Hemolytic disease of the newborn

Hemolytic disease of the newborn: Description, Causes and Risk Factors: Hemolytic disease of the newbornHemolytic disease of the newborn (HDN) is a disease in which there is hemolysis in a newborn or fetus caused by blood-group incompatibility between mother and child. A person's blood type is determined by the presence of two different types of proteins, called antigens. The A, B and O antigens represent the classification of a person's blood as Type A, B, AB or O. If a person also has the Rh factor antigen, his blood is Rh-positive, and if not, it is Rh-negative. Hemolytic disease of the newborn most frequently occurs when a mother with Rh-negative blood becomes pregnant by an Rh- positive father, resulting in an Rh-positive baby. Hemolytic disease of the newborn is caused by a mismatch between the Kell antigens of the mother and fetus. About 91% of the population are Kell1 negative and about 9% are Kell1 positive. A fraction of a percentage are homozygous for Kell1. Therefore, about 4.5% of babies born to a Kell1 negative mother are Kell1 positive. The disease results when maternal antibodies to Kell1 are transferred to the fetus across the placental barrier. These antibodies can cause severe anemia by interfering with the early proliferation of red blood cells as well as causing alloimmune hemolysis. Very severe disease can occur as early as 20 weeks gestation. Hydrops fetalis can also occur early. The finding of anti-Kell antibodies in an antenatal screening blood test (indirect Coombs test) is an indication for early referral to a specialist service for assessment, management and treatment. Hemolytic disease of the newborn is relatively uncommon in the United States due to advances in early detection and treatment, limiting it to approximately 4,000 cases a year. It is more likely to happen during a mother's second or subsequent pregnancy. HDN due to Rh incompatibility occurs more frequently and is about three times more likely in Caucasian babies than in African-American babies. The severity of this condition can vary. Some babies have no symptoms. In other cases, problems such as hydrops can cause the baby to die before, or shortly after birth. Severe HDN may be treated before birth by intrauterine transfusion. Symptoms: HDN can destroy the newborn baby's blood cells very quickly, which can cause symptoms such as: Edema (swelling under the surface of the skin). Signs: Anemia or low blood count.
  • Enlarged liver or spleen.
  • Hydrops (fluid throughout the body's tissues, including in the spaces containing the lungs, heart, and abdominal organs)--which can lead to heart failure from too much fluid.
Diagnosis: Hemolytic disease of the newborn can be diagnosed during pregnancy or after the baby is born. Tests conducted during pregnancy may include: Complete blood count test for the mother.
  • Ultrasound.
  • Amniocentesis.
  • Cordocentesis.
After birth, tests may include: Complete blood count test for the baby.
  • Umbilical cord blood test.
Treatment: It is obviously way better to prevent HDN than to try to treat it once it is developed. That's why the mother's blood type is determined very early in pregnancy, and RhoGAM is administered if mother is D negative. If HDN does develop, there are several options for treatment. Minimally affected newborns can be treated with phototherapy. Light oxidizes unconjugated bilirubin (toxic) to water-soluble, readily-excreted dipyrroles (harmless). Severely affected fetuses can be treated by total exchange transfusion of the infant (through umbilical vein). The mother can be treated with plasmapheresis (which removes antibody). High-dose intravenous immunoglobulin can be used too - but the best dosage and timing are not well-defined. NOTE: The above information is for processing 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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