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Encyclopedia > Hemolytic disease of the newborn
HDN
Classification & external resources
ICD-10 P55.
ICD-9 773
DiseasesDB 5545
MedlinePlus 001298
eMedicine ped/959 

Hemolytic disease of the newborn, also known as HDN, is an alloimmune condition that develops in a fetus, when the IgG antibodies that have been produced by the mother and have passed through the placenta include ones which attack the red blood cells in the fetal circulation. The red cells are broken down and the fetus can develop reticulocytosis and anemia. This fetal disease ranges from mild to very severe, and fetal death from heart failure (hydrops fetalis) can occur. When the disease is moderate or severe, many erythroblasts are present in the fetal blood and so these forms of the disease can be called erythroblastosis fetalis (or erythroblastosis foetalis). The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // P00-P96 - Certain conditions originating in the perinatal period (P00-P04) Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery (P00) Fetus and newborn affected by maternal conditions that may be unrelated to present pregnancy (P01) Fetus and newborn affected by maternal complications of... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... ... A human fetus A fetus (or foetus, or fœtus – see below) is a developing mammal after the embryonic stage and before birth. ... Schematic of antibody binding to an antigen An antibody is a protein complex used by the immune system to identify and neutralize foreign objects like bacteria and viruses. ... Schematic of antibody binding to an antigen An antibody or immunoglobulin is a large Y-shaped protein used by the immune system to identify and neutralize foreign objects like bacteria and viruses. ... The placenta is an ephemeral (temporary) organ present only in female placental vertebrates during gestation (pregnancy). ... Human red blood cells Red blood cells are the most common type of blood cell and the vertebrate bodys principal means of delivering oxygen from the lungs or gills to body tissues via the blood. ... A reticulocyte is an immature red blood cell that appears especially during regeneration of lost blood. ... Anemia (AmE) or anaemia (BrE), from the Greek () meaning without blood, refers to a deficiency of red blood cells (RBCs) and/or hemoglobin. ... Hydrops fetalis is a blood condition in the fetus characterized by an edema in the fetal subcutaneous tissue, sometimes leading to spontaneous abortion. ... A normoblast (or erythroblast) is a type of red blood cell which still retains a cell nucleus. ...

Contents

Symptoms

Hemolysis leads to elevated bilirubin levels. After delivery bilirubin is no longer cleared (via the placenta) from the neonate's blood and the symptoms of jaundice (yellowish skin and yellow discolouration of the whites of the eyes) increase within 24 hours after birth. Like any other severe neonatal jaundice, there is the possibility of acute or chronic kernicterus. Hemolysis (alternative spelling haemolysis) literally means the excessive breakdown of red blood cells. ... Bilirubin is a yellow breakdown product of heme catabolism. ... The term symptom (from the Greek syn = con/plus and pipto = fall, together meaning co-exist) has two similar meanings in the context of physical and mental health: Strictly, a symptom is a sensation or change in health function experienced by a patient. ... Jaundice, also known as icterus (attributive adjective: icteric), is a yellowing of the skin, conjunctiva (clear covering over the sclera, or whites of the eyes) and mucous membranes caused by increased levels of bilirubin in the human body (or the body of another red blooded animal). ... Jaundice, also known as icterus (adjective:Icteric), is yellowing of the skin, sclera (the white of the eyes) and mucous membranes caused by increased levels of bilirubin in the human body. ... Kernicterus is damage to the brain centers of infants caused by jaundice. ...


Profound anemia can cause high-output heart failure, with pallor, enlarged liver and/or spleen, generalized swelling, and respiratory distress. The prenatal manifestations are known as hydrops fetalis; in severe forms this can include petechiae and purpura. The infant may be stillborn or die shortly after birth. Pallor is an abnormal loss of skin or mucous membrane color. ... Hepatomegaly is the condition of having an enlarged liver. ... Splenomegaly is an enlargement of the spleen, which usually lies in the left upper quadrant (LUQ) of the human abdomen. ... Edema (American English) or oedema (British English), formerly known as dropsy or hydropsy, is swelling of any organ or tissue due to accumulation of excess lymph fluid, without an increase of the number of cells in the affected tissue. ... Dyspnea (Latin dyspnoea, Greek dyspnoia from dyspnoos - short of breath) or shortness of breath (SOB) is perceived difficulty breathing or pain on breathing. ... Hydrops fetalis is a blood condition in the fetus characterized by an edema in the fetal subcutaneous tissue, sometimes leading to spontaneous abortion. ... minor Petechia A petechia (IPA pronunciation: ), plural petechiae (IPA pronunciation: ) is a small red or purple spot on the body, caused by a minor hemorrhage (broken capillary blood vessels). ... Purple discolorations on the skin caused by bleeding underneath the skin. ... The expected result of pregnancy is the birth of a living child. ...


Causes

Antibodies are produced when the body is exposed to an antigen foreign to the make-up of the body. If a mother is exposed to an alien antigen and produces IgG (as opposed to IgM which does not cross the placenta), the IgG will target the antigen, if present in the fetus, and may affect it in utero and persist after delivery. The three most common models in which a woman becomes sensitized toward (i.e., produces IgG antibodies against) a particular blood type are: An antigen is a substance that stimulates an immune response, especially the production of antibodies. ... IgM (Immunglobulin M) antibody molecule consisting of 5 base units. ... Wikipedia does not yet have an article with this exact name. ... Blood type (or blood group) is determined, in part, by the ABO blood group antigens present on red blood cells. ...

  • Fetal-maternal hemorrhage can occur due to trauma, abortion, childbirth, ruptures in the placenta during pregnancy, or medical procedures carried out during pregnancy that breach the uterine wall. In subsequent pregnancies, if there is a similar incompatibility in the fetus, these antibodies are then able to cross the placenta into the fetal bloodstream to attach to the red blood cells and cause hemolysis. In other words, if a mother has anti-RhD (D being the major Rhesus antigen) IgG antibodies as a result of previously carrying a RhD-positive fetus, this antibody will only affect a fetus with RhD-positive blood.
  • The woman may receive a therapeutic blood transfusion with an incompatible blood type. ABO blood group system and Rhesus blood group system typing are routine prior to transfusion. Suggestions have been made that women of child bearing age or young girls should not be given a transfusion with Rhc-positive blood or Kell1-positive blood to avoid possible sensitization. This would strain the resources of blood transfusion services, as it is currently considered uneconomical to screen for these blood groups.
  • The third sensitization model can occur in women of blood type O. The immune response to A and B antigens, that are widespread in the environment, usually leads to the production of IgM anti-A and IgM anti-B antibodies early in life. On rare occasions, IgG antibodies are produced. In contrast, Rhesus antibodies are generally not produced from exposure to environmental antigens.

To meet Wikipedias quality standards, this article or section may require cleanup. ... The placenta is an ephemeral (temporary) organ present only in female placental vertebrates during gestation (pregnancy). ... A pregnant woman near the end of her term Pregnancy is the carrying of one or more embryos or fetuses by female mammals, including humans, inside their bodies. ... Human red blood cells Red blood cells are the most common type of blood cell and the vertebrate bodys principal means of delivering oxygen from the lungs or gills to body tissues via the blood. ... Hemolysis (alternative spelling haemolysis) literally means the excessive breakdown of red blood cells. ... Donating blood Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another. ... A blood type is a description of an individuals characteristics of red blood cells due to substances (carbohydrates and proteins) on the cell membrane. ... The term Rhesus blood group system refers to the five main Rhesus antigens (C, c, D, E and e) as well as the many other less frequent Rhesus antigens. ... The Kell antigen system (also known as Kell-Cellano system) is a group of antigens on the human red blood cell surface which are important determinants of blood type and are targets for autoimmune or alloimmune diseases which destroy red blood cells. ... A request has been made on Wikipedia for this article to be deleted in accordance with the deletion policy. ...

Examples of serological diagnosis

  • Rhesus system
    • rhesus D hemolytic disease of the newborn (often called Rh disease) is the most common form of severe HDN. The disease varies from mild to severe.
    • rhesus E hemolytic disease of the newborn is a mild disease
    • rhesus c hemolytic disease of the newborn can range from a mild to severe disease - is the third most common form of severe HDN
    • rhesus e hemolytic disease of the newborn - rare
    • rhesus C hemolytic disease of the newborn - rare
    • antibody combinations (ie anti-Rhc and anti-RhE antibodies occurring together) - can be severe
    • (the Rh d antigen and Rh d antibodies do not exist)
  • Kell system
    • anti-Kell hemolytic disease of the newborn
      • anti-K 1 antibodies - disease ranges from mild to severe - over half of the cases are caused by multiple blood transfusions - is the second most common form of severe HDN
      • anti-K 2 ,anti-K 3 and anti-K 4 antibodies - rare
  • Other blood group antibodies (Kidd, Lewis, Duffy, MN, P and others).

ABO blood group incompatibility and sensitisation is one cause of hemolytic disease of the newborn. ... Rh disease (also known as Rh (D) disease, Rhesus disease, RhD Haemolytic Disease of the Newborn, Rhesus D Haemolytic Disease of the Newborn or RhD HDN) is one of the causes of hemolytic disease of the newborn (also known as HDN). ... Hemolytic disease of the newborn (anti-Rhc) can range from a mild to a severe disease. ... Hemolytic disease of the newborn (anti-Kell 1) ranges from mild disease to a very severe disease. ...

Diagnosis

The diagnosis of HDN is based on history and laboratory findings: In general, a diagnosis (plural diagnoses) covers a broad spectrum, or spectra, of testing in some form of analysis; such tests based on some collective reasoning is called the method of diagnostics, leading then to the results of those tests by ideal (ethics) would then be considered a diagnosis, but...


Blood tests done on the newborn baby

  • Positive direct Coombs test (might be negative after fetal interuterine blood transfusion)

Blood tests done on the mother Jaundice, also known as icterus (attributive adjective: icteric), is a yellowing of the skin, conjunctiva (clear covering over the sclera, or whites of the eyes) and mucous membranes caused by increased levels of bilirubin in the human body (or the body of another red blooded animal). ... The term morphology in biology refers to the outward appearance (shape, structure, colour, pattern) of an organism or taxon and its component parts. ... Reticulocyte Erythrocyte Reticulocytes are immature red blood cells, typically comprising about 1% of the red cells in the human body. ... A normoblast (or erythroblast) is a type of red blood cell which still retains a cell nucleus. ... Coombs test (also known as Coombs test, antiglobulin test or AGT) refers to two clinical blood tests used in hematology and immunology. ...

Coombs test (also known as Coombs test, antiglobulin test or AGT) refers to two clinical blood tests used in hematology and immunology. ...

Treatment

Before birth, options for treatment include intrauterine transfusion or early induction of labor when pulmonary maturity has been attained, fetal distress is present, or 35 to 37 weeks of gestation have passed. The mother may also undergo plasma exchange to reduce the circulating levels of antibody by as much as 75%. Donating blood Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another. ... Gestation is the carrying of an embryo or fetus inside a female viviparous animal. ... An exchange transfusion is a medical treatment in which apheresis is used to remove one persons red blood cells or platelets and replace them with transfused blood products. ...


After birth, treatment depends on the severity of the condition, but could include temperature stabilization and monitoring, phototherapy, transfusion with compatible packed red blood, exchange transfusion with a blood type compatible with both the infant and the mother, sodium bicarbonate for correction of acidosis and/or assisted ventilation. Light therapy or phototherapy consists of exposure to specific ranges of light wavelengths (using lasers or LEDs), or very bright, full-spectrum light, for a prescribed amount of time. ... An exchange transfusion is a medical treatment in which apheresis is used to remove one persons red blood cells or platelets and replace them with transfused blood products. ... Blood type (or blood group) is determined, in part, by the ABO blood group antigens present on red blood cells. ... Sodium bicarbonate is the chemical compound with the formula NaHCO3. ... Acidosis is an increased acidity (i. ...


Rhesus-negative mothers who have had a pregnancy with/are pregnant with a rhesus-positive infant are given Rh immune globulin (RhIG) during pregnancy and after delivery to prevent sensitization to the D antigen. It works by binding any fetal red cells with the D antigen before the mother is able to produce an immune response and form anti-D IgG. A drawback to pre-partum administration of RhIG is that it causes a positive antibody screen when the mother is tested which is indistinguishable from immune reasons for antibody production. Globulin is one of the two types of serum proteins, the other being albumin. ...


Complications

Complications of HDN could include kernicterus, hepatosplenomegaly, inspissated (thickened or dried) bile syndrome and/or greenish staining of the teeth, hemolytic anemia and damage to the liver due to excess bilirubin. Kernicterus is damage to the brain centers of infants caused by jaundice. ... Hepatosplenomegaly is the simultaneous enlargement of both the liver (hepatomegaly) and the spleen (splenomegaly). ... Types of teeth Molars are used for grinding up foods Carnassials are used for slicing food. ... Hemolytic anemia is anemia due to hemolysis, the abnormal breakdown of red blood cells either in the blood vessels (intravascular hemolysis) or elsewhere in the body (extravascular). ...


Similar conditions

Similar conditions include acquired hemolytic anemia, congenital toxoplasma and syphilis infection, congenital obstruction of the bile duct and cytomegalovirus infection. Hemolytic anemia is anemia due to hemolysis, the abnormal breakdown of red blood cells either in the blood vessels (intravascular hemolysis) or elsewhere in the body (extravascular). ... Binomial name Toxoplasma gondi (Nicolle & Manceaux), 1908 Toxoplasma gondii is a species of parasitic protozoa, belonging to the Apicomplexa, that can cause the disease toxoplasmosis in humans. ... Syphilis is a sexually transmitted disease (STD) caused by a spirochaete bacterium, Treponema pallidum. ... X-Ray of the bile duct during a laprascopic cholecystectomy A bile duct is any of a number of long tube-like structures that carry bile. ... Species see text Cytomegalovirus (CMV), is a genus of Herpes viruses; in humans the species is known as Human herpesvirus 5 (HHV-5). ...


References

  • Geifman-Holtzman O, Wojtowycz M, Kosmas E, and Artal R. Female allo-immunization with antibodies known to cause hemolytic disease. Obstetrics and Gynecology 1997 89, 272-275
  • Mollison PL, Engelfriet CP and Contreras M. Blood Transfusion in Clinical Medicine. 1997. 10th edition. Blackwell Science, Oxford, UK.

See also

Coombs test (also known as Coombs test, antiglobulin test or AGT) refers to two clinical blood tests used in hematology and immunology. ... Hemolytic anemia is anemia due to hemolysis, the abnormal breakdown of red blood cells either in the blood vessels (intravascular hemolysis) or elsewhere in the body (extravascular). ... Hematology is the branch of medicine that is concerned with blood and its disorders. ... An exchange transfusion is a medical treatment in which apheresis is used to remove one persons red blood cells or platelets and replace them with transfused blood products. ...

External links

  • Blood Groups and Red Cell Antigens: Hemolytic disease of the newborn

 
 

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