Tokushukai Medical Group

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Pediatric Diseases: Blood Disease (1), mother-child immunity comes to an issue- Hemolytic Anemia of Newborn

It is considered that the clinical condition of maternal antibody destroy fetal blood cell or organ cells, is the result of maternal-child incompatible pregnancy, where maternal antibody, which mother does not have originally, is produced as the target of maternal immune reaction where sugar, protein or glycoprotein appears on the surface of fetus cell membrane. In this kind of diseases, they are Hemolytic Anemia of Newborn, Neonatal Hemochromatosis (GALD) and Neonatal Allogeneic Immune Thrombocytopenia (NAIT).

Maternal antibody attacks the fetal blood cell caused by Blood Type Incompatible Pregnancy.

It is called as Maternal Blood Type Incompatible Pregnancy as blood type of mother and fetus is different so that antibody is developed in mother’s body against fetus erythrocyte, and Hemolytic Anemia of Newborn is developed in neonatal infant. There is rhesus incompatibility pregnancy and ABO blood type incompatibility pregnancy. There is CcDEe in Rh Antigen, but normally, the existence of D antigen is set as Rh (+) and no existence of D antigen is set as Rh (-).

Rhesus type incompatibility pregnancy means; it is a case when mother’s blood type is Rh (-), father’s blood type is Rh (+), and fetus blood type is Rh(+), hemolytic anemia of newborn is developed. When Rh (-) female become pregnant as first time and then fetus blood enters mother’s body at the time of childbirth, antibody is developed in mother’s body against to Rh (+) fetus blood cells. This is called as maternal sensibilization, and become pregnant for second child, this IgG antibody in mother’s body is transferred to fetus body then this antibody destroys fetus erythrocyte. However, in case when Rh (-) type mother’s body has received Rhesus factor incompatible blood transfusion from Rh (+) blood donor in prior to pregnancy, sensibilization has already established in mother’s body so that symptom may appear even for first baby at first pregnancy.

On the other hand, ABO blood type incompatible pregnancy is the case where mother’s blood is O type and fetus blood is either A or B type, and Anti-A or anti-B antibody is produced in mother’s body, then this antibody attacks fetus blood cells resulted the development of hemolytic anemia of newborn.

Risk of death or after effect exists in rhesus type severe disease case.

Symptom is anemia of fetus/newborn and early-stage hemolytic anemia, and when in severe case it becomes a fetal edema. It is, therefore, in case of severe Rhesus blood type, the risk of fetal or neonatal death becomes higher. Because of severe hemolytic anemia, bilirubin is deposited on nucleus basalis and/or hippocampal gyrus, and when nerve cell is destroyed, it becomes hemolytic anemia, furthermore it may cause brain paralysis as after effect. In case of ABO blood type incompatible pregnancy, severe case is the most unlikely possible.

Examination and diagnosis for neonatal infant hemolytic anemia.

At the pregnancy, blood type (Rhesus type, ABO type) of father and mother are verified. On that basis, Coombs Test, to check the existence of anti-Rh, anti-A, anti-B antibody, is conducted. Every single neonatal infant born from Rh (-) mother body are tested by direct coombs test, serum bilirubin concentration test, and erythrocyte morphology test. There is a case for which amniotic fluid test is necessary.

For severe case, early expulsion or intrauterine fetal transfusion treatment is applied.

As to preventive method, immediately after (within 72 hours) the birth of Rh (+) infant from naïve Rh (-) mother body, anti-D immune globulin is applied to prevent after delivery mother body from the establishment of sensitization. In addition, the same procedure will take place when naïve Rh (-) mother body miscarried. For severe rhesus blood incompatible pregnancy, there exist a risk that the fetus develops extreme anemia/hydrops and die. In this case, intrauterine fetal transfusion, or apply blood transfusion after early expulsion. For intrauterine fetal transfusion, there are two methods, the one is to inject intra-abdominal Rh (-) concentrated red cells under ultrasonic guidance, or the other is to transfuse blood directly into fetus blood vessel. In case fetal edema is possibly considered by amniotic fluid test, and if there past 30 weeks pregnancy, early expulsion method is taken place.