Rhesus haemolytic disease of the newborn, also known as Rh disease or erythroblastosis fetalis, is a condition that can affect newborn babies whose mothers are Rh-negative and whose blood comes into contact with Rh-positive blood from the baby. This article explores the causes, risk factors, symptoms, diagnosis, treatment, and prevention strategies associated with Rhesus haemolytic disease of the newborn.
Causes and Mechanism
Rhesus haemolytic disease occurs when there is an incompatibility between the blood types of the mother and fetus. The Rh factor is a protein found on the surface of red blood cells. If a Rh-negative mother carries a Rh-positive fetus, there is a risk that fetal red blood cells may enter the maternal circulation during pregnancy or childbirth. This exposure can sensitize the mother’s immune system to Rh-positive blood cells, leading to the production of antibodies.
Risk Factors
The primary risk factor for Rhesus haemolytic disease is Rh incompatibility between the mother and fetus. Other risk factors include:
- Previous Pregnancy: A history of Rh incompatibility in a previous pregnancy increases the risk of developing antibodies against Rh-positive blood cells.
- Blood Transfusion: Rh-negative individuals who have received Rh-positive blood during a transfusion may develop antibodies.
- Miscarriage or Abortion: Any event during pregnancy, childbirth, or abortion that causes fetal blood to enter the maternal circulation can sensitize the mother.
Symptoms
The severity of Rhesus haemolytic disease can vary widely depending on the level of maternal antibodies and the extent of fetal red blood cell destruction. Symptoms may include:
- Mild Cases: Mild cases may present with mild jaundice (yellowing of the skin and eyes) in the newborn due to the breakdown of red blood cells.
- Severe Cases: Severe cases may lead to fetal or neonatal anemia, jaundice, enlarged liver and spleen, fluid accumulation (edema), and potentially life-threatening complications such as brain damage or stillbirth.
Diagnosis
Diagnosis of Rhesus haemolytic disease typically involves:
- Maternal Blood Tests: Blood tests to determine the mother’s blood type and Rh factor, as well as to detect the presence of Rh antibodies.
- Amniocentesis: In some cases, amniotic fluid may be tested for levels of bilirubin, a substance produced from the breakdown of red blood cells, which can indicate the severity of fetal anemia.
- Ultrasound: Ultrasound scans may be used to monitor fetal development and detect signs of fetal anemia or other complications.
Treatment and Management
Treatment of Rhesus haemolytic disease depends on the severity of the condition and may include:
- Intrauterine Transfusion: In severe cases of fetal anemia, blood transfusions may be performed while the fetus is still in the womb to correct the anemia and prevent complications.
- Phototherapy: Phototherapy may be used to treat jaundice in newborns by helping to break down excess bilirubin in the blood.
- Exchange Transfusion: In cases where newborns develop severe jaundice or complications, exchange transfusion may be performed to replace the baby’s blood with Rh-negative blood to remove antibodies and bilirubin.
Prevention
Prevention strategies for Rhesus haemolytic disease include:
- Rh Immunoglobulin (RhIg) Injections: Rh-negative pregnant women are routinely given RhIg injections during pregnancy and within 72 hours after childbirth or any event where fetal blood may enter the maternal circulation (such as miscarriage or abortion). RhIg prevents the mother’s immune system from developing antibodies against Rh-positive blood cells.
- Blood Typing and Antibody Screening: Regular blood tests during pregnancy to monitor for the development of Rh antibodies and to assess the risk of Rhesus haemolytic disease.
Rhesus haemolytic disease of the newborn is a condition that can have serious implications for both mother and baby if not properly managed. Through early detection, monitoring, and appropriate medical interventions such as RhIg injections and intrauterine transfusions, the risks associated with this condition can be significantly reduced. Understanding the causes, symptoms, diagnosis, treatment options, and prevention strategies is essential for healthcare providers and expectant mothers alike to ensure optimal maternal and fetal outcomes.