Hemolytic disease

Describe how the Rh factor may lead to hemolytic disease of the newborn... 

Rh incompatibility may occur when an Rh negative mother carries an Rh-positive fetus. At the time of delivery, a small amount of the baby s Rh-positive blood may gain access to the maternal circulation. In response, the immune system of the mother produces anti-Rh antibodies. During the subsequent pregnancy, the fetus is exposed to these antibodies as they cross the placenta. If this fetus is also Rh-positive, then the anti-Rh antibodies attack the fetal erythrocytes and cause hemolytic disease of the newborn (erythroblastosis fetalis). This may occur in about 3% of second Rh-positive babies and about 10% of third Rh-positive babies. The incidence continues to increase with subsequent pregnancies. 

Suggested Alternatives for Differential Diagnosis African swine fever, salmonellosis, erysipelas, anticoagulant poisoning, and hemolytic disease of the newborn, porcine dermatitis and nephropathy syndrome and postweaning multisystemic wasting syndrome, pseudorabies, parvovirus, and border disease. 

BayRho-D Rh antigen on red blood Prevention of Rh hemolytic disease... 

Hemolytic disease of the newborn Rho(D) immune globulin Excellent... 

The thalassemias are hereditary hemolytic diseases in which an imbalance occurs in the synthesis of globin chains. As a group, they are the most common single gene disorders in humans. Normally, synthesis of the a- and p-globin chains are coordinated, so that each a-globin chain has a p-globin chain partner. This leads to the forma... 

Thalassemias are hereditary hemolytic diseases in which an imbalance occurs in the synthesis of either a or 3 globin chains. Each thalassemia can be classified as either a disorder in which no globin chains are produced (a0- or p°-thalassemia), or in which some chains are synthesized but at a reduced rate (a+- or p+-thalassemia). [Note In p-thalassemias, synthe sis of p globin chains is decreased or absent, whereas in a-thalassemias, synthesis of a globin chains is decreased or absent.]... 

Specific proteins can be covalently attached via a carbohydrate bridge to membrane-bound PI (glycosylphosphatidylinositol, or GPI). This allows GPI-anchored proteins rapid lateral mobility on the surface of the plasma membrane. A deficiency in the synthesis of GPI in hematopoietic cells results in a hemolytic disease, paroxysmal nocturnal hemoglobinuria. 

Contreas M, deSilva M. 1994. The prevention and management of the hemolytic disease of newborn. J Royal Soc Med. 87 256-258. 

Myasthenia is treated with cholinergic drugs, which actually have no influence on the course of the disease itself, or with therapeutic regimens such as thymectomy, corticosteroids, or immunosuppressive agents, which are intended to induce remission of the disease. Immunosuppressive agents are used in isoimmune disorders such as Rh hemolytic disease of the newborn. 

Type II hypersensitivity results from the formation of antigen-antibody complexes between foreign antigen and IgM or IgG immunoglobulins. One example of this type of hypersensitivity is a blood transfusion reaction that can occur if blood is not cross-matched properly. Preformed antibodies bind to red blood cell membrane antigens that activate the complement cascade, generating a membrane attack complex that destroys the transfused red blood cells. In hemolytic disease of the newborn, anti-Rh IgG antibodies produced by an Rh-negative mother cross the placenta, bind to red... 

Bilirubin is often present in the liquor amnii when the fetus is affected by hemolytic disease of the newborn (B5). Walker (Wl) examined fresh specimens of amniotic fluid before the 35th week and found that the presence of bilirubin correctly indicated the disease in 94.5 Jo of his afflicted cases. 

The toxic action of bilirubin on tissue metabolism has been demonstrated both by in vitro and in vivo experiments. Lathe (LI) added bilirubin to brain brei, in concentrations such as occur in hemolytic disease of the newborn and prematurity, and observed a decrease in oxygen consumption. Day (D3) was able to reverse this depressed respiration by the addition of cytochrome c or methylene blue. Bowen and Waters (B16) then showed that this reversal could also be efFected by diphosphopyridine nucleotide. Zetterstrom and Ernster (Zl), using isolated rat liver mitochondria, showed that bilirubin in concentrations... 

In a small proportion of cases of hemolytic disease of the newborn (inspissated bile syndrome), large amounts of conjugated bilirubin as well as free bilirubin accumulate in the plasma due to obstruction (J3, L2, S16). Conjugated bilirubin is apparently nontoxic to the brain so that exchange transfusions in such infants are indicated only if the free bilirubin and not the total bile pigment concentration is rising above 20 mg/100 ml plasma. 

J3. Jirsova, V., Jirsa, M., and Janovsky, M., Importance of the quantitative determination of direct and indirect bilirubin in hemolytic disease of newborn. Acta Tediat. 47, 179-186 (1958). 

Stempfel, R., Broman, B., Escardo, F., and Zetterstrom, R., Obstructive jaundice complicating hemolytic disease of the newborn. Pediatrics 17, 471-481 (1956). 

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