Francisco Frances Lorraine R.

Immunohematology
17-2-00897 Ms. KATELYN JOY DAÑO

Hemolytic Diseases of the Fetus and Newborn

Pathophysiology

Maternal alloantibodies cross the placenta, enter the fetal circulation and cause hemolysis. Depending on
severity, hemolysis can lead to bilirubin in amniotic fluid, fetal anemia and hydrops fetalis.

Alloimmnunization via
 Previous transfusion
 Previous pregnancy
 Current pregnancy (CVS, amniocentesis, trauma, spontaneous/elective abortion

Severity of disease determined by

 IgG subclass
 Amount of antibody
 Number of antigenic sites on red cells

Etiology

ABO HDFN - Leading cause of HDFN. Usually group O mom and group A or B child. Unlike other groups, O
patients have IgG (antiA,B antibody) that crosses the placenta into fetal circulation – Since these ABO antibodies are
naturally occurring, interaction can occur during the first pregnancy. Hemolysis is very mild since fetal/neonatal RBC’s
only have weak ABO antigen expression. HDFN due to Kell is the most common cause of severe HDFN followed by anti-c
– Kell is present on fetal RBC’s, unlike other antigens. Classic HDFN is caused by anti-D antibodies which is usually not
seen in first pregnancy.

Diagnosis

Titers less than 1:16 have very low risk of hemolysis. Titers greater than 1:16 warrant monitoring for fetal
hemolysis. Indications for RhIG D- woman with a D+ or D-unknown fetus – Ppx= 300 μg (full vial) at 28 wks and at term –
Fetomaternal hemorrhage of unknown qty (ectopic, amnio, CVS)= 50 μg (small vial) in first 12 wks of gestation and 300
μg (full vial) after 12 wks

Prevention

D- women should be checked for anti-D ab:

– If she does not have anti-D antibodies, give prophylactic doses of RhIg at 28 weeks gestation and anytime there is
fetomaternal hemorrhage
– If she does have anti-D antibodies, maternal antibody titer is determined; if titer is high,
monitor fetal hemolysis -- intrauterine transfusion or early delivery may be necessary