Topics of discussion

• What is Erythroblastosis Fetalis?

• What is Rh incompatibility?
• Signs of Rh incompatibility.
• Diagnostic tools.
• Prevention.
• Treatment.
 Definition

Erythroblastosis Fetalis is a hemolytic

anemia in the fetus or neonate, caused by
trans-placental transmission of maternal
antibodies to fetal RBCs. The disorder usually
results from incompatibility between maternal
and fetal blood groups, often Rh antigens.
 Types

• ABO incompatibility

• Rh incompatibility
 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.
• 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.
 Signs

Mother
• 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
• Hypotonia
• Mental retardation and hearing problems in
the long term
• Polyhydramnios
- Presence of excessive amniotic fluid
surrounding the fetus.
 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
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.
• 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.
- FBS is used to look at a fetus's red blood
cell count and oxygen level, and it also looks
for signs that your immune system is
destroying fetal red blood cells.
 Prevention

- Rh immune globulin
• 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.
• 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.
• 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.
 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
• 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
• 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 mother's immune system.
 This treatment meant to keep the fetus healthy
until he or she is mature enough to be delivered .
• 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 fetus's lungs before delivery is
scheduled.
• 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,