Hemolytic anemia is a disorder in which red blood cells are destroyed faster than they can be made. The destruction of red blood cells is called hemolysis. Red blood cells carry oxygen to all parts of your body. If you have a lower than normal amount of red blood cells, you have anemia. When you have anemia, your blood can’t bring enough oxygen to all your tissues and organs. Without enough oxygen, your body can’t work as well as it should. Hemolytic anemia can be inherited or acquired:

1. Sabratha University
Faculty of Medical Technology- Surman
BLOOD BANK
Fourth Year Laboratory Medicine
2018
Monia

2. HAEMOLYTIC DISEASE OF THE
NEW BORN (HDN)

3. Hemolytic disease of newborn
• It is destruction of the red blood cells (RBCs)
of the fetus and neonate by antibodies
produced by the mother
(the ability of bone marrow to erythropoiesis is
unimpaired)
• Causes of HDN:
i. Rh incompatibility (Anti D most common).
ii. ABO incompatibility.
iii. Other system Antibody incompatibility.

4. Hemolytic disease of newborn

5. Rh incompatibility
Mechanism
• 1st pregnancy
– mother is Rh- and fetus is Rh+
– mother is exposed to fetal blood at some point during
pregnancy or delivery and generates anti-Rh (IgG)
antibodies
• 2nd pregnancy
– mother is Rh- and fetus is Rh+
– maternal anti-Rh IgGs cross the placenta and attach to
fetal RBCs
– fetal splenic macrophages phagocytose IgG coated
RBCs

6. ABO incompatibility
• mother has blood type O and the fetus has
blood type A or B or AB
• Group O individuals have (Anti-A,B and anti-
A and anti-B) in their plasma, fetal RBCs
attacked by mother’s antibodies.

7. Other system Antibody
incompatibility
Other Rh antibody
anti c (third most common form of severe HDN)
anti E (mild disease)
anti e, anti C (rare)
Other Minor blood group antigens
kell (anti K), kidd, Duffy
Anti K (second most common form of severe HDN )

8. Clinical Presentation
Clinical features are varies from mild to sever disease
BOFORE BIRTH
• Anemia (destruction of red cells)
• Hydrops
• Heart failure
• Fetal death
AFTER BIRTH
• Jaundice
• Anemia (hypoxia) and Pallor
• Edema
• Kernicterus (yellow collering of brain tissue)
• Hepatosplenomegaly
• Resoiratory distress
• Islet cell hyperplasia

9. Laboratory Findings
 Blood grouping
• Mother: Rh Negative
• Father: Rh Positive
• Baby: Rh Positive
 Direct Coombs test: Positive in baby
 Indirect Coombs test: Positive in mother
 Biochemical test
• Hyperbilirubinemia
• Hypoalbuminemia
• LDH: Increase
• Haptoglobin Decrease

10. Management
Phototherapy for neonate with mild
jaundice
Exchange transfusion in Severe cases

11. Prevention of Rh D
alloimmunization
• Give anti-D globulin to Rh negative mothers
during 72 hours after delivery.
• anti-D globulin hemolyzes fetal RBCs that
enter maternal circulation before an immune
reaction can be mounted against the Rh
antigen
• prevents formation of anti-Rh IgG in mother

12. Rh(D) sensitization

13. anti-D globulin
It is concentrated
solution of human IgG
containing a high titre
of antibodies against
Rho (D) antigen of the
red cell
Dose
• 500 units IM injected