Diagnosing Hemolytic Disease of the Newborn

Tammy Annette Brantley

doi:10.29074/ascls.15.3.140

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Tammy Annette Brantley⇑
1. was a senior clinical laboratory science student at Indiana University, Indianapolis at the time this paper was written

Address for correspondence: Tammy A Brantley, 3030 North 1000 West, Tipton, IN 46072.

Extract

A Rh negative, pregnant female presented to a major medical center for possible Rh alloimmunization. This female had nine previous pregnancies, including three spontaneous abortions, four live births, and two fetal demises. Because of poor prenatal care, the immunization Rh immune globulin was administered to only the first two pregnancies. After much laboratory testing and treatment, this tenth pregnancy also ended in fetal demise.

ETIOLOGY OF HDN Erythroblastosis fetalis, more commonly known as hemolytic disease of the newborn (HDN), is an immune response disorder. It is caused mostly in pregnancies with blood incompatibilities, such as ABO or Rh, with Rh being the most common. It occurs in approximately 10% of pregnancies.¹ The fetal red blood cells (RBCs), contain an antigen such as A, B, or D that the mother's red blood cells do not have. For example, an Rh− woman who has no D antigen present on her RBCs is pregnant with an Rh+ fetus that does have the D antigen present on its RBCs. The four most common antibodies are anti-D, anti-c, anti-E, and anti-Kell, which is the highest significance clinically.² In this case study, the antibody of concern is anti-D, which is associated with Rh incompatibility. This is determined by the mother's rising IDAT testing of anti-D antibodies. According to Dr Lopez-Plaza, only 17% of Rh− mothers will become immunized if exposed to fetal Rh+ cells.³ This often happens when the placenta breaks from the mother's uterus during delivery because fetal RBCs can enter maternal circulation. When the…

ABBREVIATIONS: HDN = hemolytic disease of the newborn; IDAT = indirect anti-globulin test; IUFT = intrauterine fetal transfusion; PUBS = percutaneous umbilical blood sample; RBC = red blood cells.