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American Academy of Pediatrics
Case Report

Conservative Management of Alloimmune Hemolysis and Cholestasis With Extreme Laboratory Abnormalities

Chelsea Kotch, David F. Friedman, Benjamin J. Wilkins and Benjamin J. Samelson-Jones
Pediatrics February 2021, 147 (2) e20193367; DOI: https://doi.org/10.1542/peds.2019-3367
Chelsea Kotch
aDivision of Hematology and
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David F. Friedman
aDivision of Hematology and
bDepartment of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
cPerelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Benjamin J. Wilkins
bDepartment of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
cPerelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Benjamin J. Samelson-Jones
aDivision of Hematology and
cPerelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract

Alloimmune hemolytic disease of the fetus or newborn (HDFN) is a rare cause of neonatal cholestasis. HDFN-associated cholestasis has most often been reported secondary to anti-D alloimmunization. In utero transfusions are also an identified risk factor. A variety of diagnostic and therapeutic strategies have been described, mostly in case reports. Here, we report 2 cases of HDFN-associated cholestasis that were notable for extreme laboratory abnormalities including a peak ferritin of 24 700 ng/mL and a peak alanine aminotransferase of 1406 U/L (33.5-fold upper limit of normal). One case was due to alloimmunization other than anti-D. These cases help define the range of laboratory derangements that are consistent with HDFN-associated cholestasis, including extreme hyperferritinemia. Although in a number of cases, researchers have reported the use of iron chelation in these infants, herein, we describe successful management without iron chelation.

  • Accepted June 1, 2020.
  • Copyright © 2021 by the American Academy of Pediatrics

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Pediatrics
Vol. 147, Issue 2
1 Feb 2021
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Conservative Management of Alloimmune Hemolysis and Cholestasis With Extreme Laboratory Abnormalities
Chelsea Kotch, David F. Friedman, Benjamin J. Wilkins, Benjamin J. Samelson-Jones
Pediatrics Feb 2021, 147 (2) e20193367; DOI: 10.1542/peds.2019-3367

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Conservative Management of Alloimmune Hemolysis and Cholestasis With Extreme Laboratory Abnormalities
Chelsea Kotch, David F. Friedman, Benjamin J. Wilkins, Benjamin J. Samelson-Jones
Pediatrics Feb 2021, 147 (2) e20193367; DOI: 10.1542/peds.2019-3367
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  • Congenital Chylothorax and Hydrops Fetalis: A Novel Neonatal Presentation of RASA1 Mutation
  • Hemolysis and Neurologic Impairment in PAMI Syndrome: Novel Characteristics of an Elusive Disease
  • Toddler With New Onset Diabetes and Atypical Hemolytic-Uremic Syndrome in the Setting of COVID-19
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