Haemolytic Disease of Newborn is a disease which cause destruction of the RBC of the fetus and newborn.
This can mainly cause by maternal antibodies.
- Only IgG antibodies involved.
- IgA or IgM antibodies are not involved.
- RBC defects can also cause HDN.
Pathophysiology of Haemolytic Disease of Newborn
When we look at how Haemolytic Disease of Newborn occur,we can simply describe it as follows.
Most of the times transfer of maternal antibodies is good,but sometimes transfer of RBC anibodies may result in HDN.Most oftenly antigens of the the Rh and ABO blood group involved in HDN, but also can result from any blood group system.This can happen when fetus is POSITIVE for an antigen(inherited from father) and the mother is NEGATIVE for the same antigen.
What happen in HDN cases?
When maternal IgG crosses the placenta and attaches to antigens on fetal cells,the senitized cells are removed by the spleen.This RBC destruction depends on various factors of RBC and antibodies.RBC destruction and anaemia cause bone marrow to release erythroblasts to blood stream.When erythroblasts are used up in the bone marrow ,erythropoiesis in the spleen and liver also get increased.This can lead to
- High billirubin levels and jaundice.
High billirubin levels and Jaundice in Haemolytic Disease of Newborn
Haemoglobin is metabolised to billirubin inside human body.Before birth,”indirect” billirubin is transported across the placenta and conjugated in maternal liver(“direct billirubin”) and it is excreted.But after birth,the new born baby’s liver is unable to conjugate the billirubin.So the unconjugated billirubin can reach toxic levels and kernicterus may result,leading to permanant brain damage.
Diagnosis and Management of HDN
Antinatal testings can be done to,
- Identify pregnancies at risk of fetal and neonatal haemolytic disease.
- To identify women who need anti D prophylaxis.
- To provide compatible blood promply to the newborn and mother when required.
There are some purposes of follow up tests when red cell antibodies are present.One is to identify fetus requiring treatment before term.Another purpose is to predict infants likely to require treatment for HDN post delivery and to identify additional red cell antibody during the course of pregnancy.
Treatments for Haemolytic Disease of Newborn
There are some treatments for HDN(Haemolytic Disease of Newborn).
- Intrauterine blood transfusion.
- Early delivery.
- This can be done after birth.Change of unconjugated billirubin to biliverdin occur in this procedure.This may avoid the need for exchange transfusion.
- Newborn transfusion.
- This can be done by Exchange transfusion or by giving small aliquots of blood.
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