Hemolytic Disease of the Newborn

Aka: Hemolytic Disease of the Newborn, Erythroblastosis Fetalis

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II. Pathophysiology

  1. Maternal Rh Sensitization
    1. Maternal anti-Rh Antibodies are present in newborn plasma
  2. Results in fetal Hemolytic Anemia (Alloimmune Hemolytic Anemia)
    1. Increased Unconjugated Hyperbilirubinemia
    2. Compensating Erythropoiesis
    3. Hepatosplenomegaly
      1. Red Blood Cell production and destruction
    4. Placenta enlarged
  3. Additional Risk Factors
    1. G6PD Deficiency (highest risk for Kernicterus)

III. Labs

  1. Direct Antibody Test (Direct Coombs test) positive

IV. Differential Diagnosis

  1. Hereditary Spherocytosis
  2. Inherited Hemoglobinopathy (Sickle Cell Anemia, Thalassemia)

V. Complications

  1. Fetal hydrops
  2. Hemolytic Anemia
  3. Congenital Anemia (Mild Hemolysis)
  4. Icterus Gravis (Severe Hemolysis)
  5. Kernicterus

VI. References

  1. Phillips (2018) Am Fam Physician 98(6): 354-61 [PubMed]

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