iii.Antibody-mediated hemolysis

Antibodies are the proteins that are synthesized by the immune system. These proteins normally attach to the surface of any foreign invaders such as bacteria and viruses and destroy them. In the case of antibody-mediated hemolysis, the body makes antibodies against its red blood cells. These antibodies target red blood cells and kill them before completion of their life cycle (**Figure 3**). It depends on the duration and the rate of hemolysis, whether the anemia may or may not occur. If the degree of hemolysis is moderate and the erythropoietic response of the bone marrow is completely compensating for the decreased RBC lifespan, then the hemoglobin concentration may remain normal. If the erythropoietic response is not sufficient to completely compensate for decreased RBCs lifespan, then anemia will occur [18].

Anemia has multi-factorial etiology in pregnancy. There is a rare chance of maternal complication due to Pregnancy-induced hemolytic anemia that occurs during pregnancy and resolves later on delivery. The absence of any identifiable immune mechanism or intracorpuscular or extracorpuscular defects despite the use of specific and sensitive complement-fixation techniques and an assay of all red blood cell (RBC) enzymes are the characteristics of this problem. It is necessary to rule out other causes of non-immune hemolytic anemia including broad etiologies such as congenital, mechanical, toxic agents, medications, infection, lymphoproliferative disorder, etc. to embark on the diagnosis of idiopathic hemolytic anemia. A rare entity called Coomb's negative hemolytic anemia of pregnancy may be life-threatening, and for an optimum maternal-fetal outcome it desires a tireless diagnostic and appropriate treatment approach [19].

**Figure 3.** *Antibody-mediated hemolysis of red blood cells.*
