Jun Kunikata 1 , Takashi Kusaka 2 , Saneyuki Yasuda 2 ,

1. Hemolytic Jaundice Due to Anti-Mia, Diagnosed by Management with An Hour-Specific Nomogram for Transcutaneous Bilirubin (TcB) Values Jun Kunikata1, Takashi Kusaka2, Saneyuki Yasuda2, Shinji Nakamura2, Kosuke Koyano2, Satoshi Hamano1, Hitoshi Okada1, Susumu Itoh1 1Department of Pediatrics, Faculty of Medicine, Kagawa University, Japan 2Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Japan

2. Introduction • Hemolytic jaundice can develop in neonates born to mothers who have irregular antibodies. • All pregnant women are recommended to have Irregular antibody screening test, but there are many irregular antibodies that cannot be found by routine prenatal screening tests.

3. Introduction • It is considered that these low frequency antibodies are rarely cause of hemolytic jaundice and there are no established management for these antibodies. • We experienced a case of hemolytic jaundice due to anti-Mia antibody that was diagnosed early by transcutaneous jaundice meter.

4. Transcutaneous jaundice meter (Konica Minolta, JM-103) 150 g

5. 97.5%tile Average 2.5%tile Transcutaneous Bilirubin (TcB ) Levels in the First 72 Hours in a Normal Newborn Population in JAPAN 342 TcB (µM) 171 TcB (mg/dL) 0 Postnatal Age (hours)

6. Case Report • Patient : A male infant delivered by cesarean section at 38 weeks' gestation with a birth weight of 3148 g. • Anti-Miahad beenfound in his mother’s serum in a prenatal antibody screening test. • He showed no abnormal findings at birth and was admitted to a newborn nursery. But a transcutaneous jaundice meter (JM-103) showed 1.8 mg/dL (30.8 μM) one hour after birth, which were above the treatment line in our hour-specific nomogram. • So we admitted him to our NICU and started treatment.

7. Clinical Course 2 hours after birth plasma total bilirubin 6.1mg/dL (104.3 μM) 1 hour after birth transcutaneous jaundice meter (JM-103) showed 1.8 mg/dL (30.8 μM) (exceed treatment line)

8. Laboratorydata (2 hours after birth)

9. Clinical course Administration of γ-globulin Diagnosis: Hemolytic jaundice induced by anti-Mia antibody Jaundice wasswiftlyimproved Starting Photo therapy Need no further treatment afterDay 3

10. About anti-Mia antibody • Anti-Mia is one of irregular antibodies that react with the Mi III phenotype. • Several studies have reported that Asians tend to have Mi III phenotype much more than Whites: 7.3% in Taiwan Chinese blood donors, 6.28% in Hong Kong Chinese blood donors, 9.7% in Thai blood donors and 0.0098% in Whites). • The frequency of Anti-Mia antibody among Chinese patients is 0.28%.1) • There are only a few reports of hemolytic disease caused by anti-Mia, so Mia antigen is not considered to be necessary to test red blood cells for irregular antibody screening test. 1)R.E.Broadberry and M.Lin, The incidence and significance of anti-”Mi” in Taiwan, TRANSFUSION 1994;34;349-352.

11. HitoshOhto：新生児溶血性疾患と母児免疫.輸血学(改訂第3版), Tokyo, Chugai-Igakusya, 2004,512-521 (III)

12. Antigen Profile of test red blood cells

13. Discussions • Since it is hard tofindthe presence of low frequency antibodies such as anti-Mia, we should considerthe possibility ofhemolytic jaundice caused by irregular antibodies when hemolytic jaundice happens without reasons. • Even if hemolytic jaundice cannot be predicted, transcutaneous jaundice meter can identify hemolytic jaundice early andhelp to prevent kernicterus or exchange transfusion.

14. Conclusion • Transcutaneous jaundice meter and an hour-specific 97.5th percentile-based TcB nomogram is useful in the management of newborn jaundice as a non-invasive first-line examination.

15. Management of jaundice and treatment progress