The newborn female of a now gravida 4 para 3 mom with maternal history Rh D, C, and Jka (Kidd) alloimmunization during a prior pregnancy presented with anemia. There was fetal anemia at 30 weeks’ gestation for which she received two intrauterine transfusions. She was delivered via C-section at 34 weeks because of fetal distress. At birth, hematocrit was 19.4% and bilirubin was 6.5 mg/dl. The child’s antibody screen was positive for anti-D, anti-C, and anti-Jka antibodies. She required a 10-day neonatal intensive-care unit stay during which time she received intravenous immunoglobulin, blood transfusions, and phototherapy.