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HDFN and the clinical impact of specific antibodies

Clinically Significant Antibodies

The table below is modified from ACOG Practice Bulletin No. 192: Management of Alloimmunization During Pregnancy. Please note that while some antibodies are listed as only causing mild disease, ALL antibodies are capable of causing severe disease in the right circumstances. A prudent search of the medical literature can find cases of all of these antibodies causing HDFN, even ones which were historically thought to not cause HDFN (such as anti-Lea).

Mild to severe 1

Blood Group Antibodies Related to HDFN Disease Severity
Diego anti-Dia Mild to severe
anti-Dib Mild to severe
anti-Wra * Mild to severe
Duffy anti-Fya Mild to severe
anti-Fyb ++
anti-Fy3 * Moderate 2, 3
Hh anti-H * Mild to severe 4
Kell anti-K Mild to severe
anti-k * Mild to severe5, 6
anti-Kpa Mild
anti-Kpb * Mild to severe 8, 9
anti-K0 aka anti-Ku * Mild to severe 7
anti-Jsa * Mild to severe 10, 11
anti-Jsb * Mild to severe 12, 13, 14, 15
anti-U1a * Mild to severe 16
Kidd anti-Jka Mild to severe
anti-Jkb * Mild to severe 17
anti-Jk3 Mild
Lewis anti-Lea * Mild 18
anti-Leb * Mild 18
Lutheran anti-Lua Mild
anti-Lub Mild
MNS anti-M Mild to severe
anti-N Mild
anti-S Mild to severe
anti-s Mild to severe
anti-U Mild to severe
anti-Mia Moderate
MSS anti-Hil Mild
anti-Hut Mild
anti-Mta Moderate
anti-Mur Mild
anti-Vw Mild
P anti-PP1PK (Tja) Mild to severe
Rh (non-D) anti-c Mild to severe
anti-C Mild to severe
anti-E Mild to severe
XG anti-Xga Mild
Public antigens anti-Coa Severe
anti-Co1b Mild
anti-Ena Moderate
anti-Ge Mild
anti-Jra * Mild to severe
anti-Lan * Mild
anti-Yta Moderate to severe
anti-Ytb Mild
Private antigens anti-Batty Mild
anti-Becker Mild
anti-Berrens Mild
anti-Biles Moderate
anti-Evans Mild
anti-Gonzales Mild
anti-Good Severe
anti-Heibel Moderate
anti-Hunt Mild
anti-Jobbins Mild
anti-Radin Moderate
anti-Rm Mild
anti-Ven Mild
anti-Wra Severe
anti-Wrb Mild
anti-Zd Moderate

* Information not on original ACOG chart. Not a proven cause of HDFN.
++ Not a cause of HDFN


  1. 1. Dean L. Blood Groups and Red Cell Antigens [Internet]. Bethesda (MD): National Center for Biotechnology Information (US); 2005. Chapter 11, The Diego blood group..
  2. 2. Albrey, J., Vincent, E., Hutchinson, J., Marsh, W., Allen, F., jr., Gavin, J. and Sanger, R. (1971), A New Antibody, Anti-Fy3, in the Duffy Blood Group System. Vox Sanguinis, 20: 29-35. https://doi.org/10.1111/j.1423-0410.1971.tb01797.x.
  3. 3. Buchanan, D.I., Sinclair, M., Sanger, R., Gavin, J. and Teesdale, P. (1976), An Alberta Cree Indian with a Rare Duffy Antibody, Anti-Fy 3. Vox Sanguinis, 30: 114-121. https://doi.org/10.1111/j.1423-0410.1976.tb02801.x.
  4. 4. Shastry S, Lewis LE, Bhat SS. A rare case of haemolytic disease of newborn with Bombay phenotype mother. Asian J Transfus Sci. 2013;7(2):153-155. doi:10.4103/0973-6247.115583.
  5. 5. Bowman JM, Harman FA, Manning CR, Pollock JM. Erythroblastosis fetalis produced by anti-k. Vox Sang. 1989;56(3):187-9. doi: 10.1111/j.1423-0410.1989.tb02024.x. Erratum in: Vox Sang 1990;58(2):139. PMID: 2728396.
  6. 6. Rigal D, Juron-Dupraz F, Biggio B, Jouvenceaux A. Mort foetale et maladie hémolytique bénigne du nouveau-né par allo-immunisation anti-Cellano: Deux nouvelles observations [Fetal death and benign hemolytic disease of the newborn from anti-Cellano alloimmunization: 2 new case reports]. Rev Fr Transfus Immunohematol. 1982 Feb;25(1):101-4. French. doi: 10.1016/s0338-4535(82)80083-4. PMID: 7071459.
  7. 7. Antonia Manoura, Eftychia Korakaki, Eleftheria Hatzidaki, Emmanuel Saitakis, Sofia Maraka, Isabella Papamastoraki, Emmanuel Matalliotakis, Kaliopi Foundouli & Christine Giannakopoulou (2007) USE OF RECOMBINANT ERYTHROPOIETIN FOR THE MANAGEMENT OF SEVERE HEMOLYTIC DISEASE OF THE NEWBORN OF A K0 PHENOTYPE MOTHER, Pediatric Hematology and Oncology, 24:1, 69-73, DOI: 10.1080/08880010601001453
  8. 8. Dacus, J. Severe erythroblastosis fetalis secondary to anti-Kpb sensitization, AJOG. DOI:https://doi.org/10.5555/uri:pii:0002937884904691
  9. 9.Gorlin JB, Kelly L. Alloimmunisation via previous transfusion places female Kpb-negative recipients at risk for having children with clinically significant hemolytic disease of the newborn. Vox Sang. 1994;66(1):46-8. doi: 10.1111/j.1423-0410.1994.tb00275.x. PMID: 8146981.
  10. 10. Ringressi A, et al. The first case of hydrops fetalis caused by anti-jsa. Blood Transfusion.
  11. 11. Donovan, L.M., Tripp, K.L., Zuckerman, J.E. and Konugres, A.A. (1973), Hemolytic Disease of the Newborn Due to Anti-Jsa. Transfusion, 13: 153-153. https://doi.org/10.1111/j.1537-2995.1973.tb05464.x.
  12. 12. Gordon MC, Kennedy MS, O'Shaughnessy RW, Waheed A. Severe hemolytic disease of the newborn due to anti-Js(b). Vox Sang. 1995;69(2):140-1. doi: 10.1111/j.1423-0410.1995.tb01686.x. PMID: 8585197.
  13. 13. Stanworth S, Fleetwood P, de Silva M. Severe haemolytic disease of the newborn due to anti-Js(b). Vox Sang. 2001;81(2):134-5. doi: 10.1046/j.1423-0410.2001.00092.x. PMID: 11555475.
  14. 14. Al Riyami AZ, Al Salmani M, Al Hashami S, Al Mahrooqi S, Al Hinai S, Al Balushi H, Al Riyami N, Gowri V, Al Dughaishi T, Al Hosni S, Al-Khabori M, Al-Farsi K, Al Huneini M, Alkindi S. Successful management of severe hemolytic disease of the fetus due to anti-Jsb using intrauterine transfusions with serial maternal blood donations: a case report and a review of the literature. Transfusion. 2014 Jan;54(1):238-43. doi: 10.1111/trf.12331. Epub 2013 Jul 5. PMID: 23829228.
  15. 15. Lowe, R.F., Musengezi, A.T. and Moores, P. (1978), Severe Hemolytic Disease of the Newborn Associated with Anti-Jsb. Transfusion, 18: 466-468. https://doi.org/10.1046/j.1537-2995.1978.18478251242.x
  16. 16. Sakuma, K., Suzuki, H., Ohto, H., Tsuneyama, H. and Uchikawa, M. (1994), First Case of Hemolytic Disease of the Newborn due to Anti-Ula Antibodies. Vox Sanguinis, 66: 293-294. https://doi.org/10.1111/j.1423-0410.1994.tb00332.x
  17. 17. Kim WD, Lee YH. A fatal case of severe hemolytic disease of newborn associated with anti-Jk(b). J Korean Med Sci. 2006;21(1):151-154. doi:10.3346/jkms.2006.21.1.151
  18. 18. Makroo RN, Arora B, Bhatia A, Chowdhry M, Luka RN. Clinical significance of antibody specificities to M, N and Lewis blood group system. Asian J Transfus Sci. 2014;8(2):96-99. doi:10.4103/0973-6247.137442


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