This was my first pregnancy with antibodies. I’m A+ and my partner is O+. I’ve never had a blood transfusion before, but I have had 2 losses and 2 term pregnancies. This pregnancy, I had anti-Jka antibodies show up during my routine 28 week blood work. My antibodies were too low to titer, but when my labs were repeated 2 weeks later they had jumped to 1:16. Since 1:16 is considered the critical titer for anti-Jka, we commenced MCA scans.

When the antibodies were detected I was quite shocked to be honest. I wasn’t expecting to develop antibodies since I am a positive blood group. As a midwife, I knew of anti-D antibodies, and I had heard of a few more common antibodies like anti-M and anti-E, but never anti-Jka or anti-Fya. Due to a shortened cervix, I was already having 2 weekly scans up until 24 weeks. Once my cervix stabilized, I thought we were in the clear after an extremely anxious 1st half of my pregnancy. Now, I had these new antibodies to worry about and I was quite anxious throughout the rest of the pregnancy. I also have a history of PTSD from my 1st daughter’s pregnancy. During that pregnancy, I had complications from a uterine abnormality, a short cervix, multiple bleeds, and threatened preterm labor. I guess I don’t do pregnancies the easy way.

At 32 weeks, my anti-Jka had dropped to 1:8, and anti-Fya showed up at 1:16. At 34 weeks I had reduced movements and my anti-Jka had jumped again to 1:128. My anti-Fya titer stayed at 1:16 throughout this pregnancy. My MCA Dopplers were always normal. I was induced at 37+6 and my little girl was Coombs positive. She also had a cephalohaematoma from the ventouse (vacuum) delivery, which can also cause jaundice. At 24 hours of age, she started phototherapy for high bilirubin levels. This continued for 6 days, but she never required transfusions since her hemoglobin level never dropped.

Do you have any advice or encouragement for families dealing with HDFN?

My advice for parents would be to pack for the hospital like you’re staying for a week, and take an eye mask! I was lucky enough that my hospital allowed the baby to room in with me under double lights, but the lights are very bright to sleep with!