Erythroblastosis fetalis

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Erythroblastosis fetalis

  1. 1. Topics of discussion• What is Erythroblastosis Fetalis?• What is Rh incompatibility?• Signs of Rh incompatibility.• Diagnostic tools.• Prevention.• Treatment.
  2. 2. Definition Erythroblastosis Fetalis is a hemolyticanemia in the fetus or neonate, caused bytrans-placental transmission of maternalantibodies to fetal RBCs. The disorder usuallyresults from incompatibility between maternaland fetal blood groups, often Rh antigens.
  3. 3. Types• ABO incompatibility• Rh incompatibility
  4. 4. Rh incompatibility• Mother Rh-Positive & fetus Rh-Negative.• RBCs from the fetus can go into the mother’s bloodstream through the placenta.• Rh-Negative mother’s immune system treats the Rh-Positive fetal cells as a foreign substance and makes antibodies against them.• These anti-Rh antibodies may cross the placenta into the fetus, where they destroy the fetus’s circulation red blood cells.
  5. 5. • First-born infants are often not affected unless the mother has had previous mis-carriages or abortions, which could have sensitized her system for developing antibodies.
  6. 6. SignsMother• Polyhydramnios in mother.Baby• Pallor ++• Hepatosplenomegaly – signifying active haemolysis• Jaundice MAY NOT be there at birth – since the mother’s kidney will take out the excess bilirubin – Jaundice develops in the next few hours of delivery
  7. 7. • Hypotonia• Mental retardation and hearing problems in the long term
  8. 8. • Polyhydramnios - Presence of excessive amniotic fluid surrounding the fetus.
  9. 9. Exams and Tests• A positive Coombs’ Test result – Direct and Indirect Coomb’s test• Fetal Blood Sampling ( FBS ) for Rh sensitization during pregnancy.• A high Level of bilirubin in the baby’s cord blood
  10. 10. Coombs’ Test: The Coombs’ test looks for antibodies that may bind to fetal blood cells and causes premature RBC destruction ( hemolysis).Indirect Coomb’s test (Mother)- for unbound circulating antibodies against red blood cells & used to determined if the person have a reaction to blood transfusion.Direct Coombs’ test (Baby) - to detect antibodies that are already bound to the surface of red blood cells in the baby.
  11. 11. • Fetal Blood Sampling ( FBS ) for Rh sensitization - Directly from the umbilical cord or fetus. - Tested for signs of anemia. - FBS is also known as cordocentesis or percutaneous umbilical cord blood sampling.
  12. 12. - FBS is used to look at a fetuss red bloodcell count and oxygen level, and it also looksfor signs that your immune system isdestroying fetal red blood cells.
  13. 13. Prevention- Rh immune globulin
  14. 14. • Rh immune globulin contains antibodies to the Rh factor in blood.• The antibodies come from mother’s blood stream had been sensitized to Rh factor.• Giving these Rh antibodies to an Rh-Negative pregnant woman prevent her immune system from producing its own anti-Rh antibodies, which would attack the Rh-Positive red blood cells of the fetus.
  15. 15. • Given to all Rh-Negative women who may be carrying an Rh-Positive fetus.• It cannot prevent damage to an Rh-Positive fetus if their mother is already sensitized to Rh factor.
  16. 16. • Rh immune globulin should be given to an Rh-negative woman to prevent sensitization :1. After amniocentesis, fetal blood sampling or CVS..2. When bleeding occurs in the second or third trimester of pregnancy.3. At 28 weeks of pregnancy.4. After an external cephalic version of a breech fetus.5. After abdominal trauma during pregnancy.6. Within 72 hours after delivery of an Rh-positive infant.7. After a threatened or complete miscarriage, or an induced abortion.8. Before or immediately after treatment for ectopic pregnancy or a partial molar pregnancy.
  17. 17. Treatment• Affected baby should be treated with: – Aggressive hydration – Early Phototherapy – Early Exchange transfusion if required • Removes Bilirubin • Removes antibodies • Removes sensitised cells which are liable to be haemolysed • Replaces the RBC numbers – haemolysed
  18. 18. • Antenatal Management – Mother’s titres Positivity / rise in titres – Giving Anti D to the mother – Amniotic fluid bilirubin levels (Lilleys charts) to look at early delivery – Foetal transfusion to prevent onset of severe anaemia and cardiac failure – Hydrops foetalis
  19. 19. • Fetal Blood Transfusion - Transfusions can be given through the fetal umbilical veinAn intrauterine transfusion provides blood to Rh- positive fetus when fetal red blood cells are being destroyed by Rh antibodies.A blood transfusion is given to replace fetal red blood cells that are being destroyed by the Rh- sensitized mothers immune system. This treatment meant to keep the fetus healthy until he or she is mature enough to be delivered .
  20. 20. • In a severely affected fetus, transfusions are done every 1 to 4 weeks until the fetus is mature enough to be delivered safely.• Amniocentesis may be done to determine the maturity of the fetuss lungs before delivery is scheduled.
  21. 21. • Hypotonia ( floppy infants ) - Decreased muscle tone. - Floppy & feels like a “rag doll” when held. - Their elbows and knees are loosely extended, while infants with normal tone tend to have flexed elbows and knees. - Head control may be poor or absent, with the head falling to the side, backward/forward,

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