Neonatal hyperbilirubinaemia necessitating exchange transfusion due to maternal sickle cell crisis: Maternal sickle cell disease and neonatal hyperbilirubinaemia

Background: Pregnancy in women with sickle cell disease is associated with a number of fetal complications such as intra-uterine death, intra-uterine growth restriction (IUGR), preterm birth, low birth weight and an increased perinatal mortality and morbidity. Hyperbilirubinemia necessitating exchange transfusion in an infant of a mother with sickle cell disease, to our knowledge, has not been previously described.
Highlights: An infant was delivered at 33 weeks and 5 days of gestation due to a maternal sickle cell crisis. The infant had an unconjugated bilirubin level of 153 micromols/L on admission to the neonatal intensive care unit at 30 minutes of age. Phototherapy was immediately commenced, intravenous immunoglobulin administered and then a double-volume exchange transfusion performed. There was, however, no evidence of haemolysis in the infant and the infant’s haemoglobin level remained stable following the exchange. No further exchange transfusions were required. The mother had a high unconjugated bilirubin level (151 micromols/L) prior to delivery.
Conclusion: High neonatal unconjugated bilirubin levels necessitating exchange transfusion can occur due to haemolysis in the maternal circulation, in this case due to sickle cell disease.