Immune haemolytic anaemia after exchange transfusion.

Two cases of immune haemolytic anaemia in newborn infants who had received exchange transfusion on the first day of life because of hyperbilirubinaemia probably due to a conjugation defect, are reported. The first baby, born in the 30th week of gestation presented erythrocyte-fixed IgM antibodies + C, neutropenia, and circulating leucocytotoxic antibodies. The second baby, born at term to a diabetic mother showed erythrocyte-fixed IgG + IgM antibodies + C and a selective IgA deficit. In both cases the anaemia improved and the Coombs test became negative spontaneously in the 4th and 5th months of life, respectively. These haematologic alterations are similar to a graft versus host (GVH) reaction due to the persistence in the neonate blood of the donor's immunocompetent cells.