ERYTHROBLASTOSIS FETALIS
This is a condition in which the red blood cells are destroyed by an autoimmune system of our body and thereby cause oxygen depletion and tissue death. The condition is very serious and fatal.
Rh factor is a kind of an inherited protein usually present on the surface of the red cells(RBC). People whose RBC contains Rh factor are considered to be Rh-positive. On the contrary those whose RBC not contains Rh factor are considered to be Rh-negative.
If the mother is Rh-negative and the father is Rh-positive then the child would be mostly Rh-positive. If this is the case then the pregnancy will be risky for both mother and child. During such pregnancy if any opportunity occurred for mixing the mother and baby's blood on either side then it is fatal and risky of getting erythroblastosis by any of them or both.
OPPORTUNITIES
1. During delivery when the placenta detaches from the uterus wall.
2.Pregnancy with heavy bleeding
3.Manual rotation of a breech baby
4.Miscarriage (premature delivery or spontaneous abortion)
5.Ectopic pregnancy(PREGNANCY OUTSIDE WOMB)
6.Abortion
7.Traumas, or a sudden fall.
8.Invasive prenatal tests such as amniocentesis or chorionic villus sampling.
Dangerous Rh sensitization occurs in the mother during chorionic villus sampling. The Rh-negative mother is at risk by mixing her baby's potentially Rh-positive blood with her own.
As a result the mother's body immune system will recognize in future any blood entry of the Rh-positive factor as a foreign body and will attack them. The antibodies produced by the mother may pass into the fetus also and causes the destruction of its RBCs.The result is the death of a fetus or illness due to erythroblastosis and abortion.
The Rh-positive contamination can occur due to careless uses of contaminated injection needles, and blood transfusion.
Erythroblastosis may not occur due to the difference in blood groups.
The fetus may be born with defective blood or illness. The RBCs of the fetal blood are destroyed. They lost their oxygen-carrying function. Severe anemia will stimulate the liver, spleen, and bone marrow to produce more RBC. This may cause organ damage. Excess formation of bilirubin as a byproduct of RBC damage may cause jaundice and the baby will look yellow in color.
Symptoms
1.Yellowish amniotic fluid (The fluid-filled in the pregnant womb) due to excess bilirubin seen on an amniocentesis test
2.An enlarged liver, spleen or heart
3. Fluid builds up in the abdomen, lungs, and scalp can be recognized by an ultrasound scan test.
Newborns may bear with the following symptoms
1.Pale skin
2.Yellow amniotic fluid, umbilical cord, skin, or eyes either at birth or within 24 to 36 hours after delivery.
3.Organs such as liver or spleen enlargement
4.Breathing difficulties due to full body fluid build-ups.Heart failure. The condition is known as Hydrops Fatalis
Complications
1.Mild to severe anemia
2.Jaundice
3.Organ enlargement
4. Kernicterus:-Excess bilirubin build up in the brain causes deafness, seizures, brain damages, and death.
Diagnosis and Treatments
1. A test for Rhesus or Rh factor may be helpful to diagnose and treat the problem.
An antibody screening test in the first semester, followed by a repeat test after 28 weeks of gestation.
This may reveal a clear knowledge about the presence of Rh incompatibility during pregnancy.
2. Testing the fetus include ultrasound test, amniocentesis, fetal middle cerebral artery blood flow measurement, and fetal umbilical cord blood testing.
After birth in the newborn tests for hemolytic anemia must be carried out.
1.Test for blood group and Rh factor
2.RBC count
3.Test for antibodies and bilirubin levels.
The treatments include fetal blood transfusion and delivery of the baby between 32 to 37th week of gestation.
Treatments of the newborn should be carried out with the following conditions:-
1.Blood transfusion
2.Intravenous fluids
3.Management of breathing difficulties
4.Use of Intra Venous Immuno Globin. The use of IVIG antibody treatment is to reduce the RBC destruction and to control bilirubin raise.
Some times exchange transfusions are carried out by replacing a portion of the newborn's blood in order to increase RBC count and to minimize the bilirubin level.
Prevention
The Rh sensitization can be prevented by giving the medication Rh immunoglobin (RhIg) also known as RhoGAM before women become sensitized.
This is medication helps the mother not develop destructive antibodies.
But this medicine may not helpful to those women who have been already sensitized
Hence this medicine can be helpful only to those women who are not yet sensitized but at the risk of sensitization.RhoGAM can be given as follows:
1.After 28th week of gestation
2.72 hours following delivery
3. Within 72 hours of miscarriage, abortion, or ectopic pregnancy.
4.Following an invasive prenatal test such as amniocentesis, and chorionic villus sampling.
5. Following vaginal bleeding, if any
If a woman carries beyond 40 weeks of gestation an additional dose of RhoGAM is recommended.
