Abdulla , Madzlina B.

Amil, Alkhadi B.
a

SIGNIFICANT EVENT OF
HDFN

1609

Paris midwives

Description of HDN

1940

Landsteiner -Weiner

Rh system identified

1941

Diamond

Anti-D identitified as cause

common of HDFN

1946

Wallerstein

Neonatal exchange
Transfusion

1958

Cremer and Perryman

Phototheraphy

1963-1964

Freda, Gorman , Polack

POSTPARTUM RhIG

1967

Donald and Abdulla

Ultrasonography

1982

Sebring and Polesky

Rosette screening test for

FMH

1998

Lo etal

Maternal plasma used for

fetal RHD determination.

1961-1963

Liley

Liley Graph for B1B2 in

amniotic fluid and
intrauterine transfusion.

 Also known as Erythroblastosis Fetalis

Disorder of the fetus or new born in which red cells are
destroyed by maternal IgG antibodies
The IgG antibodies cross the placenta and shorten red cell
survival
The Premature red cell destruction results in disease
varying from mild anemia to death in utero.

HDFN/HDN

 Fetal red cells , carrying antigens inherited from the

father, stimulates the mother to produce IgG antibodies.
Maternal IgG antibodies destroy fetal red cells

HDFN Occurs When:

 In the utero, this destruction can cause anemia, which can

result in heart failure and possibly death.
After delivery, red cell destruction continues with the
increase of Bilirubin, causing jaundice and possible
kernictus.

HEMOLYTIC PROCESS CAN

CAUSE THE FOLLOWING:

1. ABO
2. Rh or
3. Other IgG Antibodies.

HDN CAN CAUSED BY :

 ABO antibodies are more commonly involved in new born

red cell destruction than Anti-D.
Most clinical cases are subclinical and do not necessary
treatment
ABO HDN is the most common type of HDN and occurs
mostly in group 0 mothers who delivered group A or B
babies.
In ABO HDN , the 1st born infant may be affected as well
as the subsequent pregnancies in which lead to ABOincompatible antigens of the fetal RBCs.

1. ABO

 Anti-D is the most severe type of HDN.

It occurs most commonly in women with anti-D negative
who deliver D-positive infants.

2. Rh

 Any IgG antibodies can cause HDN if the child inherits

the antigen from the father and the rd cells antigen is well
developed on the fetal red cells
Anti C and Anti-K are most frequently reported after
anti-D.

3. Other IgG antibodies

1.
2.
3.
4.
5.

ABO/D Phenotype and Antibody screen

Prenatal
Titration of the maternal antibody
Ultrasound Technique
Amniocentesis

LABORATORY TEST TO PREDICT,PREVENT OR

MONITOR HDN BEFORE DELIVER

 The prenatal specimen must be typed for ABO and Rh.

the antibody screening method must be able to detect clinically significant
IgG antibodies that are reactive at 37C and antiglobulin phboth.ase.
If the antibody screen is reactive , the antibody identify must be determined.
Lewis system antibodies are rather common in pregnant women but have
not been reported to caused HDN.
Antibodies such as anti-m and Ant-N can be IgM and IgG or a combination
of
Both Anti-M and Anti-N can cause milld to moderate HDN.
Many Rh negative pregnant women have weakly reactive anti-D,
Particularly during the third trimester.

1. ABO/Rh and Antibody screen

 Prenatal or Antepartum testing serves the following Two

Purposes:
1. To identify the D-negative women who are
candidates for RhIG
2. To identify ,women with antibodies capable of
causing HDN which help asses potential risk to the fetus.
Prenatal testing should be performed in the first trimester.

2. PRENATAL

 Helpful in decisions regarding the performance and

timing of procedures such amniocentesis , Ultrasound ,
Color Doppler Ultrasonography and Cordocentesis.
The baseline antibody titer should be determined during
the first trimester and the specimen should be frozen for
future testing.
Testing should be repeated at 4 to 6-week intervals
thereafter.

3. ANTIBODY TITRATION

 Fetal anemia caused by Hemolysis of Red Cells during

pregnancy can be detected by this technique specifically
the color doppler Ultrasonography which can be used to
measure blood flow velocity.
It can determine the severity of fetal anemia without
invasive procedures.
Nonserological

4. ULTRASOUND TECHNIQUES

 one measure of red cell destruction and the severity of HDN

is the level of Bilirubin pigment found in amniotic fluid.
Amniotic fluid is obtained by AMNIOCENTESIS or the
insertion of the needle through the mothers abdominal wall
and uterus and extraction of fluid from the amniotic sac.
The aspirated fluid is scanned spectrophometrically from 350
t 700 nm.
Used to assess the severity of fetal Hemolytic disease.
Is uncommonly used.

5. AMNIOCENTESIS

1.
2.
3.
4.
5.

Cord blood testing

Rh IG dosage
DAT
Exchange Transfusion
Others

AFTER DELIVERY,HDN IS MONITORED

, PREVENTED AND TREATED BY:

 A cord blood specimen should be collected and labelled

with two unique identifiers of the Infant.
Cordocentesis is a useful diagnostic and therapeutic
technique.
Using an ultrasound-guided needle , the umbilical vein is
punctured near the point of placental insertin.a fetal blood
sample is apirated , which can be used to measure
hematologic exam.
This test help determines whether a D-negative mother
should receive post-partum RhIG.

1. Cord Blood Testing

 RhIG should be adminstered to the mother within 72 hours

following delivery.
Used to prevent active immunization by the Rh(D) antigens
on fetal cells.
RhIG attaches to fetal Rh-positive RBCs in maternal
circulation , blocking immunization and subsequent
production of Anti-D.
It is determined by the fetal screen (rosette) and KleihauerBetke test performed on a mother.

2. RhIG Dosage

 Most frequently used method to screen FMH.

In this method, A Suspension of maternal red cells (Containing a D-negative
maternal red cells and a small number D-positive fetal red cells) is
incubated with anti-D
During incubation , anti-D binds to the D-positive red cells. The suspension
wash thoroughly and D-positive indicator red cells are added, which bind
to the anti-D to form a rosette around the D-positive fetal red cells.
And the bloos suspension placed on the slide and examined microscopicaly
for the apperance and number of rosettes.
A positie test indicates significant of FMH and potentially need for more
than one dose of RhIG
ROSETTE test detects a bleed of only 10mL (SCREENING TEST ONLY)

A. Rosette Test

A quantitaive test .
It is performed to calculate the dose of RhIG.
It measures fetal hbg or D-positive red cells or both.
It is based on the fact that Fetal Hbg is resistant to acid
elution and adult hbg is not.

B. KLEIHAUER-BETKE
TEST/flow cytometry

 After delivery, the neonate can develop

Hyperbilirubinemia of unconjugated bilirubin.
Photheraphy at 460 to 490 nm/420-475 is used to change
the unconjugated bilirubin to isomers, which are less
lipophilic and less toxic to the brain.
Relatively high doses are given by using two banks of
lights to surround the infants body.
It is perform as an initial treatment for
Hyperbilirubinemia

3. PHOTOTHERAPHY

 The most important serologic test for diagnosing HDFNwith anti-IgG reagent.
It must be performed carefully because the result may be
weak, specially in cases of ABO HDN.
If DAT is positive, HDFN could be due to ABO or other
blood group incomptability.

4. DIRECT ANTIGLOBULIN TEST

 Exchange Transfusion used to:

1. Correct Anemia without expanding blood volume.
2. Remove sentisized red cells and replaces them with antigen-negativecells
3. Reduces levels of maternal antibody
4. Reduces levels of Bilirubin to prevent kernictus.#
Blood for exchange and intrauterine transfusion should:
1. less than 7 days old.
2. Irradiated blood
3. Hemoglobin S-Negative blood
4. blood lacks antigen corresponding to maternal antigen.
5. Group O ( ABO incompatible ) D-Negative blood
6. compatibel cross match with maternal serum
7. CMV reduced risk compnents; CMV Seronegative donors or Leukocyte reduced.

5. EXCHANGE TRANSFUSION

RHOGAM/RhIg
- Contains purified anti-D (passive)
- Administration within 72 hours after delivery
FULL DOSE OF RHOGAM
- Contain 300mg Anti-D
- Greater than 12 weeks of gestation
- Protect up to 30mL
MINI/MICRODOSE
- Contains 50mg of Anti-D.
- Protects up to 5mL
- Less than 12 weeks of gestation

TREATMENT

 Prenatal/Antenatal time period before birth.

Antepartum period of time between conception and onset of labor, used with
reference to the mother.
Neonatal time period within the first 28 days after birth.
Fetomaternal Hemorrhage escape of fetal cells into the maternal
circulation , usually occuring at the time of delivery.
Hydrops Fetalis edema in the fetus
Erythroblastosis Fetalis also called HDFN/HDN
Rh immune globulin ( RhIG)- commercially available human source gamma
globulin consisting of high-titered anti-D that is used in preventing
alloimmunization to the D-Antigen.
Phototheraphy treatment of elevated bilirubin or other conditions with UV
light rays.

TERMINOLOGIES

 Liley Graph graph used to predict the severity of HDN

during pregnancy by evaluation of the amminiotic fluid.
Blocking Phenomenon The D-antigen phenotype on
cord blood maybe falsely negative if the cells are heaviy
coated with maternal anti-d
. Rosette Test/fetal screen is a screening or qualitative
test.
Kleihauer Betke and Flow cytometric methods are
quantitative test for determining dosage of RhIG

TERMINLOGIES

 Reporter s would like to Conclude that :

1. HDFN is prevented , Monitored and treated with the
help of tests performed in the Laboratory.
2. Understanding the physiology of HDFN is important
in choosing correct tests to perform in detecting early
indicators of hemolytic disease.

CONCLUSION

 MODERN BLOOD BANKING AND TRANSFUSION

PRACTICES by Denise M. Harmening
BASIC AND APPLIED CONCEPTS OF BLOOD
BANKING AND TRANSFUSION PRACTICES by
Kathy D. Blaney and Paula R. Howard
IMMUNOHMATOLGY: PRICIPLES AND
TECHNIQUES by Eva Quinley
ONLINE SOURCE:
WWW WIKEPEDIA/BLOODBANKING.COM

REFERENCE

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