Lec 6

• What does HDFN stand for?

  Hemolytic Disease of the Fetus and Newborn
• How does HDFN occur?

  It occurs due to the passage of maternal antibodies across the placenta into the fetal circulation.
• What is the effect of maternal antibodies on fetal red blood cells?

  They cause destruction of fetal red blood cells, leading to a shortened lifespan of these cells.
• What happens to hemoglobin from lysed RBCs before birth?

  It is metabolized into unconjugated bilirubin.
• How does the mother handle bilirubin before birth?

  The mother metabolizes the bilirubin without problems.
• What condition may result from continued RBC destruction in the fetus?

  Anemia may occur in the fetus.
• What severe condition can result from fetal anemia?

  Cardiac failure may result from anemia.
• What happens to bilirubin levels after birth in HDFN?

  Bilirubin accumulates in the baby's circulation.
• Why can't the infant metabolize bilirubin effectively after birth?

  The infant's liver is not functioning at full capacity.
• What are the potential consequences of bilirubin buildup in infants?

  It can lead to jaundice, deafness, mental retardation, kernicterus, or death.
• What is kernicterus?

  Bilirubin accumulation that causes brain damage or death.
• What is the most severe form of Rh Hemolytic Disease of the Newborn (HDN)?

  It occurs when a D-negative mother develops antibodies during her first pregnancy with a D-positive baby.
• What happens to the mother's anti-D antibodies in subsequent pregnancies?

  They attack the fetus if the baby's RBCs are D-positive.
• What laboratory results indicate Rh Hemolytic Disease in newborns?

  Positive DAT and increased serum bilirubin.
• What treatment may be needed to avoid kernicterus in newborns with Rh HDN?

  Exchange transfusion may be needed.
• What are the clinical features of Rh HDN?

  Clinical presentation is variable, ranging from mild anemia and jaundice to severe forms like fresh stillbirth.
• What can damage the basal ganglia in Rh HDN?

  Kernicterus can lead to damage to the basal ganglia.
• What is the most common form of HDN?

  ABO Hemolytic Disease.
• Who is at risk for ABO Hemolytic Disease?


  A or B babies born to O mothers are at risk.
• How is ABO Hemolytic Disease usually treated?

  It is usually not treated by transfusion but by phototherapy.
• What is the purpose of laboratory testing for predicting HDFN?

  To assess the risk and severity of hemolytic disease in the fetus and newborn.
• What tests are performed on the mother prior to delivery for HDFN prediction?

  ABO and D typing, and an antibody screen.
• What is the role of amniocentesis in HDFN?

  It may be used periodically to monitor hemolytic severity during pregnancy.
• What is antibody titration used for in HDFN?

  It is used to predict the severity of HDN.
• When should antibody titers be repeated in positive mothers?

  At 16 and 22 weeks, then every 1-4 weeks until delivery.
• What tests must be performed on cord blood of infants born to D-negative mothers?

  ABO, D, and DAT tests must be performed.
• What is the purpose of exchange transfusion in HDFN treatment?

  It addresses rapidly rising bilirubin concentration to prevent kernicterus.
• How does phototherapy help in treating HDFN?

  It converts unconjugated bilirubin into a soluble form that can be excreted.
• What is the role of albumin infusion in HDFN treatment?

  It binds free bilirubin in plasma and decreases the risk of kernicterus.
• When should Rh immune globulin (RhIG) be administered to D-negative women?

  At 28 weeks and at childbirth.
• What is the postpartum administration protocol for RhIG?

  1. D-negative women who give birth to a D-positive infant need a 300-g dose of RhIG within 72 hours of delivery.
• What are the key features of Hemolytic Disease of the Fetus and Newborn (HDFN)?

  • Destruction of fetal or neonatal red blood cells due to maternal antibodies.
  • Metabolism of hemoglobin into unconjugated bilirubin before birth.
  • Anemia in the fetus leading to potential cardiac failure.
  • Post-birth bilirubin accumulation causing jaundice and other severe complications.
• What are the clinical features and treatments for Rh Hemolytic Disease of the Newborn?

  • Clinical features: variable presentation, mild anemia, jaundice, kernicterus, fresh stillbirth.
  • Treatments: exchange transfusion, phototherapy, and monitoring bilirubin levels.
• What are the laboratory testing protocols for predicting HDFN?

  • ABO and D typing on the mother.
  • Antibody screen on the mother.
  • Amniocentesis for monitoring hemolytic severity.
  • Antibody titration to predict severity.
  • Testing cord blood for ABO, D, and DAT.
• What are the prevention strategies for HDFN?

  • Administration of Rh immune globulin (RhIG) at 28 weeks and at childbirth.
  • Postpartum RhIG for D-negative women with D-positive infants within 72 hours of delivery.
• What is HDFN

  HDFN is a disease in destruction of red cells of the fetus or new born