Haemolytic disease of newborn

Question 1

What does haemolytic disease of the newborn do?

Answer 1

Cause haemolysis in neonate

Question 2

What is haemolytic disease of the newborN?

Answer 2

Incompatability between rhesus antigens on surface of RBC of mother and foetus

Question 3

What combination of antibodies in mother and baby can cause haemolytic disease of the newborn?

Answer 3

Mother - rhesus D negative
Foetus - Rhesus D positive

Question 4

What happens in the first preganancy if a woman is RD- and foetus is RD+?

Answer 4

Foetus blood -> maternal circulation
Maternal immune system recognise rhesus antigens on foetus RBCs as foreign and produce antibodies -> SENSITISED
No probelms

Question 5

When can haemolytic disease of the newborn occur in a first pregnancy?

Answer 5

When sensitisation happens early on eg antepartum haemorrhage

Question 6

What causes haemolysis in subsequent pregnancies if baby is rhesus D+ and mother has anti-D antibodies?

Answer 6

anti-D antibodies -> placenta -> foetus, attach to rhesus antigens on RBC -> foetal immune system attacks RBC -> haemolysis

Question 7

What does haemolysis in foetus cause?

Answer 7

Anaemia
High bilirubin

Question 8

Risk factors for haemolytic disease of the newborn

Answer 8

Alloimmunisation during first pregnancy
Alloimmunisation during second or subsequent pregnancy
Failed prophylaxis

Question 9

What increases risk of large foetal maternal haemorrhage at delivery?

Answer 9

Traumatic deliveries incl C section
Manual removal of placenta
Stillbirths and intrauterine deaths
Abdo trauma - 3rd trimester
Multiple pregnancies at delivery
Unexplained hydrops fetails

Question 9

What increases risk of large foetal maternal haemorrhage at delivery?

Answer 9

Traumatic deliveries incl C section
Manual removal of placenta
Stillbirths and intrauterine deaths
Abdo trauma - 3rd trimester
Multiple pregnancies at delivery
Unexplained hydrops fetails

Question 10

How is anti-D antibodies detected antenatally?

Answer 10

Indirect coombs test

Question 11

Who has the indirect coombs test performed?

Answer 11

All rhesus negative women at first antenatal visit

Question 12

Presentation of haemolytic disease of the newborn

Answer 12

Jaundice - yellow amniotic fluid, yellow ver
Pallor
Hepatosplenomegaly
Kernicterus
Hypoglycaemia
Hydops fatalis

Question 13

What is kerniceterus?

Answer 13

Bilirubin encephalopathy

Question 14

How does hydrops fetalis present antenatally?

Answer 14

Polyhydraminos - excessive amniotic fluid

Question 15

How does hydrops fetalis present postnatally?

Answer 15

Subcutaneous oedema
Peridcardial effusion
Plueral effusion
Ascites
Hepatosplenomegaly
Placenta may be thickened

Question 16

Clinical signs of severe haemolytic disease

Answer 16

pallor
hepatosplenomegaly
oedema
petechiae
ascites

Question 17

Treatment for prenatal diagnosed haemolytic disease

Answer 17

Intrauterine transfusiom

Question 18

Investigations for haemolytic disease

Answer 18

Indirect coombs test
Antenatal US
Foetal blood smapling
FBC
Postnatal diagnosis

Question 19

What does antenatal US detect?

Answer 19

Signs of hydrops fetalis

Question 20

What does antenatal US detect?

Answer 20

Signs of hydrops fetalis

Question 21

What tests for foetal anaemia?

Answer 21

Foetal blood sample replaced by
Doppler US of MCA largely replaced foetal blood sampling as initial test

Question 22

What does an FBC show in haemolytic disease?

Answer 22

Anaemia
Reticulocyte count - up to 40% severe

Question 23

Bloods when extreme DIC?

Answer 23

Sphistocytes and burr cells may be observed
Neutropenia and thrombocytopenia

Question 24

What should be done immediately after birth in a rhesus negative mother?

Answer 24

Blood from umbilical cord checked for ABO and Rh blood group Direct coombd test Haemoglobin and baseline bilirubin

Question 25

What should be done immediately after birth in a rhesus negative mother?

Answer 25

Blood from umbilical cord checked for ABO and Rh blood group Direct coombd test Haemoglobin and baseline bilirubin

Question 26

What results after birth support haemolytic disease diagnosis?

Answer 26

Positive coombs test in presence of ABO or Rh incompatability

Question 27

Management of rhesus disease in utero

Answer 27

* O negative transfusion at 18 weeks * Successful transfusion delivery 37-38 weeks * Unsuccessful transfusion delivery - 32 weeks

Question 28

When deliver baby after successful vs unseuccessful transfusion at 18 weeks?

Answer 28

37-38 weeks Unsuccessful - 32 weeks

Question 29

Prognosis after delivery

Answer 29

50% - normal 25% - moderate disease 25% - severe disease

Question 30

What should be done for babies who have normal haemoglobin and bilirubin levels at birth with rhesus antiboides?

Answer 30

Monitored for late set anaemia at 6-8 weeks

Question 31

What to do with babies with moderate haemolytic disesae?

Answer 31

May require transfusion May need phototheraoy to treat significatn hyperbilirubinaemia which may occur within 24 hours after birth

Question 32

Why do phototherapy in jaundiced babies?

Answer 32

Avoide kernicterus

Question 33

What should happen when severe haemolytic disease of newborn anticipated?

Answer 33

Attended by a paediatrician trained in neonatal resus and fresh O negative blood immediately available

Question 34

Management of severe haemolytic disease after birth

Answer 34

Immediate resus Temo stabilisation Exchange transfusion Top up blood transfusions and phototheraoy may be needed Early administration of IV haemogloblin

Question 35

What does early administration of IV immunoglobulins do for severe haemolytic disease?

Answer 35

Reduces haemolysis, peak bilirubin levels and need for exchange transfusion