ABO Incompatibility as a Cause

of Hemolytic Disease of the

Newborn
GROUP 5
Nobleza, Yasmin
Opulencia, Miguel
Pagsisihan, Christine Israel
Queg, Christine Louise
Reyes, Alyza Marie
Rivas, Sarah Erika Mae
Rivera, Camille Anne

INTRODUCTION

ABO Incompatibility is a fairly common and milder type of hemolytic disease of

the newborn
Caused by the result of an immune system reaction.
Rh Incompatibility, another hemolytic disease of the newborn
Associated with poorer fetal outcomes.
ABO incompatibility occurs when blood from two different - and incomparable types of blood are mixed together.
ABO incompatibility is a relatively common type of hemolytic disease of
newborns
May occur during blood transfusion reactions of older people.
In contrast to an Rh Incompatibility of the newborn, ABO incompatibility of the
newborn does not generally become more severe with subsequent pregnancies.

ISOIMMUNIZATION
Absence of factor A and B
o Presence of natural antibodies against A and B
o Isoagglutinins agglutinins against antigens of the same
species
Antibodies against other blood factors, such as RH
o Not naturally present but from immunization
Pregnancy or blood transfusion
Natural antibodies are immune antibodies against A and B
Prenatally it is impossible to predict hemolytic disease of the
newborn due to ABO incompatibility

OTHER CAUSATIVE FACTORS

Water Solubility of A and B Factors
A and B factors are not only limited to red cells unlike Rh
They are present in almost all tissues in alcohol-soluble form an
also in water-soluble form in the tissue and secretions of people
Rh antibodies concentrate on destructive action on red cells which
came from the mother
May be intercepted by other tissues in ABO incompatibility, limiting
or eliminating the damage to the blood.

 It is claimed that the only one to stimulate enough antibody in the

mother and develop disease is due to the A and B blood groups
More potent antigenically.
The Rh is fully develop in red cells of fetus and newborn unlike the
antigens A and B
A and B factors are less likely to be affected.
A1 and A2 are important antigenic potency of the blood
Factor A1were found to develop hemolytic disease in newborn
but not with the A2
It is considered as antigenically weaker of the two.

Diagnosis and Indication for Therapy

The pathogenesis of hemolytic disease of the newborn due to A and
B
ABO incompatibility is important to recognize as the factor
responsible for hemolytic disease of the newborns.
The prognosis is generally much better than when Rh or some of
the other factors are responsible.
Recognizing ABO incompatibility as responsible for the disease is
important for the diagnosis
Because a (-) antiglobulin test is not given the same weight as
when Rh incompatibility is considered.
In ABO incompatibility, a negative antiglobulin test is not
uncommon
The use of sensitive techniques such as immediate

Diagnosis and Indication for Therapy

Exchange Transfusion
Recognizing the cause of ABO incompatibility as the cause of
disease is also important to know the kind of therapy to provide.
For RH incompatibility disease, the diagnosis is equivalent to an
indication for an exchange transfusion.
A non jaundiced child with a high-normal hemoglobin count,
whose mother has a previous negative obstetric history, or
obstructions to respiration are probably the only exceptions
wherein exchange of transfusion is not indicated.
Meanwhile, for the ABO hemolytic disease, the severity of the
disease is the indication for exchange transfusion.
Even mild jaundice that is not disturbing in an infant born at term
may also be an indication for an exchange transfusion.

Diagnosis and Indication for Therapy

Jaundice
Even though the ABO heterospecificic pregnancy disease is rare
and difficult to diagnose at an early diagnosis
One maybe forewarned by examining closely those minimal
evidence of jaundice within the first 24 hours.
Serum bilirubin level of 10mg. or higher, in newborn at term, in
the absence of an infection, may be considered to be diagnostic
of the hemolytic disease.
Spherocytosis can also be a sign of possible hemolytic disease in
a newborn that results from a heterospecific pregnancy.

Diagnosis and Indication for Therapy

Differential Diagnosis
Witebsky reported a test which promises to add considerably to the
differentiation between hemolytic disease of the newborn caused
by ABO and Rh incomaptibility.
o In normal infant cells, cells are clumped distincly when
suspended in a mixture of normal human serum and 30% bovine
albumin or in a normal human serum alone
o Whereas cells from an infant with ABO disease are clumped
distinctly in normal serum but faintly if at all in the serum
albumin mixture.

 Kurt Stern found homologous Anti A or anti B isoagglutinins in the

cord blood of 11 of 13 infants with ABO HDN
o Whereas only 2 of 34 infants in heterospecific pregnancies
without the disease had similar antibodies.
o These antibodies require the most sensitive methods for their
detection, such as the indirect antiglobulin test, papain-treated
red cells or combination of both.
The direct antiglobulin test is frequently negative when ABO
incompatibility is responsible.

Summary
10% haemolitic disease of the newborn is caused
by ABO compatibility
Diagnosis of haemolityc disease of the newborn
o Rh incompatibility vs ABO incompatibility

Relationship between ABO factors and the disease

o Prognosis and treatment

Prognosis in ABO disease

o Rh incompatibility vs ABO incompatibility (Exchange transfusion)