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Postnatal diagnosis and management of hemolytic disease of the fetus and newborn

Darlene A Calhoun, DO
Section Editors
Donald H Mahoney, Jr, MD
Leonard E Weisman, MD
Deputy Editor
Melanie S Kim, MD


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".)


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) [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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Literature review current through: Sep 2016. | This topic last updated: Jul 25, 2016.
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