HAEMOLYTIC DISEASE OF THE NEW

BORN
A 30 year old female had an abortion
at 25 weeks.Foetus on exam was
severly anaemic,had pleural effusions
and ascites(hydrop foetalis).The first
baby is alive and well but on
questioning the mother indicated that
the child was very “yellow” at birth
.Her blood group is O negative
.Husband’s is A positive. For some
unknown reason anti-D injection was
not given during the first pregnancy
or immediately after delivery.

QUESTIONS

(a)Discuss the pathology of

haemolytic disease of the new born
and complications in your patient.

(b)Causes of hydrops foetalis

( c)Other causes of haemolytic

INTRODUCTION

Also known as erythroblastosis

foetalis

Haematological disease in the

newborn that occurs mostly due to
rhesus incompatibility

Mother is rhesus negative while

fetus is rhesus positive

Can occur due to non-immune

causes e.g trisomy 13
Rarely occurs in first pregnancy

Disease is now reducing in

incidence

RhoGAM vaccination
pathology
Initial exposure to foreign
antigen
Feto-maternal haemorrhage due
too
trauma,abortion,childbirth,medic
al procedures
B lymphocyte clones that
recognize red blood antigen are
established
Initially maternal antibody
production is of IgM
This is termed as the primary
response

Rarely occurs in first pregnancy

After sensitisation either on current

pregnancy or subsequent maternal
anti-D cross into fetal circulation
Antibodies then attach to rhesus
antigen on fetal cells
form a rosette on macrophages in
reticulo-endothelial system
antibody coated red blood cells are
lysed by lysosomal enzymes

released by macrophages and

natural killer cells

This is independent of complement

system
COMPLICATIONS IN THE
PATIENT
The patient was severely
anaemic, had ascites, and pleural
effusions
Anaemia:due to the massive
hemolysis of the blood cells that
occurs in haemolytic disease of
the newborn.
ASCITES
Heart failure occurs in haemolytic
disease of the newborn leading to
hepatomegally,reduced liver
function-protein synthesis

Oncotic pressure

Portal hypertension
PLEURAL EFFUSION
Reduced oncotic pressure

Pulmonary congestion due to

heart failure
CAUSES OF HYDROPS
FETALIS
ANAEMIA:Immune causes e.g.
rhesus factor, kell antigens, kidd
blood group,duffy blood group

CARDIAC
DYSRHYTHMIAS:Supraventricular
tachycardia, trial flutter, congenital
heart block

STRUCTURAL HEART
LESIONS:Premature closure of
foramen ovale, tricuspid
insufficiency
VASCULAR:thrombosis of umbilical
vein or inferior venacava, true knot
of umbilical cord

LYMPHATIC:Lymphangiectasia,
cystic hygromachylothorax, chylous
ascites

THORACIC LESIONS: diaphragmatic

hernia, mediasternal teratoma

TERATOMAS:saccroccygeal
teratoma, Choriocarcinoma
CHROMOSOMAL
ABNORMALITIES:Trisomy 13,
15,16,18,21.

BONE DISEASES:Osteogenesis
imperfect, asphyxiating thoracic
dystrophy, skeletal dysplasia

CONGENITAL
INFECTIONS:Cytomegalo virus,
parvovirus B19, rubella,
 OTHER CAUSES OF
HAEMOLYTIC DISEASE OF
THE NEWBORN
Haemolytic disease of the newborn
due to ABO incompatibility
Kell group antibodies(anti-K and
anti-k)Cause severe fetal
anaemia

Kidd blood group (anti-Jka and

anti-Jkb).causes mild form of
haemolytic disease
Duffy blood group(anti-
Fya).glycoprotein receptor that
binds cytokines during
inflammation.

MNS and s blood group

antibodies
END
THANK YOU