{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:48:41Z","timestamp":1790419721809,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T00:00:00Z","timestamp":1610582400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Hemolytic disease of the fetus and newborn (HDFN) attributable to anti\u2010M is rare, although case reports implicate anti\u2010M in varying severities of HDFN, including fetal hydrops and intrauterine death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Description<\/jats:title><jats:p>We describe the case of a newborn with HDFN associated with an atypical immunoglobulin (Ig) G anti\u2010M that reacted best at cold temperatures. The maternal antibody detected in pregnancy was not reactive at 37\u00b0C, and a direct antiglobulin test (DAT) on red blood cells (RBCs) from the newborn was negative, suggesting an anti\u2010M that should not have been clinically relevant. However, the infant developed hyperbilirubinemia (bilirubin level, 17.6\u2009mg\/dL), hemolytic anemia (hemoglobin nadir, 5.5\u2009g\/dL), and reticulocytopenia. Laboratory testing demonstrated the presence of an IgG anti\u2010M in maternal and neonatal samples reacting best at 4\u00b0C. This passively acquired IgG anti\u2010M provoked hemolytic anemia in the infant and likely suppressed erythropoiesis, resulting in reticulocytopenia with prolonged anemia. He was treated for IgG anti\u2010M HDFN with 10 intravenous Ig infusions and 10\u2009days of oral prednisone followed by a taper. He required seven transfusions with M\u2212 RBCs. His hemoglobin level normalized at 3\u2009months of age. Follow\u2010up at 2\u2009years revealed no hematologic or neuro\u2010developmental concerns.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>To our knowledge, this is the second report of HDFN attributable to an IgG anti\u2010M reacting preferentially at cold temperature with no 37\u00b0C reactivity. Clinically relevant IgG anti\u2010M may elude standard testing. Early recognition and testing for cold\u2010reacting IgG anti\u2010M should be considered for newborns with hemolysis, a negative DAT, and prolonged anemia.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.16252","type":"journal-article","created":{"date-parts":[[2021,1,15]],"date-time":"2021-01-15T19:42:24Z","timestamp":1610739744000},"page":"974-978","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Hemolytic disease and reticulocytopenia of the newborn attributable to maternal immunoglobulin G anti\u2010M reacting optimally at cold temperatures"],"prefix":"10.1111","volume":"61","author":[{"given":"Lezlie H.","family":"Andersen","sequence":"first","affiliation":[{"name":"Department of Pediatric and Adolescent Medicine Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eapen K.","family":"Jacob","sequence":"additional","affiliation":[{"name":"Immunohematology Reference 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