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Immunohaematology I
Lesson 12:
Hemolytic Disease of Newborn II
Laboratory Investigation
Cord blood from infants born to Rh-negative
mothers should be tested for the D antigen
An Rh-negative woman with an Rh-positive
infant should receive one full dose of RhIG
within 72 hours of delivery, unless she is
known to be alloimmunized to D already
The presence of residual anti-D from
antepartum RhIG does not indicate ongoing
protection
Neonatal studies
Cord blood samples should be collected from
every newborn and stored for at least 7 days
in the transfusion service in the event the
newborn shows signs of HDN
If HDN is suspected, both cord and maternal
blood should be tested for ABO and Rh (and
weak D if apparently D negative)
The maternal blood should also be tested for
unexpected antibodies if the mother is D
negative and the infant is D positive
ABO/Rh Testing
Newborns who were transfused while
intrauterine often type Rh negative or weakly
Rh positive because so much of their
circulating RBCs are of donor origin
ABO grouping also reflects the donors ABO
group and may exhibit mixed-field reaction
with ABO antisera or, if the HDN is quite
severe , may group as an O
Cord blood
ABO forward only
Rh including weak D if D-negative
Direct antiglobulin test
If direct antiglobulin test is positive, do elution
and antibody identification test on eluate
Intrauterine Transfusion
Postpartum
Two consequences of HDN that may require
intervention and treatment after birth are
hyperbilirubinemia and anemia
High level of free unconjugated bilirubin are
associated with neurotoxicity
Treatment modalities for hyperbilirubinemia
are phototherapy sessions or exchange
transfusions
Phototherapy
Accelerates bilirubin metabolism through the
process of photodegradation
Effective wavelength = 420-475 nm
The insoluble form of unconjugated bilirubin is
converted into a water-soluble form, which
permits more rapid excretion, without
conjugation, through the bile or urine
Phototherapy
Exchange transfusion
When the serum bilirubin reaches a level of 18 to
20 mg/dL in any infant with HDN, exchange
transfusion must be performed
The coated infant RBCs are removed and replaced
with RBCs with normal survival
This reduces the potential for increased bilirubin
as well as reducing some of the bilirubin already
formed
Selection of blood
The RBCs used in an exchange transfusion are
from a donor whose blood type is compatible
with the mother and infants serum
It is estimated that an exchange transfusion
with a volume double that of the infants
blood volume replaces approximately 85% of
the infants circulating RBCs