Hemolytic disease of the newborn

Last revised by Dr Owen Kang on 27 Jul 2022

Hemolytic disease of the newborn (HDN) results when maternal antibodies attack the fetal red blood cells, leading to a hemolytic anemia 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 hemolytic 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:

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 anemia 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

Depending on the extent of severity, blood transfusion may be required.

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