Rhesus Haemolytic Disease and Haemorrhagic Disease of the New-born

Question 1

What is the pathophysiology of rhesus haemolytic disease?

Answer 1

1. RhD-ve mother delivers Rh+ve baby, leak of foetal RBC enters circulation and stimulates anti-D IgG production.
2. In subsequent pregnancies, they cross the placenta causing worsening rhesus haemolytic disease.

Question 2

What is this a presentation of?
Neonate, jaundice from day 1, congestive cardiac failure, oedema, ascites, hydrops fetalis, progressive anaemia, hypoalbuminaemia (liver is busy making RBCs).

Answer 2

Rhesus haemolytic disease

Question 3

What is the management for rhesus haemolytic disease?

Answer 3

1. Mild disease - phototherapy

2. If Hb <7g/dL - exchange transfusion

Question 4

What is another name for haemorrhagic disease of the newborn and when does it occur?

Answer 4

1. Vitamin K deficiency bleeding

2. 2-7 days postpartum

Question 5

What is the cause of haemorrhagic disease of the newborn?

Answer 5

No enteric bacteria to make vitamin K

Question 6

What are the clinical features of haemorrhagic disease of the newborn?

Answer 6

1. Baby well apart from bruising/bleeding

2. PT and aPTT raised, platelets normal

Question 7

How is haemorrhagic disease of the newborn prevented?

Answer 7

IM vitamin K at birth

Question 8

What is the active management for bleeding in haemorrhagic disease of the newborn?

Answer 8

IV FFP and IV vitamin K