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
Tuesday
Monday
Treatment
Treatment varies between the two types of complications of Erythroblastosis fetalis.
ABO incompatibility:
RH incompatibility:
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
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
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.
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.
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
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
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
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