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4. hydrops fetalis; pedatric pathology

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4. hydrops fetalis; pedatric pathology

  1. 1. Pediatric Pathology Pediatric Pathology 1 Dr. Krishna Tadepalli, MD, www.mletips.com
  2. 2. 4. Hydrops Fetalis 4. Hydrops Fetalis 2 Dr. Krishna Tadepalli, MD, www.mletips.com
  3. 3. Fetal Hydrops • Accumulation edema fluid; Non-immune causes (CVS, Chromosomal and Fetal anemia) are MC; Hydrops fetalis = generalized edema; • Immune type • Nonimmune type • Three major causes – parvovirus B19 – α-thalassemia – cardiovascular defects, chromosomal anomalies, and fetal anemia 3 Dr. Krishna Tadepalli, MD, www.mletips.com
  4. 4. Fetal Hydrops • Accumulation edema fluid; Non-immune causes (CVS, Chromosomal and Fetal anemia) are MC; Hydrops fetalis = generalized edema; • Immune type 4 Dr. Krishna Tadepalli, MD, www.mletips.com
  5. 5. Fetal Hydrops • Immune type • • • • MC is Rh (mainly D Antigen) incompatibility between mother and fetus Incidence is decreased in urban societies ( why?) Factors influence immune response = – Concurrent ABO incompatibility protects – depends on the dose of immunizing antigen (> 1 ml of Rh-positive fetal red cells) – subsequent pregnancy has the risk Pathology – Anemia due to hemolysis (extramedullary hematopoiesis ) – Jaundice due to hemolysis ( unconjugated bilirubin)  kernicterus – hypoxic injury to the heart and liver cardiac decompensation and failure  generalized edema and anasarca 5 Dr. Krishna Tadepalli, MD, www.mletips.com
  6. 6. Fetal Hydrops • Nonimmune type (table-10.4) • • Three major causes (cardiovascular defects, chromosomal anomalies, and fetal anemia ;- α- thalassemia &parvovirus B19) Morphology – – – – stillborn, die within the first few days, or recover Pale fetus and placenta (due to fetal anemia) liver and spleen are enlarged ( due to congestion from cardiac failure) bone marrow hyperplasia of erythroid precursors & extramedullary hematopoiesis (compensatory) – Erythroblastosis fetalis =large numbers of immature red cells, including reticulocytes, normoblasts, and erythroblasts in peripheral circulation – blood bilirubin level greater than 20 mg/dL in term infants – Kernicterus =most serious; brain is enlarged and edematous and bright yellow in color; affects mainly basal ganglia, thalamus, cerebellum, cerebral gray matter, and spinal cord • • Clinical = vary with the severity of the disease from Hepatosplenomegaly to Kernicterus Rx = for mild cases -phototherapy (visual light oxidizes unconjugated bilirubin6) and total exchange transfusion for severe cases Dr. Krishna Tadepalli, MD, www.mletips.com
  7. 7. Hydrops Fetalis Hydrops Fetalis 7 Dr. Krishna Tadepalli, MD, www.mletips.com
  8. 8. Kernicterus Kernicterus 8 Dr. Krishna Tadepalli, MD, www.mletips.com
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