Antibodies - where did you come from?

Yesterday Sunday afternoon, when I having my nap, my daughter called me and woke me up because I received a phone call from hospital. I asked her "who is it". My daughter answered " Don't know. Man voice. I think Uncle Zainudin". I walked to the phone thinking Zainudin was on the line. Well, my daughter know that Zainudin is the only man in my department. If she heard a man voice, she will think that voice belongs to Zainudin. I picked up the phone and to my surprise, it was Dr. Amir, my paediatric cardiologist. He was on-call that day. He wanted to consult me regarding a new admission to the ward. Basically, he didn't know what else to do for one of our patient that was admitted with symptoms and signs of haemolysis. The child Hb was low 4gm/dl and the haemolytic process still present. He wanted to transfuse blood for the child but during cross-matching, the lab staff found the child's blood contained plenty of antibodies. It was very difficult to find a matching blood. The presence of antibodies in the child's blood him as well as me because the child had no history of getting any blood transfusion before to explain the situation. Of course we cannot leave the child without treatment. He need blood indeed. Otherwise, if the Hb drop further, the child will develop heart failure and die. It is a critical situation. I advised him to do a few things and no matter how to try to get the blood for the baby. Worse come to worse, we need to give 'O' negative blood as the last option. Dr.Amir sounded satisfied with my advice will do as told. Sometimes as consultant, I need to be ever ready when my advice is needed. After I put down the phone, I was still thinking about the patient. How does he gets antibodies in his blood. I tried to formulate something rational but still blur. Anyway, today morning, I went to the ward to see the child, to find out how he was doing. He was a lovely chubby boy, 9 months old. Very friendly but pale. He was not in cardiac failure. There was tinge of jaundice of his conjunctiva. I also saw a few bottles of dark-coloured urine sample on the table. My doctor managed to get the most suitable blood for the child last night, informed my HO. And another pack of blood was in reserve if we need to transfuse some more. Looking at the child, I knew that he still need another blood transfusion. I ordered them to proceed with the second blood transfusion in view of the child still pale and haemolising. All my doctors were around me, listening to the questions that I asked the mother. I was trying to find out the possible cause of the haemolysis and presence of antibodies in the child's blood. The only positive relevant finding that I managed to get was about the mother who had blood transfusion for the treatment of dengue haemorrhagic fever in one of the private hospital in Kajang. One year after that, she conceived this child. So, I really don't know whether the mother developed antibodies toward the blood transfusion that she had before, and these antibodies were transfered to the baby during pregnancy via the placenta. I really am not very sure. Furthermore, I was not told the type of antibodies in the child's blood. Not only the antibodies puzzled us but the haemolysis that has occurred in the child. We still cannot find the cause of it. Several investigations done did not help to determine the cause of haemolysis in this child. My postulation is that, it could be still due to G6PD deficiency, which is very common in our population to cause haemolysis even though in this child the result of the G6PD screening test at birth was negative. I don't know and till now, I have no definitive answer to it.