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Haemolytic disease of the newborn

Extracted from Mayes' Midwifery 14th edition (2011) Sue Macdonald, Julia Magill-Cuerden (Eds). London; Baillere Tindall: 2011. Courtesy Elsevier

Haemolytic disease of the newborn (HDN) is the immune-mediated red cell breakdown that occurs in rhesus disease and ABO incompatibility (not to be confused with haemorrhagic disease of the newborn - vitamin K deficiency bleeding). The majority of HDN is caused by rhesus D antigen, which can cross the placenta and attach to fetal red blood cells, which are then destroyed by the fetus' immune system (haemolysis), resulting in anaemia, hyperbilirubonaemia and excessive erythroid tissue in the liver, spleen, bone marrow, skin and placenta. In severe cases, multi-organ failure may occur.

HDN is much less common since the introduction of anti-D prophylaxis.

Antenatally, the first indication of HDN is the presence of anti-D antibodies in the mother's blood (See Coombs Test). Routine ultrasound may detect hydrops fetalis or polyhydramnios.

Fetal blood sampling should be considered if a Doppler scan of the middle cerebral artery suggests anaemia. If confirmed, management is by transfusion via the umbilical vein.

Infants born to alloimmunised mothers may appear clinically normal in mild cases, but should be monitored closely for signs of late anaemia due to ongoing haemolysis. Signs and symptoms include lethargy, pallor and poor feeding history. It is not unusual for a baby to develop a severe anaemia requiring blood transfusion.

Further reading

Waggle S. (2016) Hemolytic disease of newborn. Medscape. Available at: http://emedicine.medscape.com/article/974349-overview

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