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HEMOLYTIC DISEASE OF THE

NEWBORN

By: Arazeli Dominguez


1609
WHAT IS IT?

• Immune and cardiovascular system disease


• Rh-negative vs Rh-positive blood types
• Usually nothing serious happens during the first
pregnancy, but during the second pregnancy, the fetus is
affected
RISK FACTORS

• Genetics
• Poor prenatal care
• Previous child with HDN
• Ethnicity/Race
• 15% of white population
• 8% of black population
• Asian or Native American not usually affected
FIRST PREGNANCY
SECOND PREGNANCY
DIAGNOSIS

• Amniocentesis
• Bilirubin levels
• Albumin levels
• Blood type
• Antigen screening
• Early in pregnancy, then at 28 weeks
• Fetal ultrasound
• Hydrops
• Doppler ultrasound
• Middle cerebral artery
SYMPTOMS

During Pregnancy After Birth


• Yellow color of amniotic fluid • Severe anemia
• Hydrops fetalis, causing edema • Jaundice
• Trouble breathing
• Big liver and spleen
COMPLICATIONS

• Severe anemia
• Jaundice
• Progression depends on how much the bilirubin
levels rise
• Hydrops fetalis
• Heart failure
• Weak pulse, hypotension, shock, murmurs
• Kernicterus (irreversible)
• If born premature or with a low weight, there is a
high risk of developing kernicterus
T R E ATME NT
( DUR I NG
P R E G NANCY)

• Rh-immunoglobulin drug:
• 28th week of the pregnancy
• Ensures that the no
antibodies will be produced
• Second injection is given 72
hours after the birth of child
that tests Rh-positive or
miscarriage
• Cannot be given blood
transfusions, as this will
stimulate production
TREATMENT (AFTER PREGNANCY)

• If the newborn is hydropic, a transfusion is required


• If bilirubin level is greater than 5mg/dL, an umbilical line placement
and exchange transfusion is required
• If newborn has elevated bilirubin levels, frequent feeding is required
• If born with severe anemia and low blood pressure, red blood cell
transfusions are required:
• 10 mL/kg packed RBC’s
SOURCES

• Elsevier Point of Care. (2018, February 26). Clinical Overview: Hemolytic Disease of the Newborn. Retrieved
from https://www-clinicalkey-com.proxy.lib.mcw.edu/#!/content/67-s2.0-d1745e7d-88ed-4716-9d67-
f070e6274c1a
• Hendrickson, J. E., & Delaney, M. (2016, October 30). Hemolytic Disease of the Fetus and Newborn: Modern
Practice and Future Investigations. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27397673
• Nassar GN, Wehbe C. Erythroblastosis Fetalis. [Updated 2018 Jun 5]. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513292/
• Nandyal, R. R. (2015, April 20). Hemolytic Disease of the Newborn. Retrieved from
https://www.omicsonline.org/open-access/hemolytic-disease-of-the-newborn-2329-8790-
1000203.php?aid=47723
• Stanford Children's Health. (n.d.). Hemolytic Disease of the Newborn. Retrieved from
http://www.stanfordchildrens.org/en/topic/default?id=hemolytic-disease-of-the-newborn-90-P02368