Summary about Disease
Erythroblastosis fetalis, also known as hemolytic disease of the fetus and newborn (HDFN), is a condition where the red blood cells of a fetus are destroyed by maternal antibodies. This occurs when there is an incompatibility between the blood types of the mother and the fetus, most commonly involving the Rh factor (Rh disease) or, less frequently, the ABO blood group system. The maternal antibodies cross the placenta and attack the fetal red blood cells, leading to anemia, jaundice, and potentially severe complications.
Symptoms
Symptoms in the fetus or newborn can range from mild to severe and may include:
Anemia: Pale skin, fatigue, rapid heart rate.
Jaundice: Yellowing of the skin and whites of the eyes.
Hydrops fetalis: Severe swelling throughout the body due to fluid accumulation. This is a life-threatening condition.
Hepatosplenomegaly: Enlargement of the liver and spleen.
Kernicterus: Brain damage caused by high levels of bilirubin in the blood.
Causes
Erythroblastosis fetalis is primarily caused by Rh incompatibility. This occurs when an Rh-negative mother carries an Rh-positive fetus. During pregnancy or delivery, fetal red blood cells may enter the mother's circulation. The mother's immune system recognizes the Rh-positive cells as foreign and produces antibodies against them (Rh sensitization). In subsequent pregnancies with an Rh-positive fetus, these antibodies cross the placenta and attack the fetal red blood cells. ABO incompatibility can also cause HDFN, but it is typically milder than Rh incompatibility.
Medicine Used
Rho(D) Immune Globulin (RhoGAM): Given to Rh-negative mothers during pregnancy and after delivery to prevent Rh sensitization.
Intrauterine Transfusions: Transfusions of red blood cells given to the fetus while still in the womb to treat severe anemia.
Exchange Transfusions: After birth, replacing the newborn's blood with donor blood to remove bilirubin and antibodies.
Phototherapy: Using special lights to break down bilirubin and reduce jaundice.
Intravenous Immunoglobulin (IVIG): Given to the newborn to block maternal antibodies.
Is Communicable
Erythroblastosis fetalis is not communicable. It is not caused by an infectious agent and cannot be transmitted from person to person. It is a condition arising from an immunological reaction between the mother and the fetus.
Precautions
Rh testing: All pregnant women should be tested for their Rh status early in pregnancy.
RhoGAM: Rh-negative mothers should receive RhoGAM injections at 28 weeks of gestation and within 72 hours after delivery of an Rh-positive baby.
Monitoring: Careful monitoring of the fetus for signs of anemia or hydrops fetalis.
Early delivery: In severe cases, early delivery may be necessary.
How long does an outbreak last?
Erythroblastosis fetalis is not an "outbreak" in the traditional sense of an infectious disease. The duration of the condition depends on the severity of the antibody-mediated destruction of fetal red blood cells. If untreated, it can lead to severe complications and even fetal death. With proper management, including intrauterine transfusions and postnatal care, the effects of the disease can be mitigated, and the newborn can recover. The acute phase lasts until the maternal antibodies are cleared from the infant's system.
How is it diagnosed?
Diagnosis involves a combination of:
Prenatal testing: Blood tests to determine the mother's Rh status and to screen for Rh antibodies.
Amniocentesis or Cordocentesis: Sampling of amniotic fluid or fetal blood to assess fetal anemia and bilirubin levels.
Ultrasound: To detect signs of hydrops fetalis.
Postnatal testing: Blood tests on the newborn to determine blood type, Rh status, bilirubin levels, and the presence of maternal antibodies.
Coombs test: Direct antiglobulin test (DAT) on the newborn's red blood cells to detect antibodies bound to their surface.
Timeline of Symptoms
The timeline of symptoms can vary depending on the severity of the disease:
During pregnancy: Fetal anemia may develop gradually, leading to hydrops fetalis in severe cases (typically in the second or third trimester).
At birth: Jaundice may be present at birth or develop within the first 24 hours. Anemia, hepatosplenomegaly, and, in severe cases, signs of hydrops fetalis may also be present.
Postnatal: Jaundice can worsen rapidly in the first few days of life, potentially leading to kernicterus if not treated promptly.
Important Considerations
Prevention is key: RhoGAM is highly effective in preventing Rh sensitization.
Early diagnosis and treatment: Prompt diagnosis and treatment are essential to minimize the risk of complications.
Severity varies: The severity of erythroblastosis fetalis can range from mild to life-threatening.
ABO incompatibility: While less severe than Rh incompatibility, ABO incompatibility can still cause jaundice and anemia in newborns.
Specialist care: Management of erythroblastosis fetalis requires specialized care from neonatologists and other healthcare professionals with expertise in this condition.