Haemolytic disease of the foetus and newborn
review article and a retrospective analysis of patients hospitalised at a tertiary neonatal centre during 2007-2016
Abstract
Haemolytic disease of the foetus and newborn (HDFN) occurs when maternal alloimmune antibodies cross the placenta to the foetal circulation and cause destruction of erythrocytes, resulting in anaemia and hyperbilirubinemia. It can result from naturally present antibodies, such as anti-A and anti-B antibodies, or isoantibodies produced by women previously sensitised during pregnancy or transfusion of incompatible erythrocytes such as anti-D antibodies. RhD antigen is the most immunogenic and causes severe HDFN, while the spectrum of HDFN due to AB0 incompatibility ranges from subclinical to severe, requiring exchange transfusion. Thanks to effective and widely implemented prophylaxis with administration of anti-D immunoglobulin to RhD negative women, the HDFN due to anti-D is nowadays a rare disease.
Present paper provides an overview on the pathophysiology, clinical characteristics, diagnostics, treatment and prevention of HDFN. In the second part of the article we present the results of a cohort retrospective analysis of 109 patients with HDFN hospitalised at the tertiary neonatal unit during 2007–2016. In 84.4 % of cases the underlying cause of HDFN were antibodies anti-A or anti-B, in 9.2 % of cases antibodies anti-D and in 6.4 % other more rare antibodies. HDFN caused by different antibodies did not result in statistically significant differences in the evaluated hematological tests. Direct Coombs test was positive in all patients with HDFN RhD and in 64 % of newborns with HDFN AB0. All patients with HDFN RhD required exchange transfusion or intrauterine transfusion.
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References
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