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Hemolytic Disease of The Fetus /newborn
Hemolytic Disease of The Fetus /newborn
/Newborn
Uncommon causes
Kell system antibodies
Rare causes
Duffy system antibodies
MNS and s system antibodies
Placental ++ + + - - -
transfer
Lymphocyte / + - + - - -
macrophage
FcR binding
Transfer of Antibody from mother to fetus
• Via the placenta.
• Only blood group reactive IgG antibodies capable of
placenta transfer.
• IgG 1 and IgG 3 due to placental transfer factor which
is locate on the Fc portion of the molecule.
• At delivery; The concentration of IgG tends to be
higher in the infants serum/or plasma than in the
mother's circulation. So Igg is transferred more
readily from mother to the fetus and remain in
23days in infants circulation.
Disease mechanism - HDN
• There is destruction of the RBCs of the fetus
by antibodies produced by mother
Unconjugated
bilirubin
Conjugated
bilirubin
• Severe forms
– Icterus gravis neonatorum (Kernicterus)
• Intrauterine death
– Hydrops fetalis
• Oedematous, ascites, bulky swollen & friable placenta
• Pathophysiology
– Extravascular hemolysis with extramedullary erythropoiesis
– Hepatic and cardiac failure
Hemolytic disease of newborn HDN
BEFORE BIRTH
• Anemia (destruction of red cells)
• Heart failure
• Fetal death (Hydrops fetalis)
AFTER BIRTH
• Anemia (destruction of red cells)
• Heart failure
• Build up of bilirubin
• Kernicterus
• Severe growth retardation
Rh HEMOLYTIC DISEASE OF NEWBORN
• Antibodies against
• Anti-D and less commonly anti-c, anti-E
• Mother is the case of anti-D is Rh -ve (negative)
• First born infant is usually unaffected
• Sensitization of mother occurs
• During gestation
• At the time of birth
• All subsequent offspring inheriting D-antigen will be
affected in case of anti-D HDN
Pathogenesis
Fetomaternal Hemorrhage
• Nonpolar bilirubin is
converted into 2 types of
water-soluble
photoisomers as a result
of phototherapy
• Decrease in bilirubin is
mainly the result of
excretion of these
photoproducts in bile
and removal via stool
Diagnosis and Management contd.
• Selection of blood
– Group O RBC’s
– Rh-negative units for Rh-
negative case
– Blood less than 5 days
old
– In CPDA1 anticoagulant
Selection of Blood for Exchange Transfusion
• Laboratory findings
• Differ from Rh- HDN; microspherocytes are characteristic of ABO- HDN
• Bilirubin peak is later; 1- 3 days after birth
• Collection of cord blood and testing eluates form red cells will reveal
anti-A or anti-B
• Treatment
• Group O donor blood for exchange transfusion which is rarely required
• Phototherapy
HDN- due to other antibodies
• Anti-c
• Usually less severe than that cause by Anti-D
• Anti-K
• May cause severe fetal anemia