Rarely an infant may show persistent hemolytic disease of the newborn (HDN). One possible explanation is absorption of intact immunoglobulins from maternal breast milk (transcytosis).
Clinical features:
(1) persistent hemolytic disease of the newborn, especially beyond the first 3 months after birth
(2) maternal breast feeding
(3) presence of immunoglobulins in maternal milk
(4) exclusion of alternative explanations
(5) reversal of the hemolytic disease on avoidance of maternal breast milk (formula or donor breast milk)
Alternative explanations:
(1) very high titers of transplacental IgG antibody
(2) autoimmune hemolytic anemia
(3) drug-induced anemia
(4) hereditary hemolytic anemia
(5) infection-related hemolytic anemia
(6) other causes of hemolytic anemia
