Hd newborn

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Hd newborn

  1. 1. UNIVERSIDAD AUTÓNOMA DE GUERRERO UNIDAD ACÁDEMICA FACULTAD DE MEDICINA ENGLISH CLASS: HEMOLYTIC DISEASE OF NEWBORN EQUIPO FISIOLOGÍA.Mendoza McGinnis Gema ItzelVillagómez Vélez Julio AndrésArzeta Serrano Laura GabrielaHernández Barrera Mario
  2. 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. 3.  Antibodies - Anticuerpos Shortened - acortado Ocurring - ocurriendo Ag Glutination - Glutinacion antigenico Inmunogenic - Inmunogenico Involves - Involucrar
  4. 4.  Phagocytic - Fagocitico Binding - Fristloorn - Microspheocytes - Microfeoscitos.
  5. 5. 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 motherIt 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
  6. 6. Antibodies Five classes of antibodies  IgM  IgG  IgA  IgD  IgE Blood groups specific antibodies are  IgG  IgM and rarely  IgA
  7. 7. 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
  8. 8. Antibodies of ABO system Anti- A Anti- B Anti- A1 Anti- H
  9. 9. 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)
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. Neonatal liver is immature and unable to handle bilirubin Unconjugated bilirubin Conjugated bilirubinCoated red blood cell are hemolysed in spleen
  14. 14. 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
  15. 15. Hemolytic disease of newborn HDNBOFORE BIRTH Anemia (destruction of red cells) Heart failure Fetal deathAFTER BIRTH Anemia (destruction of red cells) Heart failure Build up of bilirubin Kernicterus Severe growth retardation
  16. 16. 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
  17. 17. Pathogenesis Fetomaternal HemorrhageMaternal 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
  18. 18. Factors affecting immunization andseverity 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
  19. 19. Diagnosis and Management Cooperation between  Pregnant patient  Obstetrician  Her spouse  Clinical laboratory
  20. 20. 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
  21. 21. 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”
  22. 22. 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
  23. 23. 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

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