Clinical Management of Hemolytic Disease of the Newborn and Fetus

摘要: Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal alloantibodies directed against antigens present in fetal red cells. Paternally inherited Rh system, which differ to those from mother, are on cells when immune system makes contact with a significant number these create an response antibodies antigens. This may happen because fetomaternal transplacental bleeding (in traumatic events during pregnancy, obstetric procedures, labor, cesarean section) or unrelated such as transfusion, contamination needle use, etc. Maternal (IgG) can cross placenta activate macrophages spleen cause cell destruction subsequent hemolytic anemia. leads jaundice kernicterus hydrops death fetus. Before 70’s, HDFN was major problem, that had large impact neonatal morbidity mortality. Today, without appropriate programme, up 50% untreated will result severe brain damage. In developing countries, especially lacking efficient prophylactics progamme, this causes important public health problem. fact, it has been estimated more than 50 thousand fetuses could be affected condition every year India (Zipursky Paul, 2010). With established use post-natal anti-D prophylaxis for rhesus (Rh) negative women, together its increasing routine antenatal prophylaxis, incidence Rh-D sensitization dramatically fallen (Hughes RG et al., 1994). Nevertheless, 15-17% Caucasian population Europe North America D (Ubarkian S, 2002). other Kell RhC/c, RhE/e, pathology still affect pregnancies year, financial implications (Abdel-Fattah SA 2002; Illanes S Soothill P, 2009). England Wales, about 520 develop each 37 would die period 28 developmental problems (Daniels G 2004, NICE 2008). On hand, HDFN, survival rates exceed 90 percent if anemia diagnosed treated intrauterine blood transfusions timely manner (Van Kamp IL 2001). Women rising antibody levels usually referred tertiary medicine units specialized management. The main challenge facing