Hemolytic disease of the fetus and

newborn (HDN)
 INTRODUCTION
• Hemolytic disease of the fetus and newborn
(HDFN) : also known as erythroblastosis fetalis
is an anemic condition in neonates and fetus.
• This is a condition where maternal antibody
crosses the placental barrier and sensitizes the
fetal red blood cells.
• The fetus or neonate destroys these antibody
coated cells. The red cell destruction produces
a clinical condition with severity on continuum
from mild anemia to death of the infant.
 MECHANISM FOR HDFN
• During pregnancy, the mother’s body, as well
as the body of the developing fetus, is not
static or without interaction.
• the placenta is a multi-purpose organ that
creates a barrier between mother and infant.
The organ also functions to exchange oxygen,
nutrients, and waste.
• Passage of fetal cells most often occurs at the
time of separation of the placenta from the
uterine wall.
• Whether fetal cells cross the placenta during
the pregnancy or at the time of delivery, they
may stimulate antibody production by the
mother.
• the antibody is IgG, in nature, it has the ability
to cross the placenta.
• If the antibody is produced during an existing
pregnancy, it may not have a significant effect
on the in utero fetus, but will impact a
subsequent pregnancy with an antigen
positive fetus.
• The antibody may also be a naturally
occurring antibody, such as anti-A.
• The most common scenario for ABO hemolytic
disease is a group O mother and a group A
infant, although other combinations of
maternal and infant blood groups may also
result in HDFN.
• The antibodies cross the placenta and attach
to the red cells of the infant if the
corresponding antigen is present.
 Rh HDFN
• Typically, the antibody develops as a result of
the first (or a previous) pregnancy.
• The newly developed antibody will rarely have
effects during the initial pregnancy.
• Regardless of the origin of the antibody, while
the fetus is in utero the antibody may cross
the placenta and attach to the corresponding
antigens on the red blood cells of the fetus.
• Red blood cell destruction occurs in the liver
and spleen of the fetus.
• ABO HDFN is the most common, while Rh
hemolytic disease is usually the most severe.
ABO HDFN may affect a first pregnancy
whereas Rh HDFN is rarely exhibited in the
initial pregnancy.
• HDFN caused by other antibodies is
uncommon, but may be severe. Causative
antibodies, other than ABO antibodies and
anti-RhD.
• In subsequent pregnancies with Rh positive
infants, the antibody crosses the placenta and
binds to the Rh positive red cells.
• The fetus may require transfusion in utero or
treatment may not be required until the
postpartum period.
• Exchange transfusion may be instituted if the
bilirubin levels rise to critical levels may be
necessary.
• Potential for Rh HDFN is determined by testing
all expectant mothers. ABO, Rh, and antibody
screen testing are performed.
• Typically, the antibody develops as a result of
the first (or a previous) pregnancy.
• The newly developed antibody will rarely have
effects during the initial pregnancy.
 diagnosis
• Heamolytic disease of the newborn
characterize by one or more of following
clinical presentations :
• Rapidly progressive sever hyperbilirubinemia.
• Diagnosis of anaemia.
• Direct antiglobulin test (coombs test).
• Blood film finding (heamolysis).