1. UNIVERSIDAD AUTÓNOMA DE GUERRERO
UNIDAD ACÁDEMICA FACULTAD DE MEDICINA
ENGLISH CLASS: HEMOLYTIC DISEASE OF
NEWBORN
EQUIPO FISIOLOGÍA.
Mendoza McGinnis Gema Itzel
Villagómez Vélez Julio Andrés
Arzeta Serrano Laura Gabriela
Hernández Barrera Mario

2. Objectives
The student is expected to learn about clinical
symptoms, diagnosis, and treatment for hemolytic
newborn disease.
Reinforce everything learned in physiology class by
applying a case study.
Participate in a group dynamic to simplify the learning
experience.

3.  Antibodies - Anticuerpos
 Shortened - acortado
 Ocurring - ocurriendo
 Ag Glutination - Glutinacion antigenico
 Inmunogenic - Inmunogenico
 Involves - Involucrar

4.  Phagocytic - Fagocitico
 Binding -
 Fristloorn -
 Microspheocytes - Microfeoscitos.

8. Hemolytic disease of the new born and fetus
(HDN) is a destruction of the red blood
cells (RBCs) of the fetus and neonate by
antibodies produced by the mother
It is a condition in which the life span of the
fetal/neonatal red cells is shortened due to
maternal allo-antibodies against red cell
antigens acquired from the father

9. Antibodies
 Five classes of antibodies
 IgM
 IgG
 IgA
 IgD
 IgE
 Blood groups specific antibodies are
 IgG
 IgM and rarely
 IgA

10. Blood group antibodies
 Blood group antibodies can be classified as
 Naturally occurring and immune antibodies
 Depending on presensitization
 Complete and incomplete antibodies
 Depends on agglutination of saline suspended
red cells
 IgM is complete antibody; most naturally
occurring antibodies are complete and of IgM
class
 IgG is incomplete antibody

11. Antibodies of ABO system
 Anti- A
 Anti- B
 Anti- A1
 Anti- H

12. Antibodies of Rh system
 Naturally occurring
 Anti- E
 Occasionally anti-D and anti Cw
 Immune antibodies
 D antibodies are more immunogenic
 Other are anti c, E, e, C.
 Most common is anti- E
 After anti- D, anti- c is the common cause of HDN
(The vast majority of Rh antibodies are IgG and do not fix complement)

13. Complement
 Complements are series of proteins, present
in plasma as an inactive precursors
 When activated and react sequentially with
each other they mediate destruction of cells
and bacteria
 Complement activation involves two stages
 Opsonization
 Lytic stage

14. Complement
 Antibodies can fix complement and cause rapid
destruction of red cells
 Destruction depends on the amount of antibody
and complement
 In ABO- incompatible transfusion no surviving A
or B red cells can be seen after 1 hour of
transfusion
 Why?
 Remember naturally occurring Abs. are IgM and fix
complement mediating the hemolysis

15. Disease mechanism - HDN
 There is destruction of the RBCs of the
fetus by antibodies produced by mother
 If the fetal red cells contains the corresponding
antigen, then binding of antibody will occur to red
cells
 Coated RBCs are removed by
mononuclear phagocytic system

16. Neonatal
liver is immature and
unable to handle
bilirubin
Unconjugated
bilirubin
Conjugated
bilirubin
Coated red blood cell
are hemolysed in
spleen

17. Clinical features
 Less severe form
 Mild anemia
 Severe forms
 Icterus gravis neonatorum (Kernicterus)
 Intrauterine death
 Hydrops fetalis
 Oedematous, ascites, bulky swollen & friable
placenta
 Pathophysiology
 Extravascular hemolysis with extramedullary
erythropoiesis
 Hepatic and cardiac failure

18. Hemolytic disease of newborn HDN
BOFORE BIRTH
 Anemia (destruction of red cells)
 Heart failure
 Fetal death
AFTER BIRTH
 Anemia (destruction of red cells)
 Heart failure
 Build up of bilirubin
 Kernicterus
 Severe growth retardation

19. Rh HEMOLYTIC DISEASE OF
NEWBORN
 Antibodies against
 Anti-D and less commonly anti-c, anti-E
 Mother is the case of anti-D is Rh -ve
(negative)
 Firstborn infant is usually unaffected
 Sensitization of mother occurs
 During gestation
 At the time of birth
 All subsequent offspring inheriting D-antigen
will be affected in case of anti-D HDN

20. Pathogenesis
Fetomaternal Hemorrhage
Maternal Antibodies formed against Paternally derived
antigens
During subsequent pregnancy, placental passage of
maternal IgG antibodies
Maternal antibody attaches to fetal red blood cells
Fetal red blood cell hemolysis

22. Factors affecting immunization and
severity
 Antigenic exposure
 Host factors
 Antibody specificity
 Influence of ABO group
 ABO-incompatible Rh- positive cells will be hemolysed
before Rh antigen can be recognized by the mother’s
immune system

23. Diagnosis and Management
 Cooperation between
 Pregnant patient
 Obstetrician
 Her spouse
 Clinical laboratory

24. Diagnosis and Management contd.
 Intrauterine transfusion
 Zone II or III
 Cordocentesis blood sample Hb less than 10g/dl
 Ultrasound evidence of hydrops
 Early delivery
 Phototherapy
 Newborn transfusion
 Exchange transfusion
 Effects of transfusion
 Removal of bilirubin
 Removal of sensitized RBCs, and antibodies
 Suppression of incompatible erythropoiesis

25. Mechanism of action
 Administered antibodies will
bind the fetal Rh- positive cells
 Spleen captured these cells by
Fc-receptors
 Suppressor T cell response is
stimulated
 Spleen remove anti-D coated
red cells prior to contact with
antigen presenting cells
“antigen deviation”

26. ABO HEMOLYTIC DISEASE OF
NEW BORN
 For practical purpose, only group O
individuals make high titres IgG
 Anti-A and anti-B are predominantly IgM
 ABO antibodies are present in the sera of all
individuals whose RBCs lack the
corresponding antigens

27. ABO HDN contd.
 Signs and symptoms
 Two mechanism protects the fetus against anti-A and anti-B
 Relative weak A and B antigens o fetal red cells
 Widespread distribution of A & B antigen in fetal tissue diverting
antibodies away from fetal RBCs
 Anemia is most of the time mild
 ABO- HDN may be seen in the first pregnancy
 Laboratory findings
 Differ from Rh- HDN; microspherocytes are characteristic of ABO-
HDN
 Bilirubin peak is later; 1- 3 days after birth
 Collection of cord blood and testing eluates form red cells will
reveal anti-A or anti-B
 Treatment
 Group O donor blood for exchange transfusion which is rarely
required