Hemolytic disease of newborn

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

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). 

Administer to Rh0(d)-negative mother within 72 h of Rh-positive delivery to prevent hemolytic disease of newborn in subsequent pregnancy. 

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. 

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

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. 

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

Favorable results of exchange transfusion in a variety of diseases in adults, for example sickle cell disease, severe clotting disorders, hepatic failure, and acute hemolytic transfusion reactions, have been published (1). Today, however, machine apheresis procedures are more effective and safer for patients requiring exchange of cellular elements or plasma. Exchange transfusion is the most effective therapeutic procedure in the treatment of hemolytic disease of the newborn. Bilirubin removal prevents damage to the central nervous system caused by hyperbilirubinemia. In addition, sensitized erythrocytes are replaced by normally surviving cells and anemia is corrected. 

Deficiency of glucose phosphate isomerase (GPI) has been associated with chronic hemolytic disease in a few dozen reported cases and may also cause hemolytic disease of the newborn. Although the third most frequently reported enzymopathy causing hemolytic disease, it has been quite rare in our experience. 

Grenache DG. Hemolytic disease of the newborn. In Gronowsld AM, ed. Handbook of clinical laboratory testing during pregnancy. Totowa, NJ Humana Press, 2004 219-43. 

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