Mother & Baby Blood Mismatch – Causes and Treatment of Erythroblastosis Fetalis
Holding the newborn in the hands is the experience which is truly unexplainable. But this happiness comes with a lot of sacrifices and care. The most important of those careful things is to be aware of diseases related to newborns and how to take essential steps to keep them off.
Hemolytic disease of the newborn is one such condition that could prove life-threatening for some infants. Let’s learn more about this condition and how can we prevent this.
Hemolytic disease of the newborn
Also known as Erythroblastosis Fetalis, Hemolytic disease of the newborn (HDN) is a blood disorder in a newborn in which red blood cells circulating in the blood are destroyed. Human body contains trillions of red blood cells which are also called as RBCs or erythrocytes. These cells transfer iron, oxygen and other essential nutrients to various parts of the body.
When a woman is pregnant, it could be possible that her blood type will be incompatible with her baby’s blood. This can lead to hemolytic disease of the newborn or Erythroblastosis Fetalis. In this condition, the white blood cells (WBCs) of the mother attack the red blood cells of the unborn baby considering them as foreign invaders. This can lead to anemia in the fetus.
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What causes Erythroblastosis Fetalis?
There are primarily two causes of Erythroblastosis Fetalis or hemolytic disease of the newborn; Rh blood incompatibility and ABO blood incompatibility. As we know there are four blood types in human beings; A, B, AB, and O. Blood types can be either Rh positive or Rh negative.
If a person with type A blood is Rh positive, then they will have A and Rh factor antigens (substance that produces antibodies) in the red blood cells. On the other hand, if a person has AB negative blood type, they will have both A and B antigens without the Rh factor antigen. The Rh antigens are also known as D antigens.
Rh blood incompatibility
This mismatch can occur when an Rh negative woman gets pregnant with an Rh positive man. This could result in an Rh positive baby. In this case, the Rh antigens of the baby will be perceived as a foreign invasion, as generally the way bacteria and viruses are perceived. The mother’s protective immune system cells or white blood cells then attack these Rh antigens considering them as foreign invaders, ending up harming the child.
The point to be noted here is that the first pregnancy with Rh incompatibility is not a problem since these antibodies formed initially cannot cross the placenta and harm the child. However, after an Rh positive baby is born, the mother’s body creates anti-bodies against the Rh factor or D antigens. So in future pregnancies, if maternal immune system cells come in contact with D-antigen or Rh factor, then these immune cells can cross the placenta and mark the D-antigen for destruction.
This condition occurs when the maternal blood type A, B or O finds incompatibility with the baby’s blood type. However, this condition is considered less harmful then the Rh incompatibility.
Symptoms of Erythroblastosis Fetalis and Effect on the baby
It can happen that the mismatch in the first pregnancy remain unknown due to miscarriage or where there is lack of preventive measures (see below), then future pregnancies can be affected. Unfortunately, after the first affected pregnancy, the condition gets worse with every future pregnancy.
- Symptoms depend on the severity of the blood cells breakdown also known as hemolysis. Mildly affected babies will experience minor anemia or jaundice that doesn’t even require treatment. But if the red blood cell breakdown is serious, then the newborn would experience severe jaundice (excessive bilirubin).
- Unfortunately, this breakdown of red blood cells doesn’t stop even after the baby is born, since maternal antibodies linger around in the baby’s body for several weeks. On the other hand, in some cases anemia in pregnancy is so severe that it let liver and spleen enlarge to increase the production of red blood which leads to liver failure of the child.
- The hemolytic disease may also lead to a condition called as hydrops. In this disorder, watery fluid starts accumulating in the spaces where fluid is not normally present such as heart, abdomen and lungs. This can be grievous as it can affect the functionality of these vital organs.
How Erythroblastosis Fetalis is diagnosed?
During the pregnant woman visit to the doctor, he will order blood test to check the blood type. If the woman has Rh negative blood with Rh antibodies, then the blood of the father will be tested. If father’s blood is Rh negative, no further testing is required.
But if his blood type is Rh positive, then the mother’s blood will be retested between 18-20 weeks and again at 26-27 weeks. The doctor might also order blood test from umbilical cord to check the blood type and group of the baby.
If there is no Rh incompatibility found in the baby after birth but still he/she is jaundiced, then it must be due to ABO blood incompatibility. This often occurs when a mother with O blood type delivers a baby with A, B or AB blood type. This incompatibility can be tested through a blood test called as Coombs test performed after the birth of the baby. This can reveal the reason behind jaundice and anemia.
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Treatment and Prevention
If the condition is detected early, a preventive treatment called as RhoGAM or Rh immunoglobin injection is administered. The shot given at 28th week of pregnancy can reduce mother’s immune system reaction to the baby’s Rh positive red blood cells. The injection is given again 72 hours after the delivery, provided the baby’s blood is Rh positive.
If the baby experiences hemolytic disease in the womb itself, then the doctor might ask for intrauterine blood transfusions in order to reduce anemia. Further, if the doctor sees that the heart and lungs of the baby has matured enough, then he may recommend early delivery.
After the birth, blood sample might be sent for testing anemia and bilirubin levels of the infant. The elevated bilirubin levels or jaundice can be treated with phototherapy in which the baby is placed under blue lights. In the case of anemia, blood transfusions might be needed.
Once you are discharged from the hospital, you must seek close followup with the pediatrician or a hematologist to keep monitoring your child for anemia. Remember, the maternal antibodies can be harmful for the newborn for the next 4-6 weeks post-delivery.
If you take prenatal care and postpartum care seriously, then there are fewer chances of your baby developing complications.