A most unusual combination of antibodies, anti-D and anti-c produced by a transfusion and pregnancy, respectively, was identified by cross-absorption experiments. The immunized mother (propositus), whose husband was of genotype dce/dce, possessed the very rare genotype dCe/dCe, each of her parents, who were related to each other as fourth cousins, contributing the rare chromosome dCe.

The critically affected male infant was successfully treated by early replacement transfusion with the mother’s plasma-free red cells and her sibling’s rare compatible blood. The infant made a complete recovery although the preceding pregnancy ended in a macerated fetus.

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