For Medical Students

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2. Awal Mir M.Phil MLS
HEMOLYTIC DISEASE OF THE
NEWBORN

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Introduction:
 Hemolytic disease of the newborn (HDNB) is a
clincopathological entity characterized by hemolysis, jaundice,
anemia and hepatosplenomegaly
 HDNB denotes an immune hemolysis mediated by trans
placental transfer of IgG antibodies formed by the maternal
immune system against the antigens on the surface of the fetal
red cells which accidentally enter the maternal circulation
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HEMOLYTIC DISEASE OF NEWBORN

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Introduction:
 Accelerated red cell destruction stimulate increases
production of red cells ,many of which enter the
circulation prematurely as nucleated cells hence the term
“erythroblastosis fetalis”.
 Also called Hydrops fetalis as Severely affected fetuses
may develop generalized edema, called “Hydrops
fetalis”
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HEMOLYTIC DISEASE OF NEWBORN

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Types of HDN:
 Blood group incompatibility can cause HDN and types
depends on which type of blood group incompatible
1. ABO Hemolytic disease of new born (rare)
2. Rh Blood group hemolytic disease of new born (most
common)
3. Minor blood group can also causes HDN such as Kell,
Kidd and Duffy blood group system
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HEMOLYTIC DISEASE OF NEWBORN

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Pathophysiology:
 In the placenta, maternal and fetal circulations are separated
from each other by a semipermeable membrane
 Under physiological conditions there is virtually no trans
placental transfer of red cells between these two circulations
 At the time of delivery when vessels are ruptured, a small
amount of fetal blood (usually no more than 0.1 to 0.2 ml)
enters the maternal circulation 6
HEMOLYTIC DISEASE OF NEWBORN

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Pathophysiology:
 Similar transfer may take place at the time of abortion,
amniocentesis and other transabdominal manipulation
 This is of no consequence if there is no feto-maternal incompatibility
in any of the group systems between the fetus and the mother
 At times when mother is Rh negative and the fetus is Rh positive,
transplacental transfer of fetal red cells (Rh positive) to the maternal
circulation (Rh negative) can initiate an immunological process
which may have deleterious effects on subsequent pregnancies
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HEMOLYTIC DISEASE OF NEWBORN

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Pathophysiology:
 The first baby invariably escapes ‘un-hurt’ though he has
played his role as an inducer of immune response
 During the next incompatible pregnancy when fetal cells
enter the maternal circulation, a secondary response is
initiated with rapid, sustained and energetic production
of IgG type immune antibodies
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HEMOLYTIC DISEASE OF NEWBORN

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Pathophysiology:
 These sensitized red cells are destroyed by the RES of the
fetus and a chain of events is initiated
 Lead to hemolysis, jaundice hepatosplenomegaly
 Severity is depends on antigenic exposure, Host factors
and antibodies specificity
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HEMOLYTIC DISEASE OF NEWBORN

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Pathophysiology:
 In a group O mother with naturally occurring anti-A and
anti-B of the IgG subclass which can cross the placenta.
 HDN due to ABO incompatibility occurs when a group
O mother with IgG anti-A or IgG anti-B is carrying a
fetus of blood group A or blood group B respectively.
 The most common presentation of ABO HDN is jaundice
(un-conjugated hyperbilirubinaemia).
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HEMOLYTIC DISEASE OF NEWBORN

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HDN Pathophysiology

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HEMOLYTIC DISEASE OF NEWBORN

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Clinical Features:
Clinical spectrum of HDNB includes
 Anemia to hydrops fetalis, Hyperbilirubinemi,
Hepatosplenomegaly
 Postnatal problems include:
 Asphyxia (Unconsciousness)
 Pallor (due to anemia)
 Edema (hydrops, due to low serum albumin)
 Respiratory distress
 Coagulopathies (↓ platelets & clotting factors)
 Jaundice
 Kernicterus (bilirubin encephalopathy)
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HEMOLYTIC DISEASE OF NEWBORN

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HEMOLYTIC DISEASE OF NEWBORN

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Lab Diagnosis :
Cord blood parameters:
 Hemoglobin <16 g/dl
 High reticulocyte count
 Baby Rh D positive
 Direct Coomb’s test positive
 Indirect Coombs test may also be positive (depending upon the amount of
antibody transferred from the mother to the baby).
 Unconjugated hyperbilirubinemia
 Normoblastemia
 Polychromasia
 Spherocytosis
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HEMOLYTIC DISEASE OF NEWBORN

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Normoblastemia on peripheral blood :
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HEMOLYTIC DISEASE OF NEWBORN

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Lab Diagnosis :
Mother parameters:
 Rh blood group D negative
 Circulating anti-D antibodies in the serum
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HEMOLYTIC DISEASE OF NEWBORN

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Prevention:
 Prevention of active immunization
 Administration of corresponding RBC antibody (e.g anti-D)
 Use of high-titered Rh-Ig (Rhogam)
 Calculation of the dose
 Kleihauer test to evaluate volume of feto-maternal blood and
anti D dose calculation
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HEMOLYTIC DISEASE OF NEWBORN

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Kleihauer test :
 It is based on acid elution technique
 Fetal and maternal RBC have different response to KOH
solution
 Maternal cells (adult Hb ) get eluded leaving behind only
cell membrane and hence appear as swollen round large
“Ghost Cells “
 Normal fetal cells whose Hb remain unaltered hence
look as red refractile round cells due to HbF which resist
to acid solution (KoH)
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HEMOLYTIC DISEASE OF NEWBORN

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