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Rhesus disease of the newborn (immune haemolytic disease of the newborn)
Rhesus disease of the newborn
(immune haemolytic disease of the newborn)
Pathophysiology
Mechanism
Mother is negative for the antigen, baby is positive
At birth of first child, maternal and foetal blood mix and mother makes antigens to the childs antigens
With second child, the antibodies cross the placenta and destroy the foetal RBCs - neonatal haemolytic anaemia
Antigens
Rhesus antigen (anti-D), ABO antigens (anti-A, anti-B)
anti-Kell, Kidd, also C, E, c, e, Duffy
First pregnancy
Can occur in first pregnancy if blood leak e.g.
amniocentesis, CVS, APH, threatened miscarriage
Clinical
presentation
Bleeding
Focal signs
Jaundice
Seizures
Diagnosis
Examination
Neonatal exam
Jaundice, bleeds/bruising, odema
Asciates, hepatosplenomegaly,
CNS signs
Investigations
Bloods
FBC (anaemia), Fe (nil), CRP/ESR, U+E,
LFT (high bili, low Alb), clotting, G+S, crossmatch
Maternal and neonate Rh status
Direct antiglobulin (Coombs) test (+ve)
Bedside
Obs
History
PMH
Known medical conditions
DH
Meds, allergies
PC/HPC
Neonatal jaundice, bleeding,
seizures, focal signs
POH
Scans, bloods, growth, gestation,
delivery, complications
SH
Living arrangements
FH
Mothers Rh status
Previous children affected
Management
Conservative
Information, advice, support
Monitoring (anti-D titres, USS scans, amniocentesis)
Medical
Blood transfusion
Indication: in utero,
Intraperitoneal/intravascular
Exchange transfusion
Indication: severe anaemia (<7)
MOA: filters causative Abs out of blood
Phototherapy
Indication: neonatal jaundice
MOA: blue light breaks down bilirubin
Complications
Cardiomegaly
Oedema
Hydrops fatalis
Hepatosplenomegaly
Screening
Antenatal screening programme
Rh and ABO status bloods
Definition
Autoimmune heamolytic disease
occurring in the newborn
Epidemiology
Uncommon