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Hemolytic Disease of the Fetus and Newborn, Pediatric

Maureen M. Gilmore, MD Reviewed 10/2018
 


BASICS

DESCRIPTION

  • Hemolytic disease of a fetus or newborn (HDFN) occurs due to the destruction of fetal and newborn red blood cells (RBCs) by maternal antibodies passively transferred across the place...

DIAGNOSIS

HISTORY

  • Maternal exposure to incompatible blood products

  • Previous stillbirths and/or abortions

  • Neonatal hyperbilirubinemia requiring exchange transfusion in previous pregnancy

  • RhIG not given aft...

TREATMENT

GENERAL MEASURES

  • Antenatal

    • Serial fetal monitoring

    • Intrauterine RBC transfusion: for severely affected fetuses (fetal Hct <25–30%) where early delivery is not possible; usually performed aft...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Hgb/Hct and reticulocyte count every 1 to 2 weeks for first 2 to 3 months, especially for infants who had exchange transfusion, due to risk of l...

ADDITIONAL READING

  • Garabedian C, Rakza T, Drumez E, et al. Benefits of delayed cord clamping in red blood cell alloimmunization. Pediatrics.  2016;137(3):e20153236. [View Abstract on OvidInsights...

CODES

ICD9

  • 773.1 Hemolytic disease of fetus or newborn due to ABO isoimmunization

  • 773.0 Hemolytic disease of fetus or newborn due to Rh isoimmunization

  • 773.2 Hemolytic disease of fetus or newborn due to ...

FAQ

  • Q: Why does the Rh isoimmunization become worse with each pregnancy?

  • A: Most sensitizing fetomaternal hemorrhages occur at delivery. In the first exposure, mother produces IgM antibodies, which doe...

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