Erythroblastosis fetalis: Description, Causes and Risk Factors:Erythroblastosis fetalis is a blood disorder that occurs when the blood types of a mother and baby are incompatible. If the baby's incompatible red blood cells [RBCs] cross over to his mother, through the placenta during pregnancy or at delivery, her immune system sees them as foreign and responds by developing proteins called antibodies to attack and break them down. This can lead to several complications that range from mild to very severe.The mother's immune system also keeps these antibodies in case the incompatible red blood cells appear again, making her "sensitized." Because of this, erythroblastosis fetalis is more likely to occur during a mother's second or subsequent pregnancy, or following a miscarriage or abortion.Red blood cells (RBCs) carry several types of proteins, called antigens, on their surfaces. The A, B, and O antigens represent the classification of an individual's blood as type A, B, AB, or O. Depending on the genetic predisposition of the parents, an A, B, or O antigen gene can be passed to a child. How the genes are paired determines the person's blood type.A person who inherits an A antigen gene from each parent has type A blood; receiving two B antigen genes corresponds with type B blood; and inheriting A and B antigen genes means a person has type AB blood. If the O antigen gene is inherited from both parents, the child has type O blood; however, the pairing of A and O antigen genes corresponds with type A blood; and if the B antigen gene is matched with the O antigen gene, the person has type B blood.Another red blood cell antigen, called the Rh factor, also plays a role in describing a person's blood type. A person with at least one copy of the gene for the Rh factor has Rh-positive blood; if no copies are inherited, the person's blood type is Rh-negative. In blood typing, the presence of A, B, and O antigens plus the presence or absence of the Rh-factor determine a person's specific blood type, such as A-positive, B-negative, and so on.Erythroblastosis fetalis most frequently occurs when a mother with Rh - negative blood becomes pregnant by an Rh - positive father, resulting in an Rh - positive baby and the mother most common form of erythroblastosis fetalis is ABO incompatibility, which can vary in severity.In many cases of blood type incompatibility, the symptoms of erythroblastosis fetalis are prevented with careful monitoring and blood type screening. Treatment of minor symptoms is typically successful, and the baby does not suffer long-term problems.Complications:Mild anemia: When the baby's red blood cell [RBCs] count is deficient, his blood cannot carry enough oxygen from the lungs to all parts of his body, causing his organs and tissues to struggle.
Hyperbilirubinemia and jaundice: The breakdown of red blood cells produces bilirubin, a brownish yellow substance that is difficult for a baby to discharge and can build up in his blood (hyperbilirubinemia) and make his skin appear yellow.
Severe anemia with enlargement of the liver and spleen: The baby's body tries to compensate for the breakdown of red blood cells by making more of them very quickly in the liver and spleen, which causes the organs to get bigger. These new red blood cells are often immature and unable to function completely, leading to severe anemia.
Hydrops fetalis: When the baby's body cannot cope with the anemia, his heart begins to fail and large amounts of fluid build up in his tissues and organs.
Symptoms:The most common symptoms of erythroblastosis fetalisare:Pale skin.
Yellowing of the amniotic fluid, umbilical cord, skin and eyes.
Enlarged liver or spleen.
Severe swelling of the body.
Diagnosis:Erythroblastosis fetalis can be predicted before birth by determining the mother's blood type. If she is Rh - negative, the father's blood is tested to determine whether he is Rh-positive. If the father is Rh-positive, an antibody screen is done to determine whether the Rh-negative woman is sensitized to the Rh antigen (developed isoimmunity). The indirect Coombs test measures the number of antibodies in the maternal blood. If the Rh-negative woman is not isoimmunized, a repeat antibody determination is done around 28 weeks' gestation, and the expectant woman should receive an injection of an anti-Rh (D) gamma globulin called RhoGAM.In cases in which incompatibility is not identified before birth, the baby suffers recognizable characteristic symptoms such as anemia, hyperbilirubinemia, and hydrops fetalis. The blood incompatibility is uncovered through blood tests such as the direct Coombs test, which measures the level of maternal antibodies attached to the baby's red blood cells. Other blood tests reveal anemia, abnormal blood counts, and high levels of bilirubin.Other tests during pregnancy may include:Complete blood count test for the mother.
Treatment:Erythroblastosis fetalis can be treated during pregnancy or after the baby is born.Treatment during pregnancy may include:Blood transfusion.
Early delivery of the baby if severe complications arise and baby's lungs are mature.
After birth, treatment may include:Blood transfusion.
Oxygen or mechanical breathing machine.
Exchange transfusion to replace the baby's damaged blood with fresh blood.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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