Hemolytic disease of newborn(neonate).pptx

Hemolytic disease of new born erythroblastosis fetalis

1. Haemolytic disease of newborn

2. Hemolytic disease of the newborn is also called erythroblastosis fetalis. This condition occurs when there is an incompatibility between the blood types of the mother and baby. "Hemolytic" means breaking down of red blood cells "Erythroblastosis" refers to making of immature red blood cells "Fetalis" refers to fetus

3. Definition Hemolytic disease of the new born and fetus (HDN) is a destruction of the red blood cells (RBCs) of the fetus and neonate by antibodies produced by the mother.

4. It is a condition in which the life span of the fetal/neonatal RBC is shortened due to maternal allo -antibodies against red cell antigens acquired from the father. Rate of RBCs destruction is accelerated BUT ability of bone marrow to respond is NORMAL .

5. Etiology 1. Rh incompatibility : Hemolytic disease occurs most frequently Develops when an Rh - ve mother conceives a fetus which is Rh+ve 2. ABO incompatibility Mother has blood type O and the fetus has blood type A or B or AB

6. ABO Incompatibility When people who have one blood type receive blood from someone with a different blood type, it may cause their immune system to react. This is called ABO incompatibility. For example, when a mother of genotype OO (blood group O) carries a fetus of genotype AO (blood group A) she may produce IgG anti-A antibodies, which can pass through the placenta and destroyes the RBCs of fetus.

7. Rh Incompatibility Rh incompatibility is a condition which develops when there is a difference in Rh blood type between that of the pregnant mother (Rh negative) and that of the fetus (Rh positive)

8. The Rh factor, Rh+ and Rh- usually refers to presence or absence of antigen-D There are two alleles of antigen: D and d A person who is Rh - ve has two recessive traits, dd Anyone who has at least one D (DD or Dd) is Rh+ve

9. Physiology In first pregnancy, Rh sensitization is not likely. Usually, it only becomes a problem in a future pregnancy with another Rh-positive baby. When the next pregnancy occur, the mother's antibodies cross the placerita then reacts with an RBC antigen to fight the Rh-positive cells in the baby's body that the baby has inherited from the father, and that is foreign to the mother. Hence, the antigen antibody interaction occurs

10. Cont.. Sensitization of baby's red blood cell (RBC) by mother's IgG antibody causes the baby's RBC to be destroyed. These antibody-coated RBCs are removed from fetal circulation by the macrophages of the spleen and liver. Anemia will stimulate bone marrow to produce more RBC including immature RBC, which is then released to fetus circulation. This is also known as erythroblastosis fetalis.

11. Pathogenesis ↓ Fetomaternal Hemorrhage Maternal Antibodies formed against fetus derived antigens During subsequent pregnancy, placental passage of maternal IgG antibodies Maternal antibody attaches to fetal red blood cells Fetal red blood cell hemolysis Anemia

12. Complications of HDN During pregnancy: Mild anemia , hyperbilirubinemia, and jaundice. Severe anemia with enlargement of the liver and spleen. Hydrops fetalis .

13. After birth: Severe hyperbilirubinemia and jaundice. Kernicterus.

14. Diagnosis During pregnancy: Blood grouping for Rh factor Coombs test (Direct and Indirect coombs test) Ultrasound - to detect organ enlargement or fluid buildup in the fetus. Amniocentesis - to measure the amount of bilirubin in the amniotic fluid .

15. Cont.. After birth: Testing of the baby's umbilical cord blood for blood group, Rh factor, red blood cell count, and antibodies Testing of the baby's blood for bilirubin levels

16. Management Before birth(Antenatal): Intrauterine blood transfusion of red blood cells into the baby's circulation. This is done by placing a needle through the mother's uterus and into the abdominal cavity of the fetus or directly into the vein in the umbilical cord.

17. Cont.. Early delivery if the fetus develops complications. If the fetus has mature lungs, labor and delivery may be induced to prevent worsening of HDN. Plasma exchange. The mother may also undergo plasma exchange to reduce circulating levels of antibody by as much as 75%

18. Cont.. Rh immune globulin ( RhIG ): Inj. RhoGAM is administered intramuscular, At 28 weeks during pregnancy At 34 weeks during pregnancy

19. Cont.. Management After birth of baby : Blood transfusions (for severe anemia ) Intravenous fluids (for low blood pressure) Phototherapy Respiratory distress to be relieved using oxygen, surfactant, or a mechanical breathing machine Exchange blood transfusion for newborn

20. cont.. Intravenous immunoglobin(IVIG). IVIG is a solution made from blood plasma that contains antibodies to help the baby's immune system. IVIG may help reduce the breakdown of red blood cells and lower bilirubin levels. For mother, Inj RhoGAM must given within 72 hours of delivery of the newborn

21. Preventing HDN 1. Determine Rh status of the mother 2. If the mother is not sensitized, reduce the risk of future sensitization. 3. If the mother is sensitized, determine whether the fetus is at risk and monitor accordingly 4. To prevent Isoimmuization of yet unimmunized mother give Anti Rh D IgG (Rhogam) Intra Muscular at 28 weeks of gestation .