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ABO Incompatibility

Both my sons were suffered from ABO incompatibility when they were born. They both have type B blood like my husband, and my type O was problematic for them. My first son's count stayed at around 11, but my second son's count got up to 15.8. It seems there is not much concrete information out there about ABO incompatibility. I have heard however that with each subsequent child whose blood is incompatible with the mothers, the symptoms become worse. I have heard horror stories of babies who have needed blood transfusions and worse; the constant heel sticks and the extra days in the hospital were enough for me. Now we are thinking of having another child and I want to be informed about this problem before I put another child at risk for a potentially dangerous and possibly life-threatening problem at birth. Has anyone has experience with ABO incompatibility? Is there any good information out there that might help me? Thank you
~Shannon
Answers:

I am a lab tech and work in the blood bank of a pediatric hospital. I really can't think of a thing that you can do to prevent the problems with ABO incompatibility. The problem is that you, with type O blood, produce anti-A and anti-B antibodies. Unlike the Rh system, ABO antibodies are naturally occurring and can not be prevented. Your anti-B crosses the placenta and attaches to your baby's B antigens on its blood cells. It is not usually a problem because most ABO antibodies are IgM and are too big to pass through the placenta. We frequently have babies come in for us to test for ABO incompatibility and I have only rarely encountered a positive test. If your fetus with the next pregnancy was showing signs of distress, the treatment would be an intra-uterine exchange transfusion. Your baby would have his/her type B blood exchanged with type 0 blood. It is not guaranteed that your next baby will have type B blood. Your husband has two genes that code for blood type and B is dominant. It is possible that he has a B/O combination (you have O/O). Your first two may have gotten a B from him and an O from you, but if he is B/O, the next baby could get an O from him and an O from you and have an O blood type. If he is B/O then you have a 50% chance of having a type O baby next time. He could also be B/B, in which case there is a 100% chance that your next baby will be type B. There is no commonly available test to determine whether a type B person is B/B or B/O. I have not heard of ABO incompatibility ever causing the extreme situation you're talking about. The numbers I think you're referring to are bilirubin levels, and believe it or not, 15 is really not bad. My daughter's level was about 19 and she only had a few extra blood tests. We both have type O blood, but mine is Rh negative and hers is positive. Exchange transfusions on newborns are rare (we have maybe one a year) and the bilirubin would be upwards around 25. Are you positive that it is ABO incompatibility? There are a lot of other blood groups besides ABO and Rh, and it would be more likely that incompatibility is in one of these. I hope this has helped you at least a little. If you can think of any lab results (specifically, the result of the DAT or direct coomb's test of your last baby) that might help me, I could maybe help out a little more.
Answers:

My second son was born with complictions from ABO incompatiblity. He had billirubin levels in the 60's. My mom is a nurse and the blood transfusion thing happens more often than you would think. She says there really isn't much risk. But there can be long term problems without it. I grew up with someone who had brain problems due to ABO. I don't remember exactly what they were though. He did not have the tranfusions but his younger sister did and she turned out fine. I am also hoping to find more people who have encountered this to know if/how I can safely have more kids.

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