erythroblastosis fetalis
Hemolytic disease of the newborn (HDN) results when maternal antibodies attack the fetal red blood cells, leading to a hemolytic anemia and accumulation of bilirubin in the fetus or newborn. It can affect the newborn to varying degrees of severity. When the condition occurs in utero, the term is expanded into hemolytic disease of the fetus and newborn (HDFN) (or erythroblastosis fetalis).
The condition is now uncommon due to the practice of giving anti-immunoglobulin when the mother is Rhesus negative.
Clinical presentation
The newborn can present with a number of features including:
- clinical evidence of a fetal anemia
- neonatal jaundice
- neonatal hepatosplenomegaly
- generalized body edema
Pathology
The condition usually results from a feto-maternal blood group incompatibility such as:
- ABO incompatibility
- rhesus (Rh) incompatibility
This results in the destruction of fetal red blood cells by maternal IgG antibodies that cross the placenta.
Radiographic features
Antenatal ultrasound
May show evidence of or complications related to a fetal anemia such as:
- development of hydrops fetalis
- increase in fetal middle cerebral arterial (MCA) Doppler time average mean velocity (TAMV): may occur before precipitation of fetal hydrops
- increase in fetal middle cerebral arterial (MCA) Doppler peak systolic velocity (PSV): may occur before precipitation of fetal hydrops
Treatment and prognosis
Depending on the extent of severity, blood transfusion may be required.
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