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Hemolytic disease of the newborn

Hemolytic disease of the fetus and newborn (HDFN); Erythroblastosis fetalis; Anemia - HDN; Blood incompatibility - HDN; ABO incompatibility - HDN; Rh incompatibility - HDN

Hemolytic disease of the newborn (HDN) is a blood disorder in a fetus or newborn infant. In some infants, it can be life threatening.

Normally, red blood cells last for about 120 days in the body. In this disorder, red blood cells in the blood are destroyed earlier than normal.

Causes

During pregnancy, red blood cells from the unborn baby can cross into the mother's blood through the placenta. HDN occurs when the immune system of the mother sees a baby's red blood cells as foreign. Antibodies then develop against the baby's red blood cells. These antibodies attack the red blood cells in the baby's blood and cause them to break down too early.

HDN may develop when a mother and her unborn baby have different blood types. The types are based on small substances (molecules) on the surface of the blood cells.

There are 2 ways that the unborn baby's and the mother's blood may not match.

  • A, B, AB, and O are the 4 major blood types. This is the most common form of a mismatch. In most cases, this is not very severe.
  • If the mother is Rh-negative and the baby in the womb has Rh-positive cells. When this form does occur, it can cause very severe anemia in the baby. It can be prevented in most cases.

Symptoms

HDN can destroy the newborn baby's blood cells very quickly, which can cause symptoms such as:

  • Edema (swelling under the surface of the skin)
  • Newborn jaundice which occurs sooner and is more severe than normal

Exams and Tests

Signs of HDN include:

  • Anemia or low blood count
  • Enlarged liver or spleen
  • Hydrops (fluid throughout the body's tissues, including in the spaces containing the lungs, heart, and abdominal organs), which can lead to heart failure and/or respiratory failure from too much fluid

Which tests are done depends on the type of blood group incompatibility and the severity of symptoms, but may include:

Treatment

Infants with HDN may be treated with:

  • Feeding often and receiving extra fluids
  • Light therapy (phototherapy) using special blue lights to convert bilirubin into a form in which the baby's body can get rid of it
  • Antibodies (intravenous immunoglobulin, or IVIG) to help protect the baby's red cells from being destroyed
  • Medicines to raise blood pressure if it drops too low
  • In severe cases, an exchange transfusion may need to be performed. This involves removing a large amount of the baby's blood, and thus the extra bilirubin and antibodies. Fresh donor blood is infused.

Outlook (Prognosis)

The severity of this condition can vary. Some babies have no symptoms. In other cases, problems such as hydrops can cause the baby to die before, or shortly after birth. Severe HDN may be treated before birth by intrauterine blood transfusion.

Prevention

The most severe form of this disease, which is caused by Rh incompatibility, can be prevented if the mother if the mother is tested during pregnancy. If needed, she is given a shot of a medicine called RhoGAM at certain times during and after her pregnancy. If you have had a baby with this disease, talk with your health care provider if you plan to have another baby.

References

Dahlke JD and Magann EF. Immune and non-immune hydrops fetalis. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 24.

Maheshwari A, Carlo WA. Blood disorders. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 103.

    • Intrauterine transfusion

      Intrauterine transfusion - illustration

      Erythroblastosis fetalis is a condition manifested by anemia that develops in an unborn infant when maternal antibodies, usually caused by Rh incompatibility between the mother's blood type and that of the fetus, attack the red blood cells of the fetus. An intrauterine transfusion of blood may be indicated.

      Intrauterine transfusion

      illustration

    • Antibodies

      Antibodies - illustration

      Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

      Antibodies

      illustration

      • Intrauterine transfusion

        Intrauterine transfusion - illustration

        Erythroblastosis fetalis is a condition manifested by anemia that develops in an unborn infant when maternal antibodies, usually caused by Rh incompatibility between the mother's blood type and that of the fetus, attack the red blood cells of the fetus. An intrauterine transfusion of blood may be indicated.

        Intrauterine transfusion

        illustration

      • Antibodies

        Antibodies - illustration

        Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

        Antibodies

        illustration

      A Closer Look

       

      Tests for Hemolytic disease of the newborn

       

      Review Date: 11/3/2015

      Reviewed By: Kimberly G Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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