Dr. Abhijeet Deshmukh

Erythroblastosis Fetalis

Topics of discussion

• What is Erythroblastosis Fetalis?• What is Rh incompatibility?• Signs of Rh incompatibility.• Diagnostic tools.• Prevention. • Treatment.

Definition

Erythroblastosis Fetalis is a hemolytic anemia in the fetus or neonate, caused by trans-placental transmission of maternal antibodies to fetal RBCs. The disorder usually results from incompatibility between maternal and fetal blood groups, often Rh antigens.

Types

• ABO incompatibility

• Rh incompatibility

Rh incompatibility

• Mother Rh-Positive & fetus Rh-Negative.• RBCs from the fetus can go into the mother’s

bloodstream through the placenta. • Rh-Negative mother’s immune system treats

the Rh-Positive fetal cells as a foreign substance and makes antibodies against them.

• These anti-Rh antibodies may cross the placenta into the fetus, where they destroy the fetus’s circulation red blood cells.

• First-born infants are often not affected unless the mother has had previous mis-carriages or abortions, which could have sensitized her system for developing antibodies.

Signs

Mother• Polyhydramnios in mother.Baby• Pallor ++ • Hepatosplenomegaly – signifying active

haemolysis• Jaundice MAY NOT be there at birth – since the

mother’s kidney will take out the excess bilirubin– Jaundice develops in the next few hours of delivery

• Hypotonia• Mental retardation and hearing problems in

the long term

• Polyhydramnios- Presence of excessive amniotic fluid

surrounding the fetus.

Exams and Tests

• A positive Coombs’ Test result – Direct and Indirect Coomb’s test

• Fetal Blood Sampling ( FBS ) for Rh sensitization during pregnancy.

• A high Level of bilirubin in the baby’s cord blood

Coombs’ Test:The Coombs’ test looks for antibodies that may bind to fetal blood cells and causes premature RBC destruction ( hemolysis).

Indirect Coomb’s test (Mother)- for unbound circulating antibodies against red blood cells & used to determined if the person have a reaction to blood transfusion.

Direct Coombs’ test (Baby) - to detect antibodies that are already bound to the surface of red blood cells in the baby.

• Fetal Blood Sampling ( FBS ) for Rh sensitization- Directly from the umbilical cord or fetus. - Tested for signs of anemia. - FBS is also known as cordocentesis or percutaneous umbilical cord blood sampling.

- FBS is used to look at a fetus's red blood cell count and oxygen level, and it also looks for signs that your immune system is destroying fetal red blood cells.

Prevention

- Rh immune globulin

• Rh immune globulin contains antibodies to the Rh factor in blood.

• The antibodies come from mother’s blood stream had been sensitized to Rh factor.

• Giving these Rh antibodies to an Rh-Negative pregnant woman prevent her immune system from producing its own anti-Rh antibodies, which would attack the Rh-Positive red blood cells of the fetus.

• Given to all Rh-Negative women who may be carrying an Rh-Positive fetus.

• It cannot prevent damage to an Rh-Positive fetus if their mother is already sensitized to Rh factor.

• Rh immune globulin should be given to an Rh-negative woman to prevent sensitization :

1. After amniocentesis, fetal blood sampling or CVS..2. When bleeding occurs in the second or third trimester

of pregnancy. 3. At 28 weeks of pregnancy. 4. After an external cephalic version of a breech fetus. 5. After abdominal trauma during pregnancy. 6. Within 72 hours after delivery of an Rh-positive infant. 7. After a threatened or complete miscarriage, or an

induced abortion. 8. Before or immediately after treatment for ectopic

pregnancy or a partial molar pregnancy.

Treatment

• Affected baby should be treated with:–Aggressive hydration–Early Phototherapy–Early Exchange transfusion if required• Removes Bilirubin• Removes antibodies• Removes sensitised cells which are liable to be

haemolysed• Replaces the RBC numbers – haemolysed

• Antenatal Management– Mother’s titres Positivity / rise in titres– Giving Anti D to the mother– Amniotic fluid bilirubin levels (Lilleys charts) to

look at early delivery– Foetal transfusion to prevent onset of severe

anaemia and cardiac failure – Hydrops foetalis

• Fetal Blood Transfusion - Transfusions can be given through the fetal umbilical vein

An intrauterine transfusion provides blood to Rh-positive fetus when fetal red blood cells are being destroyed by Rh antibodies.

A blood transfusion is given to replace fetal red blood cells that are being destroyed by the Rh-sensitized mother's immune system.

This treatment meant to keep the fetus healthy until he or she is mature enough to be delivered .

• In a severely affected fetus, transfusions are done every 1 to 4 weeks until the fetus is mature enough to be delivered safely.

• Amniocentesis may be done to determine the maturity of the fetus's lungs before delivery is scheduled.

THANK YOU!

• Hypotonia ( floppy infants )- Decreased muscle tone. - Floppy & feels like a “rag doll” when held.

- Their elbows and knees are loosely extended, while infants with normal tone tend to have flexed elbows and knees. - Head control may be poor or absent,

with the head falling to the side, backward/forward,