Severe Neonatal Anaemia Caused by Fetomaternal Haemorrhage with a Positive Neonatal Outcome

Spontaneous massive fetomaternal hemorrhage (FMH) is a rare but significant cause of severe neonatal anemia, often presenting without identifiable risk factors and posing diagnostic challenges. This report describes the case of a 35-year-old G2A1 mother with an uneventful pregnancy who delivered a neonate exhibiting profound anemia and respiratory distress shortly after birth. FMH was confirmed by a Kleihauer-Betke test, revealing a significant fetal blood loss of 198 mL into the maternal circulation. Prompt intervention with packed red blood cell transfusion led to stabilization and a favorable neonatal outcome. FMH frequently presents with nonspecific symptoms such as decreased fetal movements or neonatal anemia, emphasizing the importance of clinician vigilance. Diagnostic methods, including the Kleihauer-Betke test and flow cytometry, play a critical role in confirming FMH and guiding treatment. This case highlights the necessity of early recognition and intervention, as well as routine FMH screening in Rh-negative pregnancies and unexplained neonatal anemia, to improve maternal and neonatal outcomes. Enhanced awareness and advancements in diagnostic technologies are crucial for better management of this underrecognized condition.