Hemolytic disease of the newborn (HDN), also known as erythroblastosis fetalis, is a blood disorder that occurs when the blood types of the mother and baby are unfavorable.
Hemolytic disease of the newborn (HDN), also known as erythroblastosis fetalis, is a blood disorder that occurs when the blood types of the mother and baby are unfavorable. HDN is very common in the United States due to advances in early detection and treatment, limiting it to approximately 4,000 cases per year. It is more likely to occur during the mother's second or next pregnancy. There are two causes, Rh incompatibility and ABO incompatibility. HDN often occurs due to Rh incompatibility and is often called Rh disease; It is three times more common in Caucasian babies than in African American babies. HDN can be treated during pregnancy or after the baby is born.
Hemolytic disease of the newborn is highly preventable. Today, almost all women with Rh negative blood are diagnosed by blood tests early in pregnancy. If a mother is Rh negative and unresponsive, she is usually given a drug called Rh immune globulin or RhoGAM. This specially developed blood product prevents the mother's Rh negative antibodies from responding to her baby's Rh positive red blood cells. Mothers generally receive RhoGAM during the 28th week of pregnancy and within 72 hours after delivery.
The symptoms are slightly different with each pregnancy and baby.
During pregnancy, you may not notice any symptoms. But your healthcare provider may see the following during a prenatal exam:
Yellow color of the amniotic fluid. This color may be due to bilirubin. It is caused by the breakdown of blood cells.
Your baby may have a large liver, spleen, or heart. There may also be excess fluid in the stomach, lungs, or scalp. These are the hydrops detail codes. This condition can cause severe swelling (edema).
After birth, your baby may have symptoms:
Pale-looking skin. Having too few red blood cells (anemia).
Yellowing of the umbilical cord, skin, and whites of your baby's eyes (jaundice). Your baby may not appear yellow right after birth. But jaundice can appear quickly. It often starts within 24 to 36 hours.
Your newborn may have a large liver and spleen.
A newborn with hydrocephalus can have severe swelling throughout their body. They may also be very pale and have trouble breathing.
Everyone has a blood group (A, B, AB, or O). Everyone also has an Rh factor (positive or negative). The problem may be if the mother and baby have a different blood type and Rh factor.
HDN occurs most often when the Rh negative mother has a child with an Rh positive father. If the baby's Rh factor is positive, like her father, it can be a problem if the baby's red blood cells pass to the Rh negative mother.
It often occurs at birth when the placenta separates. This can happen as long as the mother's and baby's blood cells meet. It can occur during a miscarriage or a fall. It can also happen during prenatal tests. These may include amniocentesis or chorionic villus sampling. These tests use a needle to take a sample of tissue. They may be bleeding.
The Rh negative mother's immune system views the baby's Rh positive red blood cells as foreign. Your immune system responds by producing antibodies to fight and destroy these foreign cells. Your immune system will store these antibodies if these foreign cells return. This can happen in future pregnancies. You now have Rh sensitivity.
Rh sensitivity is not usually a problem during the first pregnancy. Having another Rh positive baby can cause many problems in future pregnancies. During that pregnancy, the mother's antibodies fight Rh positive cells in the baby's body beyond the placenta. When the antibodies destroy the cells, the baby becomes sick. During pregnancy it is called erythroblastosis fetus. After the baby is born, it is called HDN.
HDN can cause symptoms caused by other conditions. To diagnose, your child's healthcare provider will look at blood types that may not work together. Sometimes this diagnosis is made during pregnancy. It is based on the following test results:
Blood test. Your blood is tested for Rh positive antibodies.
Ultrasound. This test will show if your baby has stretched organs or fluid.
Amniocentesis. This test is done to check the amount of bilirubin in the amniotic fluid. In this test, a needle is placed in the abdominal and cervical wall. It passes through the amniotic sac. The needle takes a sample of amniotic fluid.
Percutaneous umbilical cord blood sample. This test is also called a fetal blood sample. In this test, a sample of blood is taken from your baby's umbilical cord. Your child's healthcare provider will test this blood for antibodies, bilirubin, and anemia. This is done to check if your baby needs a cervical blood transfusion.
The following tests are used to diagnose HDN after the birth of your baby:
Your baby's umbilical cord exam. It shows your baby's blood type, Rh factor, red blood cell count, and antibodies.
Testing the baby's blood for bilirubin levels.
During pregnancy, HDN treatment may include the following.
The doctor will check your baby's blood flow with an ultrasound.
Cervical blood transfusion
This test keeps red blood cells in your baby's circulation. In this test, a needle is inserted through your uterus. It enters the umbilical cord vein into your baby's abdominal cavity. Your child may need sedatives to keep them from moving. You will need to do more than one conversion.
If your baby has some problems, she should be born prematurely. If your child has mature lungs, your healthcare provider can induce labor. This prevents HDN from deteriorating further.
After birth, treatment may include the following.
This can be done if your child has severe anemia.
This can be done if your child has low blood pressure.
In this test, your baby is placed under a special light. This will help your baby get rid of excess bilirubin.
Helps with breathing
Your baby may need oxygen, a substance in the air lungs that helps keep the small air sacs open (surfactant), or a mechanical breathing apparatus (ventilator) to breathe better.
This test removes high levels of bilirubin from your baby's blood. Replaces normal blood with normal levels of bilirubin. This will increase the number of red blood cells in your baby. It also lowers your bilirubin level. In this test, your baby will be given a small amount of blood as an alternative. This is done through a vein or artery. You may need to repeat this procedure if your baby has high bilirubin levels.
Intravenous immunoglobulin (IVIG)
Solution prepared from IVIG blood plasma. It contains antibodies that help the baby's immune system. IVIG lowers your baby's red blood cell count. It can also lower your bilirubin levels.
When your antibodies attack your baby's red blood cells, they are broken down and destroyed (hemolysis).
When your baby's red blood cells break down, bilirubin is formed. Children find it difficult to get rid of bilirubin. It can build up in your blood, tissues, and fluids. This is called hyperbilirubinemia. Bilirubin turns a baby's skin, eyes, and other tissues yellowish. This is called jaundice.
When red blood cells break down, they can cause anemia in your baby. Anemia is dangerous. In anemia, your baby's blood makes red blood cells very quickly. It occurs in the bone marrow, liver, and spleen. This causes these organs to enlarge. New red blood cells are often immature, and mature red blood cells cannot function.
Problems with HDN can be mild or severe.
During pregnancy, your baby may have the following:
Mild anemia, hyperbilirubinemia, and jaundice. The placenta releases some bilirubin. But that doesn't eliminate everything.
Severe anemia This can make your baby's liver and spleen too big. It also affects other organs.
Hydrops fetalis. This happens when your baby's organs cannot handle the anemia. Your baby will start to have heart failure. This causes a large amount of fluid to form in your baby's tissues and organs. Children with this condition are at risk of dying.
After birth, your baby may have the following:
Acute hyperbilirubinemia and jaundice. Your baby's liver does not handle large amounts of bilirubin. This can cause your baby's liver to grow too large. You will still have anemia.
Kernicterus. It is the most serious form of hyperbilirubinemia. This is due to the formation of bilirubin in your baby's brain. It can cause seizures, brain damage, and deafness. It can also cause death.
HDN can be avoided. Almost all women have a blood test in early pregnancy to determine their blood type.
If you are not Rh negative and sensitive, you may be given a medicine called Rh immune globulin (RhoGAM). This medicine can stop your antibodies from responding to your baby's Rh positive cells. Most women receive RhoGAM during the 28th week of pregnancy.
If your baby is Rh positive, they will receive a second dose of medicine within 72 hours after birth. If your child is Rh negative, she does not need a second dose
Key points about hemolytic disease of the newborn
HDN occurs when your baby's red blood cells break down at a fast rate.
HDN happens when an Rh negative mother has a baby with an Rh positive father.
If the Rh negative mother has been sensitized to Rh positive blood, her immune system will make antibodies to attack her baby.
When the antibodies enter the baby's bloodstream, they will attack the red blood cells. This causes them to break down. This can cause problems.
This condition can be prevented. Women who are Rh negative and haven't been sensitized can receive medicine. This medicine can stop your antibodies from reacting to your baby's Rh positive cells.
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