Haemolytic disease of the newborn
Haemolytic disease of the newborn (HDN) results when maternal antibodies attack the fetal red blood cells, leading to a haemolytic anaemia and accumulation of bilirubin in the fetus or newborn. It can affect the newborn to varying degrees of severity. When the condition occurs in utero, the term is expanded into haemolytic disease of the fetus and newborn (HDFN) (or erythroblastosis fetalis).
The condition is now uncommon due to the practice of giving anti-immunoglobulin when the mother is Rhesus negative.
The newborn can present with a number of features including:
- clinical evidence of a fetal anaemia
- generalised body oedema
The condition usually results from a feto-maternal blood group incompatibility such as:
This results in the destruction of fetal red blood cells by maternal IgG antibodies that cross the placenta.
May show evidence of or complications related to a fetal anaemia such as:
- development of hydrops fetalis
- increase in fetal middle cerebral arterial (MCA) Doppler time average mean velocity (TAMV): may occur before precipitation of fetal hydrops 1
- increase in fetal middle cerebral arterial (MCA) Doppler peak systolic velocity (PSV): may occur before precipitation of fetal hydrops 2
Treatment and prognosis
Depending on the extent of severity, blood transfusion may be required.
- 1. Abdel-fattah SA, Soothill PW, Carroll SG et-al. Middle cerebral artery Doppler for the prediction of fetal anaemia in cases without hydrops: a practical approach. Br J Radiol. 2002;75 (897): 726-30. Br J Radiol (full text) - Pubmed citation
- 2. Mari G. Middle cerebral artery peak systolic velocity: is it the standard of care for the diagnosis of fetal anemia? J Ultrasound Med. 2005;24 (5): 697-702. J Ultrasound Med (full text) - Pubmed citation
- 3. Dajak S, Stefanović V, Capkun V. Severe hemolytic disease of fetus and newborn caused by red blood cell antibodies undetected at first-trimester screening. 2011;doi:10.1111/j.1537-2995.2010.03006.x - Pubmed citation
- 4. McCandless DW. Kernicterus. Humana Pr. (2010) ISBN:1441965548. Read it at Google Books - Find it at Amazon
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