Scribd
Upload
9 views4 pages

Lesson 26

Uploaded by

msoriotullahsk
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
9 views4 pages

Lesson 26

Uploaded by

msoriotullahsk
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 4

MODULE Hemolytic Disease of the New Born (HDNB)

Hematology and Blood


Bank Technique

26
Notes
HEMOLYTIC DISEASE OF THE
NEW BORN (HDNB)

26.1 INTRODUCTION
Hemolytic disease of the newborn is a condition in which IgG antibodies from
maternal blood cross the placenta into the fetal circulation where they react with
fetal red cells and break them.

OBJECTIVES
After reading this lesson, you will be able to:
z explain the pathology of Hemolytic disease of the newborn
z discuss the antenatal assessment of Hemolytic Disease of Newborn
z describe the tests on maternal and cord blood at delivery
z explain the prophylaxis for hemolytic disease of new born

26.2 PATHOPHYSIOLOGY
Hemolytic disease of the newborn is a condition which occurs due to destruction
of fetal red cells by IgG antibodies from maternal blood. The antibodies cross
the placenta during pregnancy and reach into the circulation of the fetus where
they react with the red blood cells and break them. These antibodies are
commonly directed against Rh or ABO blood group antigens on fetal red cells.

The risk of maternal immunization to blood group antigens depends on the


following factors:

242 HEMATOLOGY AND BLOOD BANK TECHNIQUE


Hemolytic Disease of the New Born (HDNB) MODULE
(a) Volume of incompatible fetal red cells that cross the placenta and reach Hematology and Blood
Bank Technique
the maternal circulation (fetomaternal hemorrhage)
(b) Immunogenicity of the red cell antigen and maternal immune response

Rh incompatibility reactions occur where an Rh negative mother becomes


pregnant with an Rh positive fetus. A small number of RBCs from fetus cross
the placenta to the mother’s blood and the mother gets immunized. The first baby
of these mothers is unaffected. However, during the second pregnancy with an Notes
Rh positive fetus, the passage of fetal blood cells to maternal blood causes a
severe immune response. Large number of IgG antibodies are produced in the
mother that cross the placenta, reach the fetal blood and destroy its RBCs. This
fetomaternal hemorrhage can occur after caesarean section, vaginal delivery,
abortion, invasive procedures or clinical maneuvers. Similar condition can occur
in Rh negative females who receive incompatible blood transfusion.

The ABO incompatibility is much more common than Rh but is usually of less
severity. The antibodies are usually of the IgM type (which cannot cross the
placenta). IgG antibodies are more likely to occur when mother of blood group
“O” carries fetus of either group A or B. The ABO incompatibility may be seen
even in first pregnancy, but it is very less severe than Rh incompatibility because:

1. The fetal red cells express A&B blood group antigens weakly.
2. There is widespread distribution of carbohydrate antigens in fetal fluids &
tissues which mimic A and B red cell antigens and neutralize large part of
maternal anti-A and anti-B antibody.

26.2.1 Clinical Features


About 50% of the infants are asymptomatic or have mild disease, 30% have
moderate anemia and hyperbilirubinemia and approximate 20% are severely
affected and may develop hydrops fetalis

26.2.2 Laboratory Evaluation


All pregnant women should have their blood group (ABO and Rh) and antibody
screening (indirect Coomb’s test) done at the first visit to obstetrician. This will
help to identify women who will require Rh immunoglobulin and monitor the
increasing titer of anti D in maternal serum.

Tests on maternal and cord blood at delivery


The following tests should be carried out:

HEMATOLOGY AND BLOOD BANK TECHNIQUE 243


MODULE Hemolytic Disease of the New Born (HDNB)

Hematology and Blood Tests on cord blood:


Bank Technique
(a) ABO & Rh Group
(b) Direct Coomb’s test
(c) Hemoglobin
(d) Bilirubin
Notes
Tests on maternal blood
(a) ABO & Rh Blood group
(b) Maternal red cell antibody (anti D) titre using indirect Coombs test
(c) Kleihauer- Betke acid dilution test for quantitative estimation of fetomaternal
hemorrhage, this determines the prophylactic dose of anti D immunoglobulin
to be given to mother.
(d) Amniotic fluid analysis by spectrophotometer; based on the fact that
optical density of the amniotic fluid increases with its bilirubin concentration.
Liley curve is plotted and management of the patients is based on the
optical density at 450 nm.
(e) Noninvasive fetal monitoring using Doppler

Anti D Prophylaxis
Anti D is administered to Rh negative women during pregnancy and after
delivery or abortion to minimize the risk of HDNB.

INTEXT QUESTIONS 26.1


1. Hemolytic disease of Newborn is due to .................. or ..................
incompatibility
2. Rh incompatibility occurs when .................. mother becomes pregnant with
.................. fetus
3. In ABO incompatibility the mother is of blood group .................. & the fetus
is of group ..................
4. Increased .................. in the serum is useful in identifying the risk of
Hemolytic disease of Newborn
5. .................. test determines the feto maternal red cell damage

244 HEMATOLOGY AND BLOOD BANK TECHNIQUE


Hemolytic Disease of the New Born (HDNB) MODULE
Hematology and Blood
Bank Technique
WHAT HAVE YOU LEARNT
z In HDNB IgG antibodies from maternal blood cross the placenta into the
circulation of the fetus
z Majority of hemolytic disease of newborn is due to ABO incompatibility
but cases of Rh incompatibility are clinically more severe
Notes
z Rh incompatibility occurs when Rh negative mother becomes pregnant with
Rh positive fetus and the mother gets immunized when the fetal blood cells
cross the placenta into maternal blood and produces antibodies
z During the second pregnancy when the fetal blood cells reach the maternal
blood, large number of IgG antibodies are produced which cross the
placenta and destroy fetal RBCs
z An increasing titre of Anti D in maternal serum is useful in identifying
pregnancies at risk
z Anti D may be administered to Rh negative women during pregnancy and
after delivery to minimize the risk of HDNB.

TERMINAL QUESTIONS
1. Explain the tests on maternal and cord blood at delivery
2. Explain briefly the pathogenesis of Hemolytic disease of Newborn

ANSWERS TO INTEXT QUESTIONS

26.1
1. ABO & Rh
2. Negative, Positive
3. O, A or B
4. Anti D titre
5. Kleihaurer- Betke test

HEMATOLOGY AND BLOOD BANK TECHNIQUE 245

You might also like