Yifan Xiao, MD

Hemolytic disease of the newborn

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Chapter 54 Normocytic Anemia (Increased Hemolysis)  HEMOLYTIC DISEASE OF THE NEWBORN osms.it/hemolytic-disease-of-the-newborn PATHOLOGY & CAUSES ▪ Anemia caused by hemolytic destruction of fetal/neonatal erythrocytes by maternal antibodies ▪ AKA alloimmune HDFN/erythroblastosis fetalis  CAUSES  ▪ Fetomaternal hemorrhage exposes maternal circulation to antigens present on fetal RBCs → maternal sensitization → formation of maternal IgG antibodies against fetal RBCs → IgG antibodies small enough to cross placenta → antibody attachment to fetal cells → agglutination (clumping) → microcirculatory impairment → hemolysis, destruction of RBCs by macrophages in reticuloendothelial system ▫ Involves Rhesus (Rh) blood group/A, B, AB, O blood groups ▪ Causes of maternal sensitization include normal delivery, spontaneous/induced abortion, chorionic villus sampling, amniocentesis, antenatal hemorrhage, maternal trauma, idiopathic ▫ Small amount (0.1mL) of fetal blood needed to induce maternal immune response ▪ Rh incompatibility ▫ Rh negative mother exposed to Rh positive fetal RBCs → maternal anti-D antibodies formed ▫ Usually will not affect ﬁrst pregnancy when initial exposure occurs; adversely affects subsequent pregnancies ▫ Decreasing occurrence due to availability of Rh(D) immune globulin prophylaxis ▪ ABO incompatibility ▫ More common, less severe morbidity, mortality than with Rh incompatibility  ▫ Occurs in type O mother with naturallyoccurring Anti-A and Anti-B antibodies + Type A/Type B fetus ▫ Can occur in ﬁrst and all subsequent pregnancies  RISK FACTORS  ▪ Blood group incompatibility, fetomaternal hemorrhage  COMPLICATIONS  ▪ Anemia, hyperbilirubinemia, kernicterus ▪ Growth restriction, hydrops fetalis, erythroblastosis fetalis ▫ Increased immature RBCs in fetal circulation  SIGNS & SYMPTOMS ▪ Hemolytic disease caused by ABO incompatibility ▫ Mild to moderate hyperbilirubinemia within ﬁrst 24h of life ▫ Mild to moderate anemia ▪ Hemolytic disease caused by Rh incompatibility (more severe) ▫ Hyperbilirubinemia, kernicterus: possible ▫ Symptomatic anemia: pallor, lethargy, tachycardia, tachypnea ▫ Hydrops fetalis: related to severe anemia-induced hypoxia; subcutaneous edema, pleural/pericardial effusion, ascites, signs and symptoms of shock ▪ Antenatal presentation ▫ Intrauterine growth restriction signals problems with ongoing hemolysis, hypoxia  OSMOSIS.ORG 429   

ABO Hemolytic Disease of the Fetus and Newborn

Rh Hemolytic Disease of the Fetus and Newborn

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Hemolytic disease of the newborn

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