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| '''For patient information on Hemolytic disease of the newborn, click [[Hemolytic disease of the newborn (patient information)|here]]'''
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| '''For patient information on Rh incompatibility, click [[Rh incompatibility (patient information)|here]]'''
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| '''For patient information on ABO incompatibility, click [[ABO incompatibility (patient information)|here]]'''
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| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = HDN | | | Name = HDN | |
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| {{SI}} | | {{Hemolytic disease of the newborn}} |
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| ==Overview==
| | '''For patient information on Hemolytic disease of the newborn, click [[Hemolytic disease of the newborn (patient information)|here]]''' |
| '''Haemolytic disease of the newborn''', also known as '''HDN''' or '''Erythroblastosis fetalis''', is an [[alloimmune]] condition that develops in a [[fetus]], when the [[IgG]] [[antibody|antibodies]] that have been produced by the mother and have passed through the [[placenta]] include ones which attack the [[red blood cell]]s 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 [[erythroblast]]s are present in the foetal blood and so these forms of the disease can be called '''erythroblastosis fetalis''' (or '''erythroblastosis foetalis'''). | |
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| ==Symptoms==
| | '''For patient information on Rh incompatibility, click [[Rh incompatibility (patient information)|here]]''' |
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| [[Hemolysis]] leads to elevated [[bilirubin]] levels. After delivery bilirubin is no longer cleared (via the placenta) from the neonate's blood and the [[symptom]]s 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]].
| | '''For patient information on ABO incompatibility, click [[ABO incompatibility (patient information)|here]]''' |
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| Profound anemia can cause high-output [[heart failure]], with [[pallor]], [[hepatomegaly|enlarged liver]] and/or [[splenomegaly|spleen]], generalized [[edema|swelling]], and [[shortness of breath|respiratory distress]]. The prenatal manifestations are known as [[hydrops fetalis]]; in severe forms this can include [[petechia]]e and [[purpura]]. The infant may be [[stillborn]] or die shortly after birth.
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| ==Causes==
| | {{SK}} HDN; erythroblastosis fetalis |
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| 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 an alien antigen and produces IgG (as opposed to [[Immunoglobulin M|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:
| | ==[[Hemolytic disease of the newborn overview|Overview]]== |
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| *Fetal-maternal [[hemorrhage]] can occur due to trauma, abortion, childbirth, ruptures in the [[placenta]] during [[pregnancy]], or medical procedures carried out during pregnancy that breach the uterine wall. In subsequent pregnancies, if there is a similar incompatibility in the fetus, these antibodies are then able to cross the placenta into the fetal bloodstream to attach to the [[red blood cell]]s and cause [[hemolysis]]. In other words, if a mother has anti-RhD (D being the major Rhesus antigen) IgG antibodies as a result of previously carrying a RhD-positive fetus, this antibody will only affect a fetus with RhD-positive blood.
| | ==[[Hemolytic disease of the newborn historical perspective|Historical Perspective]]== |
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| *The woman may receive a therapeutic [[blood transfusion]] with an incompatible blood type. [[ABO|ABO blood group system]] and [[Rhesus blood group system]] typing are routine prior to transfusion. Suggestions have been made that women of child bearing age or young girls should not be given a transfusion with Rhc-positive blood or [[Kell antigen system|Kell<sub>1</sub>]]-positive blood to avoid possible sensitization, but this would strain the resources of blood transfusion services, and it is currently considered uneconomical to screen for these blood groups.
| | ==[[Hemolytic disease of the newborn classification|Classification]]== |
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| *The third sensitization model can occur in women of blood type O. The [[immune response]] to A and B antigens, that are widespread in the environment, usually leads to the production of IgM anti-A and IgM anti-B antibodies early in life. On rare occasions, IgG antibodies are produced. In contrast, Rhesus antibodies are generally not produced from exposure to environmental antigens.
| | ==[[Hemolytic disease of the newborn pathophysiology|Pathophysiology]]== |
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| == Serological diagnoses == | | ==[[Hemolytic disease of the newborn differential diagnosis|Differentiating Hemolytic disease of the newborn from other Diseases]]== |
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| *ABO system
| | ==[[Hemolytic disease of the newborn epidemiology and demographics|Epidemiology and Demographics]]== |
| **[[ABO hemolytic disease of the newborn]] can range from mild to severe, but generally it is a mild disease.
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| *** anti-A antibodies
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| *** anti-B antibodies
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| *Rhesus system (the Rh d antigen and Rh d antibodies do not exist)
| | ==[[Hemolytic disease of the newborn risk factors|Risk Factors]]== |
| **[[Rhesus disease|rhesus D hemolytic disease of the newborn]] (often called Rh disease) is the most common form of severe HDN. The disease varies from mild to severe.
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| **[[Hemolytic disease of the newborn (anti-RhE)|rhesus E hemolytic disease of the newborn]] is a mild condition
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| **[[Hemolytic disease of the newborn (anti-Rhc)|rhesus c hemolytic disease of the newborn]] can range from a mild to severe disease - is the third most common form of severe HDN
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| **rhesus e hemolytic disease of the newborn - rare
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| **rhesus C hemolytic disease of the newborn - rare
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| **antibody combinations (ie anti-Rhc and anti-RhE antibodies occurring together) - can be severe
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| *Kell system
| | ==[[Hemolytic disease of the newborn screening|Screening]]== |
| **[[Hemolytic disease of the newborn (anti-Kell)|anti-Kell hemolytic disease of the newborn]]
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| ***anti-K<sub> 1</sub> antibodies - disease ranges from mild to severe - over half of the cases are caused by multiple blood transfusions - is the second most common form of severe HDN
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| ***anti-K<sub> 2</sub> ,anti-K<sub> 3</sub> and anti-K<sub> 4</sub> antibodies - rare
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| *Other blood group antibodies (Kidd, Lewis, Duffy, MN, P and others).
| | ==[[Hemolytic disease of the newborn natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| {{distinguish|Haemorrhagic disease of the newborn}}
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| The [[diagnosis]] of HDN is based on history and laboratory findings:
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| '''Blood tests done on the newborn baby'''
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| * Biochemistry tests for [[jaundice]]
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| * Peripheral blood [[morphology (biology)|morphology]] shows increased [[reticulocyte]]s. [[Erythroblast]]s (also known as nucleated red blood cells) occur in moderate and severe disease.
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| * Positive [[Coombs test#Direct Coombs test|direct Coombs test]] (might be negative after fetal interuterine blood transfusion)
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| '''Blood tests done on the mother'''
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| * Positive [[Coombs test#indirect Coombs test|indirect Coombs test]]
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| ==Treatment==
| | [[Hemolytic disease of the newborn history and symptoms|History and Symptoms ]] | [[ Hemolytic disease of the newborn physical examination|Physical Examination]] | [[Hemolytic disease of the newborn laboratory findings|Laboratory Findings]] | [[Hemolytic disease of the newborn ultrasound|Ultrasound]] | [[Hemolytic disease of the newborn other imaging findings|Other Imaging Findings]] | [[Hemolytic disease of the newborn other diagnostic studies|Other Diagnostic Studies]] |
| Before birth, options for treatment include intrauterine [[blood transfusion|transfusion]] or early induction of labor when pulmonary maturity has been attained, fetal distress is present, or 35 to 37 weeks of [[gestation]] have passed. The mother may also undergo [[exchange transfusion|plasma exchange]] to reduce the circulating levels of antibody by as much as 75%.
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| After birth, treatment depends on the severity of the condition, but could include temperature stabilization and monitoring, [[phototherapy]], transfusion with compatible packed red blood, [[exchange transfusion]] with a [[blood type]] compatible with both the infant and the mother, [[sodium bicarbonate]] for correction of [[acidosis]] and/or assisted ventilation.
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| Rhesus-negative mothers who have had a pregnancy with/are pregnant with a rhesus-positive infant are given Rh immune [[globulin]] (RhIG) at 28 weeks during pregnancy and within 72 hours after delivery to prevent sensitization to the D antigen. It works by binding any fetal red cells with the D antigen before the mother is able to produce an immune response and form anti-D IgG. A drawback to pre-partum administration of RhIG is that it causes a positive antibody screen when the mother is tested which is indistinguishable from immune reasons for antibody production.
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| ==Complications== | | ==Treatment== |
| Complications of HDN could include [[kernicterus]], [[hepatosplenomegaly]], inspissated (thickened or dried) bile syndrome and/or greenish staining of the [[teeth]], [[hemolytic anemia]] and damage to the liver due to excess bilirubin.
| | [[Hemolytic disease of the newborn medical therapy|Medical Therapy]] | [[Hemolytic disease of the newborn primary prevention|Primary Prevention]] | [[Hemolytic disease of the newborn secondary prevention|Secondary Prevention]] | [[Hemolytic disease of the newborn cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hemolytic disease of the newborn future or investigational therapies|Future or Investigational Therapies]] |
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| ==Similar conditions==
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| Similar conditions include [[Hemolytic anemia#Acquired|acquired hemolytic anemia]], congenital [[toxoplasma]] and [[syphilis]] infection, congenital obstruction of the [[bile duct]] and [[cytomegalovirus]] infection.
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| ==References== | | ==Case Studies== |
| *{{cite journal|last=Geifman-Holtzman|first=O|coauthors=Wojtowycz M, Kosmas E, and Artal R|year=1997|title=Female allo-immunization with antibodies known to cause hemolytic disease|url=|journal=Obstetrics and Gynecology|issn=0029-7844|volume=89|issue=2|pages=272-275|doi=}}
| | [[Hemolytic disease of the newborn case study one|Case #1]] |
| *{{cite book|last=Mollison|first=PL|coauthors=Engelfriet CP and Contreras M|authorlink=|title=Blood Transfusion in Clinical Medicine|edition=10th edition|publisher=Blackwell Science|location=Oxford, UK|year=1997|isbn=0-86542-881-6|series=}}
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| ==See also== | | ==Related Chapters== |
| *[[Coombs test]] | | *[[Coombs test]] |
| *[[Hemolytic anemia]] | | *[[Hemolytic anemia]] |
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| {{HDN}} | | {{HDN}} |
| {{Certain conditions originating in the perinatal period}} | | {{Certain conditions originating in the perinatal period}} |
| {{SIB}}
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| [[Category:Disease state]]
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| [[Category:Hematology]]
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| [[Category:Obstetrics]]
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| [[Category:Pediatrics]]
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| [[Category:Transfusion medicine]]
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| [[Category:Mature chapter]]
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| [[de:Morbus haemolyticus neonatorum]] | | [[de:Morbus haemolyticus neonatorum]] |
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