What is the hemolytic disease of the newborn?

Hemolytic disease of the newborn:

Rhesus factor is a kind of protein occurring on the surface of red blood cells; every individual is born with either present (positive Rh type) or absent ( negative Rh type) Rh typing. Hemolytic disease is the blood disorder that occurs in newborn infants when the Rhesus factor (positive or negative ) in the blood group becomes incompatible between the mother and baby. Rhesus factor incompatibility occurs when an Rh-negative mother carries an Rh-positive fetus, causing hemolytic disease.

 

The immune system of the mother identifies the Rh-positive red blood cells of the fetus as a foreign body. It produces antibodies to destroy the red blood cells. In other words, hemolytic disease refers to the breakdown of red blood cells in infants, also referred to as erythroblastosis fetalis. (breaking down of red blood cells in the fetus)

The immune system thus keeps a memory of this encounter during the first pregnancy, and the mother becomes Rh-sensitized, thus making future pregnancies a high-risk option for the infant's blood cells to be destroyed by the sensitized Rh antibodies.


Symptoms:

During pregnancy, the symptoms may include:

  • Amniotic fluid may appear yellow and have traces of bilirubin.

  • An ultrasound test of the fetus may reveal an enlarged heart, liver, spleen, or fluid buildup in the abdomen.

After birth, the presenting symptoms may be:

  • The baby may develop jaundice within 24 to 36 hours after birth (yellowing of the skin)

  • A pale color may develop due to anemia 

  • The baby may develop swelling of the entire body (edema) and may have an enlarged spleen and liver

  • The baby may have difficulty breathing.


Diagnosis:

The accurate diagnosis of hemolytic disease depends upon determining the compatibility of the blood group and Rh factor between the mother and fetus. The diagnosis of hemolytic disease in the newborn can be done even during the pregnancy of the mother ( prenatal screening ), includes:

  1. Testing for the presence of Rh-positive antibodies in the blood of the mother

  2. Ultrasound test to detect organ enlargement

  3. Amniocentesis measures the amount of bilirubin in the blood

After the birth, certain diagnostic tests may be performed to diagnose the disease, including:

  1. Testing the blood from the umbilical cord of the baby to determine Rh factor and blood grouping

  2. Bilirubin levels of the baby

  3. A complete blood count may reveal the occurance of anemia and immature red blood cells


Treatment:

  1. Intrauterine blood transfusion: It involves the transfer of non-compatible Rh blood of the fetus with freshly compatible donor blood directly through the vein of the umbilical cord.

  2. Antibodies ( immunoglobulins) are given to prevent the red blood cells from being destroyed.

  3. Intravenous fluids for support therapy

  4. Drugs to raise blood pressure if it falls below

  5. Phototherapy uses blue lights to get rid of the bilirubin.


Prevention:

Women not sensitized to Rh antibodies can receive Rh immunoglobulin (RhoGAM). This injection is usually given around the 28th week of pregnancy and the next dose around 72 hours of childbirth. RhIg prevents the mother's immune system from producing antibodies against Rh-positive blood cells. Anti D 300mcg injection contains active components called Anti-Rh(D) immunoglobulin. It is a medication used to prevent Rh(D) hemolytic disease of the newborn (HDN).


Conclusion:

Hemolytic disease of a newborn is a serious condition that may lead to potential complications if not detected and treated early and properly. With advances in the screening methods and treatment options available, this condition can be treated effectively, and potential risks can be minimized and ensure a healthy lifestyle for the baby.

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