Hemolytic Disease Of Newborn

HAEMOLYTIC DISEASE OF THE NEW BORN A 30 year old female had an abortion at 25 weeks.Foetus on exam was severly anaemic,had pleural effusions and ascites(hydrop foetalis).The first baby is alive and well but on questioning the mother indicated that the child was very “yellow” at birth .Her blood group is O negative .Husband’s is A positive. For some unknown reason anti-D injection was not given during the first pregnancy or immediately after delivery. QUESTIONS (a)Discuss the pathology of haemolytic disease of the new born and complications in your patient. (b)Causes of hydrops foetalis ( c)Other causes of haemolytic

INTRODUCTION Also

known as erythroblastosis foetalis

Haematological

disease in the newborn that occurs mostly due to rhesus incompatibility

Mother

is rhesus negative while fetus is rhesus positive

Can

occur due to non-immune causes e.g trisomy 13

Rarely occurs in first pregnancy Disease is now reducing in incidence RhoGAM vaccination

pathology Initial

exposure to foreign antigen Feto-maternal haemorrhage due too trauma,abortion,childbirth,medic al procedures B lymphocyte clones that recognize red blood antigen are established Initially maternal antibody production is of IgM

This is termed as the primary response Rarely occurs in first pregnancy After sensitisation either on current pregnancy or subsequent maternal anti-D cross into fetal circulation Antibodies then attach to rhesus antigen on fetal cells form a rosette on macrophages in reticulo-endothelial system

antibody coated red blood cells are lysed by lysosomal enzymes released by macrophages and natural killer cells This is independent of complement system

COMPLICATIONS IN THE PATIENT The

patient was severely anaemic, had ascites, and pleural effusions Anaemia:due to the massive hemolysis of the blood cells that occurs in haemolytic disease of the newborn.

ASCITES Heart

failure occurs in haemolytic disease of the newborn leading to hepatomegally,reduced liver function-protein synthesis

Oncotic Portal

pressure

hypertension

PLEURAL EFFUSION Reduced

oncotic pressure

Pulmonary

congestion due to heart failure

CAUSES OF HYDROPS FETALIS ANAEMIA:Immune

causes e.g. rhesus factor, kell antigens, kidd blood group,duffy blood group

CARDIAC

DYSRHYTHMIAS:Supraventricular tachycardia, trial flutter, congenital heart block

STRUCTURAL

HEART LESIONS:Premature closure of foramen ovale, tricuspid insufficiency

VASCULAR:thrombosis of umbilical vein or inferior venacava, true knot of umbilical cord LYMPHATIC:Lymphangiectasia, cystic hygromachylothorax, chylous ascites THORACIC LESIONS: diaphragmatic hernia, mediasternal teratoma TERATOMAS:saccroccygeal teratoma, Choriocarcinoma

CHROMOSOMAL ABNORMALITIES:Trisomy 13, 15,16,18,21. BONE DISEASES:Osteogenesis imperfect, asphyxiating thoracic dystrophy, skeletal dysplasia CONGENITAL INFECTIONS:Cytomegalo virus, parvovirus B19, rubella,

OTHER CAUSES OF HAEMOLYTIC DISEASE OF THE NEWBORN

Haemolytic disease of the newborn due to ABO incompatibility Kell group antibodies(anti-K and anti-k)Cause severe fetal anaemia Kidd blood group (anti-Jka and anti-Jkb).causes mild form of haemolytic disease

Duffy

blood group(antiFya).glycoprotein receptor that binds cytokines during inflammation.

MNS

and s blood group antibodies

END THANK

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