Postnatal diagnosis and management of hemolytic disease of the fetus and newborn
- Darlene A Calhoun, DO
Darlene A Calhoun, DO
- Medical Director of NICU
- Sarasota Memorial Hospital
- Section Editors
- Donald H Mahoney, Jr, MD
Donald H Mahoney, Jr, MD
- Section Editor — Pediatric Hematology
- Professor of Pediatrics
- Baylor College of Medicine
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
Hemolytic disease of the fetus and newborn (HDFN), also known as alloimmune HDFN or erythroblastosis fetalis, is caused by the destruction of red blood cells (RBCs) of the neonate or fetus by maternal immunoglobulin G (IgG) antibodies. These antibodies are produced when fetal erythrocytes, which express an RBC antigen not expressed in the mother, gain access to the maternal circulation.
The postnatal diagnosis and management of alloimmune HDFN in the newborn will be reviewed here. The prenatal diagnosis and management of HDFN are discussed separately. (See "Management of non-Rh(D) red blood cell alloantibodies during pregnancy" and "Overview of Rhesus D alloimmunization in pregnancy".)
TYPES OF HDFN
Alloimmune HDFN primarily involves the major blood groups of Rhesus (Rh), A, B, AB, and O, although minor blood group incompatibilities (Kell, Duffy, MNS, P, and Diego systems) can also result in significant disease (table 1) . Because of the low frequency of HDFN due to the minor blood groups, they are not presented in detail as part of this review. (See "Red blood cell antigens and antibodies".)
Only maternal immunoglobulin G (IgG) causes HDFN, because transfer of maternal antibodies across the placenta depends upon the fragment crystallizable (Fc) component of the IgG molecule, which is not present in immunoglobulin A (IgA) and immunoglobulin M (IgM). (See "Structure of immunoglobulins", section on 'Antibody fragments'.)
Rh(D) hemolytic disease — Individuals are classified as Rhesus (Rh) negative or positive based upon the expression of the major D antigen on the erythrocyte. The original description of HDFN was due to Rh(D) incompatibility, which is associated with the most severe form of the disease (hydrops fetalis).
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- TYPES OF HDFN
- Rh(D) hemolytic disease
- ABO hemolytic disease
- Other blood group antibodies
- CLINICAL PRESENTATION
- Mild to moderate disease
- Hydrops fetalis
- Antenatal diagnosis
- Postnatal diagnosis
- DIFFERENTIAL DIAGNOSIS
- ANTENATAL MANAGEMENT
- POSTNATAL MANAGEMENT
- Delivery room management
- Early anemia
- - Life-threatening severe anemia (hydrops fetalis)
- - Symptomatic anemia and stable cardiovascular status
- - Asymptomatic anemia
- Late anemia
- - Ongoing monitoring
- - Phototherapy
- - Hydration
- - Exchange transfusion
- - Immune globulin therapy
- SUMMARY AND RECOMMENDATIONS
- Clinical presentation and diagnosis