HDN HEMOLYTIC DISEASE OF THE NEWBORN

Katleen June P. Espejo

 Also

called Eryhroblastosis fetalis

It

is the destruction of the RBCs of the fetus and the neonate by IgG antibodies produced by the mother IgG antibodies are actively transported across the placenta

Only

 Can

cause kernicterus permanent damage to parts of the brain

pathogenesis:

hemolysis anemia erythropoeisis

RH HDN
Rh

negative mother and Rh positive child

Firstborn

is not yet affected because the mother is not yet immunized subsequent pregnacies fetal cells carrying Rh antigen immunize Rh negative mother and stimulate anti-D production severe

in

More

ABO HDN
ABO

incompatibility between the mother and newborn Mother is group O and the newborn is either A or B Firstborn maybe affected Manifested by onset of hyperbilirubinemia and jaundice w/n 12 to 48 hours

DIAGNOSIS AND MANAGEMENT

ABO and Rh Testing Antibody Screen Antibody Identification Anti-D, anti-K, anti-E, anti-c, anti-C and anti-Fya are the most significant antibodies that can cause HDN Amniocyte Testing Antibody Titers Saline antiglobulin Test 60 minute incubation at 37 degrees

DAT
It

is the most important serologic test for diagnosis of HDN. results indicate antibody is coating the infants RBCs. may be found in infants without clinical or other laboratory evidence o hemolysis (e.g., mother received RhIg)

Positive

It

RHIG (RH IMMUNE GLOBULIN)

Used

to prevent imunization to D antigen

It

is adminstered to the mother within 72 hours following delivery attaches to fetal Rh positive RBCs in maternal circulation that blocks immunization and production of anti-D

It

AMNIOCENTESIS
It s done to assess the status of the fetus It is done during 18 to 20 weeks gestation Bilirubin in amniotic fluid correlates with the extent of fetal anemia

CORDOCENTESIS
Umbilical vein is visualized at the level of the cord insertion into the placenta Fetal blood sample can be tested for hemoglobin, hematocrit,blood type, antigen phenotype and DAT.

INTRAUTERINE TRANSFUSION Injecting the RBC into the fetal peritoneal cavity where the RBC can be absorbed into the circulation

AIHA AUTOIMMUNE HEMOLYTIC ANEMIA

 Autoantibodies

Antibodies directed against the individuals own RBCs. They my agglutinate, sensitize or lyse RBC severity of the condition varies depending on the underlying cause e.g. cytomegalovirus, hepatitis, HIV and lupus.

SIGNS AND SYMPTOMS

Fatigue Dark urine Pallor Rapid heartbeat Irregular heartbeat Chest pain Dizziness High blood bilirubin levels Jaundice

Anemia Hemolytic anemia Increased reticulocyte count Asymptomatic in mild cases Low red blood cell count Hemoglobin in urine

DIAGNOSIS
1.

DAT Using polyspecific and monospecific antiglobulin reagents

2.

Characterization of the autoantibody detection and identification procedures

Cold reactive Autoantibodies Performed at 4C IgM immunoglobulins can activate complement in vitro. Anti-I, Anti-I, Anti-H

Warm Reactive Autoantibodies Best react at 37C IgG immunoglobulins

RBC hemolysis, Hemolytic anemia

PCH Idiopathic Cold AIHA CHD

DAT: positive

DAT: negative