Isoimmunization disease

Intrauterine growth retardation and anomalies of the fetal urinary tract, such as bilateral renal agenesis or obstruction of the urethra, are associated with oligohydramnios, an abnormally low amniotic fluid volume. Increased fluid volume is known as hydramnios (also termed polyhydramnios). Conditions associated with hydramnios are as diverse as maternal diabetes mellitus, severe Rli isoimmune disease, fetal esophageal atresia, multifetal pregnancy, anencephaly, and spina bifida. 

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. 

The pathophysiology of isoimmune hemolysis is the same for all antigens. The differences in severity of disease are due to differences in the expression of the antigen on the surface of the cells, the intrinsic immunogenicity of the antigen, and peculiarities of the immune response of the mother. Destruction of the fetal erythrocytes, which is the central problem, produces several other problems. Fetal anemia imposes an extra burden on the fetal heart to provide adequate oxygen supply to fetal tissues. Anemia stimulates the fetal marrow and extramedullary erythropoiesis in the liver and spleen to replace the destroyed erythrocytes. Extramedullary erythropoiesis destroys hepatocytes and leads to decreased production of serum albumin and decreased oncotic pressure in tire intravascular space. 

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