Hemolytic Disease of the Newborn (HDN)

References

Diagnosis

Dulay, A. T. (2017). Erythroblastosis Fetalis - Gynecology and Obstetrics. Retrieved February 11, 2017, from http://www.merckmanuals.com/professional/ gynecology-and-obstetrics/abnormalities-of-pregnancy/erythroblastosis- fetalis

Grossman, S. C., & Porth, C. (2014). Porth's pathophysiology: concepts of altered health states (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Hemolytic Disease of the Newborn (HDN). (2017). Retrieved February 10, 2017, from https://www.urmc.rochester.edu/encyclopedia/content.aspx? ContentTypeID=90&ContentID=P02368

Hemolytic Disease of the Newborn [Photograph found in Intensive Care Nursery House Manual, University of California San Francisco Children's Hospital, San Francisco]. (n.d.). Retrieved February 11, 2017, from https:// www.ucsfbenioffchildrens.org/pdf/manuals/42_Hemol.pdf (Originally photographed 2004).

Stanford Children's Health. (2017). Retrieved February 11, 2017, from http:// www.stanfordchildrens.org/en/topic/default?id=hemolytic-disease-of-the- newborn-90-P02368

History/Physical:

Mother with Rh- blood

Father with Rh+ blood

Diagnosis/Lab Tests:

*A prenatal blood type test can be performed on mother

During Pregnancy:

• Blood testing of the mother for Rh+ antibodies
• Ultrasounds to see if there is any fetal organ enlargement or buildup of fluid
• Amniocentesis to test for levels of bilirubin
• Percutaneous umbilical cord testing for antibodies, bilirubin, and anemia
• Positive result can tell if the baby needs an intrauterine blood transfusion

Newborn Diagnosis:

• Test baby's umbilical cord for blood type, Rh factor, red blood cell count, and antibodies
• Blood test for levels of bilirubin

Treatment

After Birth:

• Blood transfusions
• IV Fluids
• Use of oxygen, surfactant, or mechanical breathing machine to reduce respiratory distress
• Replace damaged blood with an exchange blood transfusion
• IV immunoglobulins

When diagnosed during pregnancy:

• Intrauterine blood transfusion
• If the baby is mature enough, early delivery may be necessary to prevent declining health or status of disease

("Hemolytic Disease of the Newborn, 2017).

("Hemolytic Disease of the Newborn", 2017).

Pathogenesis

When an Rh negative mother comes in contact with the red blood cells of an Rh positive baby, through placental circulation, the mother attacks the foreign blood cells of the baby due to the development of anti Rh antibodies. The mother’s antibodies react with the Rh positive infant’s red cell antigens and results in agglutination and hemolysis.

Grossman &Porth, 2014).

Etiology

Hemolytic Disease of the Newborn

(HDN)

Etiology

Primary

HDN most commonly results from an Rh negative mother reproducing with an Rh positive father. The unborn child may be given the father's positive Rh factor, and in turn, will sensitize the mother to the Rh positive factor during the birthing process, prenatal tests, or during a fall or miscarriage.

Secondary

When an Rh negative mother is pregnant with an Rh positive baby, the mother's immune system sends antibodies to fight the positive Rh factor in the fetus that the antibodies recognize as foreign. This results in sensitization in the mother. When the mother’s immune system attacks the baby’s red blood cells, erythroblastosis fetalis occurs (the name applies to the infected fetus before it is born)This occurrence most usually happens when the placenta breaks away during birth. In a first pregnancy, the mixing of blood cells between mother and baby is inevitable, whether the mother chooses to have an abortion, or the baby does not make it to full term. When red blood cells are mixed, the Rh negative mother sees the baby’s Rh positive blood cells as foreign and the mother’s immune response is to rid of the foreign cells and begins developing anti-Rh antibodies. (“Hemolytic Disease of the Newborn,” 2017).

("Hemolytic Disease of the Newborn," 2017)

(Dulay, 2016).

Risk Factors

Primary

• Genetics
• Rh factors of parents
• Sensitized mother with anti-Rh antibodies (Grossman & Porth, 2014).

Secondary

• Caucasian baby
• Mother’s choice to have a second pregnancy with history of Rh positive baby
• Mother’s choice to receive vaccine Rh immunoglobulin (RhoGAM)
• After blood tests of the mother and father show Rh- mother and Rh+ father, if the mother does not get 2 vaccines, one during and one after her first pregnancy that stops sensitization of her body to the baby’s Rh+ blood
• Race
• Three times more common in Caucasian babies than African American babies

("Hemolytic Disease of the Newborn," 2017)

Clinical Manifestations

Symptoms

NOTE: During pregnancy, the mother will not notice any symptoms.

• After birth, a mother may notice pallor of the skin or a yellowing of the umbilical cord
• 24-36 hours after birth, it is possible to notice jaundice in the skin and/or the sclera of the eyes

("Hemolytic Disease of the Newborn", 2017).

Pathophysiology, Section 2, Group 13 Afton Phillips, Elizabeth Fleming Zimmerman, Alex Guyton, Sandya Lall, Austin Campitelli

Clinical Manifesations

Signs

• Fetal jaundice
• Indicated by yellow amniotic fluid caused by high levels of bilirubin, which can be tested with amniocentesis, or seen after birth
• Anemia
• Baby may have splenic rupture
• Enlargement of the heart, liver, or spleen caused by anemia
• Can be tested with ultrasound
• Hydrops Fetalis- can cause fluid buildup in the stomach, lungs or scalp
• Can be tested with an ultrasound
• Post natal signs in the newborn: asphyxia, pallor (from a decreased red blood cell count), respiratory distress, jaundice, hypoglycemia, pulmonary hypertension, edema, coagulopathies (a decreased platelets and clotting factors), kernicterus (resulting from hyperbilirubinemia), hepatosplenomegaly

("Hemolytic Disease of the Newborn", 2017 & UCSF).