Haemolytic Dis Of Newborn

Question 1

Physiology

Answer 1

Maternal Ab cause baby haemolysis. Natural or sensitised AB (eg transfusion).
One eg is rhesus alloimmunisation. Due to several rhesus Ags, but mostly D.
ABO incompat now biggest western cause as antiD therapy.

Question 2

complics

Answer 2

Anaemia- HF, hydrops

Neonatal jaundice- kernicterus

Question 3

RFs

Answer 3

Alloimmunisation during prev preg
Failed prophylaxis
Traumatic deliv eg C sec
Manual placenta removal
Stillbirth or IU death
Abdo trauma during 3rd trimester
Multiple preg
Unexpl hydrops fetalis

Question 4

px

Answer 4

Coombs test detects antiD Ab in mum antenatally (Done in all rhesusD neg women)
USS detects hydrops fetalis or polyhydramnios
Neon- Jaundice, Hepatosplenomegaly, kernicterus, hydrops (subcut oedema, pericard effus, pleural effus, ascites, hepatosplenomeg), petechiae, high cord bili.
Thickened placenta

Question 5

diffs

Answer 5

Rh, ABO, Kell, Duffy, MNS, S Abs
IU congenital infec eg syph, CMV, parvo
Eryhtrocyte mem defects
RBC enz defics
Enclosed haemorrhages
Hypothyr
GI obstruc
Metabolic dis

Question 6

Ix

Answer 6

Indirect coombs test- for all RhD neg mums, monitor if pos
Non invasive rhesus genotyping
USS for hydrops signs
Doppler US of MCA for fetal anaemia
Fetal bloods- if doppler pos. US guided. FBC (anaemia, retics, DIC) and chem eg gluc.
Cord blood sample after birth- ABO and Rh, direct coombs, Hb, basel bili.

Question 7

mx

Answer 7

In utero- RBC transfus if fetal anaemia
After born-
Jaundice therapy
Mx of haemolysis- resus, temp stabilisat, exch transfus, IVIG early

Question 8

DAT aka coombes

Answer 8

Detects Abs bound to RBC Ags