hemolytic disease of the newborn

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hemolytic disease of the newborn

Alloimmune anemia of newborns,
erythroblastosis fetalis Neonatology, pediatric hematology Hemolysis due to incompatibility of fetal antigens with maternal immune system, caused by production of maternal IgG antibodies in response to fetal RBCs that enter the maternal circulation; if the IgG response and sharing of circulations–as occurs in low-grade fetomaternal hemorrhage, is intense, erythoblastosis fetalis occurs Clinical See Hydrops fetalis Lab If hemolysis is intense, the excess unconjugated/indirect BR overloads infant's liver; because of blood-brain barrier immaturity, BR deposits in basal ganglia of the brain, causing cell death, and kernicterus. See Alloimmune anemia of newborn, Kell blood group, Kernicterus. Cf Hemorrhagic disease of the newborn.

hemolytic disease of the newborn

A neonatal disease characterized by anemia, jaundice, liver and spleen enlargement, and generalized edema (hydrops fetalis). Synonym: erythroblastosis fetalis See: Rh blood group

Etiology

This disease is caused by transplacental transmission of maternal antibody, usually evoked by maternal and fetal blood group incompatibility. Incompatibilities of the ABO system are common but are not severe because maternal antibodies are too large to cross the placenta readily. Rh incompatibility, however, can result in profound fetal anemia, causing death in utero.

Rh incompatibility may develop when an Rh-negative woman carries an Rh-positive fetus. At the time of delivery, fetal red blood cells may enter maternal circulation, stimulating antibody production against the Rh factor. In a subsequent pregnancy, these antibodies cross the placenta to the fetal circulation and destroy fetal red blood cells.

Treatment

In cases of Rh incompatibility, the condition can be controlled during pregnancy by following the anti-Rh titer of the mother's blood and the bilirubin level of the fetus by amniocentesis. These indices show whether the pregnancy should be allowed to go to full term and if intrauterine transfusion is indicated; or if labor should be induced earlier. Delivery should be as free of trauma as possible and the placenta should not be manually removed. The infant with hemolytic disease should be immediately seen by a physician who is capable of and has the facilities and blood supplies available for exchange transfusion. The use of Rh (D) immune globulin after abortion, at 28 weeks' gestation, and within 72 hr of delivery has been beneficial.

Hemolytic disease of the newborn

Also known as erythroblastosis neonatorum, this is a condition in which a newborn's red blood cells are destroyed by antibodies that have crossed the placenta from the mother's blood. (Hemolytic disease begins in the fetus, in whom the disease is called erythroblastosis fetalis). Severe anemia caused by hemolytic disease is treated in the same way as other anemias, but when jaundice appears due to increased bilirubin, the jaundice is treated by exposing the infant to bright lights. In severe cases, exchange transfusion is required or brain damage may result.
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hemolytic

pertaining to, characterized by, or producing hemolysis.

hemolytic anemia
anemia caused by the increased destruction of erythrocytes which may occur in the vascular system—intravascular hemolysis, or due to phagocytosis by the monocyte-macrophage system—extravascular or intracellular hemolysis. It may result from incompatibility (see alloimmune hemolytic anemia of the newborn), from mismatched blood transfusions, from poisons such as copper, organic agents in plants such as kale, from nutritional deficiencies such as phosphorus and from protozoan infections such as babesiosis. Hemolytic anemia may also occur as a result of a disorder of the immune response in which B cell-produced antibodies fail to recognize erythrocytes that are 'self' and directly attack and destroy them. In addition to the usual signs of anemia, the patient may also exhibit jaundice.
hemolytic component
a degree of extravascular hemolysis in association with other types of anemia.
hemolytic disease of the newborn
see alloimmune hemolytic anemia of the newborn.
hemolytic enterotoxemia
a little reported disease recorded mostly in Australia in sheep, cattle and foals; a highly fatal hemolytic anemia associated with a heavy population of Clostridium perfringens type A in the intestines.
hemolytic plaque assay
see plaque assay.
hemolytic-uremic syndrome
a microangiopathic hemolytic anemia with thrombocytopenia and severe involvement of renal vasculature which leads to acute renal failure. In humans associated with verocytoxin-producing bacteria such as Escherichia coli, Shigella and some Salmonella; usually associated with the ingestion of poorly cooked meat. A similar clinical syndrome has been reported in cows, horses and dogs.