Anemia in an infant, caused when a pregnant woman produces antibodies to an antigen in her fetus's red blood cells. An Rh-negative woman (see Rh blood-group system) with an Rh-positive fetus whose ABO blood group (see ABO blood-group system) matches hers is likely to have an immune reaction after the first such pregnancy, which sensitizes her when fetal red blood cells enter her bloodstream, usually during labour. If blood typing shows incompatibility, an anti-Rh antibody injection given to the mother after the birth can destroy the fetal red cells, thus preventing trouble in a future pregnancy. If amniocentesis detects products of blood destruction, Rh-negative blood transfusions to the fetus before birth or exchange transfusion after it may save the baby's life. ABO incompatibilities are more common but usually less severe.
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Haemolytic disease of the newborn, also known as Haemolytic disease of the fetus and newborn, HDN, HDFN, or Erythroblastosis fetalis, is an alloimmune condition that develops in a fetus, when the IgG antibodies that have been produced by the mother and have passed through the placenta include ones which attack the red blood cells in the fetal circulation. The red cells are broken down and the fetus can develop reticulocytosis and anaemia. This fetal disease ranges from mild to very severe, and fetal death from heart failure (hydrops fetalis) can occur. When the disease is moderate or severe, many erythroblasts are present in the foetal blood and so these forms of the disease can be called erythroblastosis fetalis (or erythroblastosis foetalis).
Hemolysis leads to elevated bilirubin levels. After delivery bilirubin is no longer cleared (via the placenta) from the neonate's blood and the symptoms of jaundice (yellowish skin and yellow discolouration of the whites of the eyes) increase within 24 hours after birth. Like any other severe neonatal jaundice, there is the possibility of acute or chronic kernicterus.
Profound anemia can cause high-output heart failure, with pallor, enlarged liver and/or spleen, generalized swelling, and respiratory distress. The prenatal manifestations are known as hydrops fetalis; in severe forms this can include petechiae and purpura. The infant may be stillborn or die shortly after birth.
Antibodies are produced when the body is exposed to an antigen foreign to the make-up of the body. If a mother is exposed to a foreign antigen and produces IgG (as opposed to IgM which does not cross the placenta), the IgG will target the antigen, if present in the fetus, and may affect it in utero and persist after delivery. The three most common models in which a woman becomes sensitized toward (i.e., produces IgG antibodies against) a particular blood type are:
Blood tests done on the newborn baby
Blood tests done on the mother
Intravenous immunoglobulin G (IVIG) therapy for significant hyperbilirubinemia in ABO hemolytic disease of the newborn
Sep 01, 2004; Background: Although intravenous immunoglobulin G (IVIG) therapy has been reported in hyperbilirubinemia of Rh hemolytic disease,...
New hemolytic disease study findings recently were reported by researchers at Seoul National University, Department of Laboratory Medicine.
Dec 02, 2010; Scientists discuss in 'Hemolytic disease of the newborn associated with anti-Jra alloimmunization in a twin pregnancy: the first...