Brief History

     It is believed that a written description of hemolytic disease of the newborn was first recorded by Hippocrates.  This is due to the fact that this disease can be historically viewed in three pathological states, fetal hydrops, neonatal jaundice, and fetal anemia.  Hippocrates mentioned the state of a particular newborn as is directly characterized by fetal hydrops.
     There is also a record of this disease in 1609 in a set of twins who had been delivered by a French midwife.  The twin that was born first died during birth, and was described to be swollen throughout his whole body, which would later be diagnosed as edema.  Meanwhile, the second twin survived for only a couple days after birth, and was described as having unusually yellow skin, which is now known to be jaundice.
     There had been descriptions of neonatal jaundice since the previously mentioned case with the set of twins, but a connection was not made between this symptom and hydrops until 1921.  It was through this connection that later led to the discovery that both symptoms were most likely to be caused by the a common pathogenesis.
     A study had been conducted on anemia in 1919 on a family into which a newborn had been born, but had died due to neonatal jaundice.  Blood samples were then taken and discovered that the condition in which both jaundice and anemia were present was caused by a problem with the red blood cells.
     In 1933, a family was found where all three forms of fetal hydrops, neonatal jaundice, and anemia had been found.  Further hematological studies showed that the presence of all three were once again a result of one common cause.  It was in this study that kernicterus was discovered to usually accompany jaundice.

-Teresa

Treatment

Treatment varies between the two types of complications of Erythroblastosis fetalis.

ABO incompatibility:

• Antihistamines are used to treat allergic reactions
• Steroids are used for swelling
• Intravenous fluid may be required
• Medicine can be used to raise a dropping blood pressure

ABO incompatibility often creates life threatening symptoms. If these precautions aren't taken the patient will die.

RH incompatibility:

• Hydration, a newborn with Rh incompatibility needs to be rehydrated

• Infants are given Phototherapy. Phototherapy is essential to reverse neonatal jaundice. Bilirubin lights are used to breakdown the heme in hemoglobin. This substance is then excreted through the baby's stool and urine.

 Drug Treatment:
Thanks to the drug RhoGAM, Rh incompatibility fatality has dropped dramatically. RhoGAM blocks the mother's immune response from affecting the fetus. The shot is given at 28 weeks during pregnancy then again within 72 hours of the child's birth.

Transfusion:
In some cases of Rh incompatiblity it's necessary to preform a blood transfusion. This can be done via intrauterine transfusion, or shortly after birth. The fetus or newborn is given blood to replenish cells lost to the mother's antibodies. The picture below shows an exchange transfusion, where donor blood is given and the "waste" blood is removed. Leaving the newborn with healthy red blood cells free of the mother's antibodies.

-Ashton

Symptoms

In addition to the obvious symptom of the newborn's blood type being different from that of the mother's, some other symptoms detectable in the newborn include:

• Anemia:  In both forms, ABO and Rh incompatibilities, anemia is caused by the mother's lingering antibodies that destroys the newborn's red blood cells faster than is normal.  This also usually causes the skin to be unusually pale.
• Hyperbilirubinemia:  The increased production and presence of bilirubin from the rapid destruction of red blood cells that eventually damages the liver.
• Enlarged liver:  This is caused by the damage done to the liver by hyperbilirubinemia.
• Enlarged spleen
• Kernicterus:  The symptom is also caused by excess bilirubin, but is considered to be the most severe form of hyperbilirubinemia.  This buildup of bilirubin is found in the brain, however, and can lead to more serious problems such as deafness, seizures, brain damage, and even death.
• Hydrops fetalis:  This is a severe form of Rh incompatibility, where it is marked by the buildup of fluid in the areas around the fetus' liver, spleen, heart, lungs, and/or abdomen, as well as an unusually high concentration of amniotic fluid and an enlarged placenta.
• Edema:  This is characterized by the swelling of a newborn's entire body, usually in conjuction with the presence of Hydrops fetalis.
• Jaundice:  Increased levels of bilirubin causes the yellowing of the newborn's umbilical cord and amniotic fluid, but is most evident in the skin and eyes.

-Teresa

Less Common Form: Rh Incompatibility

     The less common form of Erythroblastosis fetalis is Rh incompatibility.  This is similar to what happens in ABO incompatibility, but the mother's blood type is Rh-negative, while the fetus' blood type is Rh-positive.  As in the other form, the mother's antigens produces antibodies as an immune system reaction to the foreign blood type of the fetus, thus attempting to expel the fetus from the mother's body.  The anti-Rh antibodies produced by the mother would then cross into placental membrane and into the fetus' bloodstream, where they would result in the increased production of bilirubin.  Once again, as in ABO incompatibility, increased levels of bilirubin in a newborn could eventually lead to newborn jaundice.
     However, unless the mother has had previous pregnancies that had ended in either miscarriages or abortions, the firstborns are not affected by this disease.  It seems that time is needed for the mother's body to produce the anti-Rh antibodies sensitive enough to attack the fetus' Rh-positive blood type.  Following pregnancies with fetal blood type of Rh-positive would induce Rh incompatibility.

-Teresa

Most Common Form: ABO Incompatibility

     ABO incompatibility is the most common form of Erythroblastosis fetalis found.  This happens if the fetus has blood type A and/or B while the mother's is type O.  Antigens found on the blood cells trigger the immune system to produce antibodies to fight a foreign blood type if different blood types come into contact with each other.  The blood of a fetus and that of the mother's usually do not come into contact, but there can be instances where they do, as in times of birth.  With ABO incompatibility, the mother's antibodies produced by the blood cells' antigens will try and expel the foreign blood type of the fetus' out of the mother's body.
     These antibodies of the mother that pass across the placental membrane could enter the newborn's bloodstream and result in the destruction of some red blood cells.  This process produces more bilirubin within the newborn and which in turn could lead to newborn jaundice.

-Teresa

Blood Typing!

There a four blood-types, A, B, AB, and O. Blood type is determined by the types of proteins called antigens that are found on the red blood cell's surface. These antigens are genetically inheritable, so our blood type is directly influenced by the blood type of our parents.  They were  In addition to these main types is the Rh factor, or the Rhesus monkey factor. Blood is typed as either Rh negative or Rh positive. Having the antigen for Rh factor is deemed Rh positive,  lacking the antigen is considered Rh negative. When a mother is Rh negative and her mate is Rh positive, their chances of producing an Rh positive baby increases. This increases the incidence of Erythroblastosis and complications.

It is Important to know ones blood type. It can be determined in a doctor's visit using ABO typing. Blood is taken from a vein using a needle and put into a tube. Blood serum (no cells) is mixed with blood that is type A or B. If anti B antigens are produced the blood type is type A, if anti A antigens are produced the blood type is B, and if both are produced the blood mix sample would be type AB.

 

The above image is what a blood sample will look like after the serum is applied. Unlike type A, B, or AB, O is absent of distinguishable proteins.

-Ashton

Darwin's Principles and E.B fetalis

Darwin proposed a group of principles.


Smoke Detector Effect
 The body perceives threat of infection and takes action.
The mother's body uses the smoke detector principle when it produces antibodies against the unborn child's blood-type. The body believes the presence of the fetus is an invasion, and prepares to get rid of this threat.

Defenses
 The body uses actions like coughing and sneezing to attempt to get rid of infection.
In the case of Erythroblastosis fetalis a miscarriage would be an example of the body's way of ridding what it sees as a potential threat. 

Desires 
The need to procreate often outweighs the risk for disease. Early humans with no knowledge of blood type would have procreated without regard to possible diseases. In early cases of Erythroblastosis fetalis the cause was a mystery. After failed pregnancies couples were more likely to try again, continuing the cycle of the disease.

-Ashton

What Is Erythroblastosis Fetalis?

Erythroblastosis fetalis or Hemolytic disease of the newborn is a blood disorder. Problems occur when  an Rh positive mother becomes pregnant with an Rh negative fetus. The mother's body recognizes the fetus as a foreign object and  will most likely produce antibodies against the unborn child. The production of these antibodies is a process, this generally doesn't affect the first pregnancy, but subsequent pregnancies are prone to having problems.

The video below offers an overview of Erythroblastosis fetalis.

-Ashton