edited by extendedforecast
Darn you autocorrect!!!
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Just a more positive story... only my oldest & youngest have been blood-typed (I have the kit to type ds, I just keep forgetting to do it). Both of them are A pos, I'm O pos. They filled my head with Dire Predictions after the birth of my oldest, done of which came to fruition. Same with my youngest, except no one around to predict dire things. ;) Some jaundice is a variation of normal, so it may not be a pathology, despite the ABO incompatibility.

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do they know there is incompatability? It seems that that might still just be normal jaundice?

 

Why did she check out AMA?

 

Yes, she is O, baby is A. They discharged her but not the baby because protocol is to check the bilirubin every 6 hours. She didn't want to do that. She thinks they also wanted to keep the baby because she refused the abx for GBS.

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The ABO incompatibility is common. It is solved by phototherapy, basically having the baby under a lamp until the bilirubin comes down. You want the bilirubin to come down because if they bilirubin keeps going up, it will effect the baby's brain and cause brain damage. The reason this happens is because the baby's liver is immature, even if it is full term. Sometimes, the bilirubin will shoot up to around 12 to 14 before it starts to come down. I promise you they are watching the baby very closely.

 

The mom has antibodies to both A and B so when the mom gives birth to a A baby or a B baby the mom's antibodies will attack the baby's red cells. In worse case scenarios, the baby would have to have a full exchange of their blood but at my hospital I haven't ever seen one. I think the magic number is an 18 bilirubin. I think. It has been awhile since we have had to pay attention to a baby bilirubin.

 

They usually do repeat billirubins every 4 to 6 hours.

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