CLINICAL IMMUNOHAEMATOLOGY

PRACTICUM II
SBD 0173

ASSIGNMENT II
(HAEMOLYTIC DISEASE OF
NEWBORN)

NAME: MUHAMMAD KHAIRUL NIZAM

KHAIRUDDIN

MATRIX NO: 012008050535

GROUP: A

PROGRAMME: DIPLOMA IN MEDICAL LAB TECH.

LECTURER: MISS MOLLIE KIPAU

HAEMOLYTIC DISEASE OF NEWBORN

(HDN)

Mechanism

1. Fetus inherits blood group antigens (usually Rh D antigen or ABO antigens) from the
father that are foreign to the mother.
2. Fetal blood gets into mom’s circulation (either during last trimester of pregnancy,
when cytotrophoblast is no longer present, or during childbirth).
3. Mom makes antibodies to these blood group antigens.
4. Antibodies cross the placenta, attack baby’s red cells, causing hemolytic anemia and
its consequences.

The consequences of hemolysis are numerous. One such consequence is extramedullary

hematopoiesis. If the anemia is mild, extramedullary hematopoiesis in the liver and spleen
may produce enough red cells to maintain normal numbers.

Other consequences are not so happy. If the anemia is severe, the heart and liver may
suffer hypoxic injury, resulting in circulatory and hepatic failure. Liver failure causes
decreased protein levels (proteins are synthesized in the liver) and a reduction in oncotic
pressure in the circulation. Heart failure causes an increase in venous pressure (blood is
backing up behind the failing heart). If severe enough, the combination of reduced oncotic
pressure and increased venous pressure leads to generalized edema and ascites, a condition
called hydrops fetalis, which can be fatal. Lesser degrees of edema can also occur.

If hemolysis is severe, jaundice can occur due to accumulation of unconjugated

bilirubin. Unconjugated bilirubin is water insoluble; it binds to lipids in the brain which the
blood-brain barrier in the fetus is poorly developed, causing serious damage to the CNS,
termed kernicterus. The affected brain is enlarged, edematous, and yellow.
Causes of HDN

HDN most frequently occurs when an Rh negative mother has a baby with an Rh positive
father. When the baby's Rh factor is positive, like the father's, problems can develop if the
baby's red blood cells cross to the Rh negative mother. This usually happens at delivery when
the placenta detaches. However, it may also happen anytime blood cells of the two
circulations mix, such as during a miscarriage or abortion, with a fall, or during an invasive
prenatal testing procedure.
 
The mother's immune system sees the baby's Rh positive red blood cells as foreign. Just as
when bacteria invade the body, the immune system responds by developing antibodies to
fight and destroy these foreign cells. The mother's immune system then keeps the antibodies
in case the foreign cells appear again, even in a future pregnancy. The mother is now Rh
sensitized.
 
Although it is not as common, a similar problem of incompatibility may happen between the
blood types (A, B, O, AB) of the mother and baby in the following situations:

Mother's Blood Type O A B

Baby's Blood Type A or B B A

 
In a first pregnancy, Rh sensitization is not likely. Usually it only becomes a problem in a
future pregnancy with another Rh positive baby. During that pregnancy, the mother's
antibodies cross the placenta to fight the Rh positive cells in the baby's body. As the
antibodies destroy the red blood cells, the baby can become sick. This is called
erythroblastosis fetalis during pregnancy. In the newborn, the condition is called hemolytic
disease of the newborn.
Ways to overcome HDN

During pregnancy, treatments for HDN are:

 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. It may be necessary
to give a sedative medication to keep the baby from moving. Intrauterine transfusions
may need to be repeated.

 early delivery if the fetus develops complications

If the fetus has mature lungs, labor and delivery may be induced to prevent worsening
of HDN.

After birth, treatments are:

 blood transfusions (for severe anemia)

 intravenous fluids (for low blood pressure)

 help for respiratory distress using oxygen or a mechanical breathing machine

 exchange transfusion to replace the baby's damaged blood with fresh blood
The exchange transfusion helps increase the red blood cell count and lower the levels
of bilirubin. An exchange transfusion is done by alternating giving and withdrawing
blood in small amounts through a vein or artery. Exchange transfusions may need to
be repeated if the bilirubin levels remain high.

Also include if rhesus-negative mothers who have had a pregnancy with/are pregnant with a
rhesus-positive infant are given Rh immune globulin (RhIG) at 28 weeks during pregnancy
and within 72 hours after delivery to prevent sensitization to the D antigen. It works by
binding any fetal red cells with the D antigen before the mother is able to produce an immune
response and form anti-D IgG.

Reference:

1. http://www.pathologystudent.com/?p=1521
2. http://www.ucsfchildrenshospital.org/pdf/manuals/42_Hemol.pdf