Show  By Lori Smith, MSN, BSN, WHNP-BC on September 28, 2018 Erythroblastosis fetalis is a severe medical condition that most commonly results from incompatibility between certain blood types of a woman who is pregnant and the fetus. The condition involves a component of blood called Rh factor. Rh factor is an inherited protein, found on the surface of red blood cells. Not everyone has this protein. If a person has the protein, they are Rh positive. Those who do not have the Rh protein are Rh negative. If a woman is Rh negative and the fetus is Rh positive, it can lead to Rh incompatibility and potential complications in the pregnancy.
Erythroblastosis fetalis can occur when different Rh factor blood types mix during pregnancy. Problems can arise even if small amounts of Rh-positive and Rh-negative blood mix. Although it is rare for blood between the woman and the fetus to mix during pregnancy, it could happen as a result of:
If Rh-negative blood mixes with Rh-positive blood, an immune response known as Rh sensitization may occur. This means that the person with Rh-negative blood will produce antibodies to fight any future exposure to Rh-positive blood. The body can also produce antibodies after contamination with a Rh-positive blood from a needle or a blood transfusion. Once sensitized, the body’s immune system will recognize any future Rh-positive cells as foreign and attack them. If Rh-positive blood from a fetus gets into the bloodstream of a woman with sensitized Rh-negative blood, the woman’s immune system will attack the invading cells and destroy them. Erythroblastosis fetalis destroys red blood cellsDestruction of the red blood cells (hemolysis) can be rapid in a fetus. As a result, the fetus will not receive enough oxygen, which may lead to anemia, other illnesses, or even death. As hemolysis continues, the fetus will rapidly attempt to produce more red blood cells. However, these cells new red blood cells are often immature and are unable to function fully. Because the body produces red blood cells in the liver and spleen, this overproduction can sometimes cause these organs to enlarge. When a newborn has this condition, it is known as hemolytic disease of the newborn. As the immature red blood cells continue to break down, bilirubin, which is a by-product of the breakdown of red blood cells, builds up. The excess amounts of bilirubin circulating in the newborn’s body will lead to jaundice, where the skin and eye whites of the infant turn yellow. Rh incompatibility is the most common cause of the condition, but other factors can also be responsible, including other cell or blood incompatibilities that produce antibodies. White infants are more likely to develop the condition than African-American infants. The risk is also higher in pregnancies where Rh sensitization has already taken place, for example, during a first pregnancy. It is important to note that having a different blood type to the fetus (ABO incompatibility) is not a cause of erythroblastosis fetalis or hemolytic disease of the newborn, though some other rare blood group differences can occasionally be a cause. It does not usually affect a first pregnancy, but problems may arise in future pregnancies. Share on PinterestUltrasound testing during pregnancy can give a clues about fetal health. Symptoms of erythroblastosis fetalis during pregnancy may show up during routine testing. These include:
Newborns with the condition may display visible symptoms as well as some that show up on scans, such as:
ComplicationsComplications experienced by the fetus may include:
Hydrops fetalis is another severe complication that causes fluid to build up in fetal tissues and organs as a result of heart failure. This is a life-threatening condition. Complications in a newborn may include:
A buildup of bilirubin in the brain can lead to a complication called kernicterus, leading to seizures, brain damage, deafness, or death. The first step in diagnosing erythroblastosis fetalis is to determine whether the cause is Rh incompatibility. A doctor can identify incompatibility using an antibody-screening test in the first trimester. They may repeat the test at 28 weeks of gestation and may also test the Rh factor of the male partner. Fetal testing may include:
In the newborn, a doctor may carry out tests to evaluate:
Share on PinterestThe newborn may need urgent medical treatment. Treatment may include a fetal blood transfusion and delivery of the fetus between 32 and 37 weeks gestation. Treatment options for newborns with the condition include:
The goal of IVIG antibody therapy is to reduce the breakdown of red blood cells and levels of circulating bilirubin. Sometimes, an exchange transfusion is necessary. This type of transfusion involves replacing small amounts of blood with different blood. The goal is to increase the presence and number of red blood cells and to lower bilirubin levels. Erythroblastosis fetalis is a preventable condition. A medication called Rh immunoglobulin (Rhig), also known as RhoGAM, can help prevent Rh sensitization. This medication prevents the pregnant woman from developing Rh-positive antibodies. However, this will not help women who have already undergone Rh sensitization. Women at risk for Rh sensitization should receive RhoGAM doses at specific times during their pregnancy and after delivery. These include:
If a woman has a pregnancy that extends beyond 40 weeks, the doctor may recommend an additional dose of RhoGAM. Erythroblastosis fetalis is a potentially dangerous condition that occurs during the development of an infant. The condition occurs when a component of blood called Rh factor is incompatible between the pregnant woman and the fetus. It can cause jaundice and other, more severe complications, including possible heart failure. Treatment includes blood transfusion, IV fluids, immunoglobin, and addressing any breathing difficulties. Giving a pregnant woman Rh immunoglobin can also help prevent the condition by blocking Rh sensitization. The adult human body is home to trillions of red blood cells, also known as RBCs or erythrocytes. These blood cells carry oxygen, iron, and many other nutrients to the appropriate places in the body. When a woman is pregnant, it’s possible that her baby’s blood type will be incompatible with her own. This can cause a condition known as erythroblastosis fetalis, where the mother’s white blood cells (WBCs) attack the baby’s RBCs as they would any foreign invaders. This condition is highly preventable and the typical, severe form is now very rare in developed countries. Catching it early can ensure a successful pregnancy for mother and child. If left untreated, however, it can be life threatening for the baby. Erythroblastosis fetalis is now known as hemolytic disease of the newborn. Babies who experience erythroblastosis fetalis symptoms may appear swollen, pale, or jaundiced after birth. A doctor may find that the baby has a larger-than-normal liver or spleen. Babies who experience erythroblastosis fetalis symptoms may appear swollen, pale, or jaundiced after birth. A doctor may find that the baby has a larger-than-normal liver or spleen. Blood tests can also reveal that the baby has anemia or a low RBC count. Babies can also experience a condition known as hydrops fetalis, where fluid starts to accumulate in spaces where fluid is normally not present. This includes spaces in the: There are two main causes of erythroblastosis fetalis: Rh incompatibility and ABO incompatibility. Both causes are associated with blood type. There are four blood types: In addition, blood can be either Rh positive or Rh negative. For example, if you’re type A and Rh positive, you have A antigens and Rh factor antigens on the surface of your RBCs. Antigens are substances that trigger an immune response in your body. If you have AB negative blood, then you have both A and B antigens without the Rh factor antigen. Rh incompatibilityRh incompatibility occurs when a Rh-negative mother is impregnated by a Rh-positive father. The result can be a Rh-positive baby. In such a case, your baby’s Rh antigens will be perceived as foreign invaders, the way viruses or bacteria are perceived. Your blood cells attack the baby’s as a protective mechanism that can end up harming the child. If you’re pregnant with your first baby, Rh incompatibility isn’t as much of a concern. However, when the Rh-positive child is born, your body will create antibodies against the Rh factor. These antibodies will attack the blood cells if you ever become pregnant with another Rh-positive baby. ABO incompatibilityAnother type of blood type mismatch that can cause maternal antibodies against her baby’s blood cells is ABO incompatibility. This occurs when the mother’s blood type of A, B, or O isn’t compatible with the baby’s. This condition is almost always less harmful or threatening to the baby than Rh incompatibility. However, babies can carry rare antigens that can put them at risk for erythroblastosis fetalis. These antigens include:
To diagnose erythroblastosis fetalis, a doctor will order a routine blood test during your first prenatal visit. They’ll test for your blood type. The test will also help them determine whether you have anti-Rh antibodies in your blood from a previous pregnancy. The fetus’s blood type is rarely tested. It’s difficult to test for a fetus’s blood type and doing so can increase the risk for complications. Frequency of testingIf initial testing shows your baby may be at risk for erythroblastosis fetalis, your blood will be continually tested for antibodies throughout your pregnancy — approximately every two to four weeks. If your antibody levels start to rise, a doctor may recommend a test to detect fetal cerebral artery blood flow, which isn’t invasive to the baby. Erythroblastosis fetalis is suspected if the baby’s blood flow is affected. Rh incompatibilityIf you have Rh-negative blood, the father’s blood will be tested. If the father’s blood type is Rh negative, no further testing is needed. However, if the father’s blood type is Rh positive or their blood type isn’t known, your blood may be tested again between 18 to 20 weeks of pregnancy, and again at 26 to 27 weeks. You’ll also receive treatment to prevent erythroblastosis fetalis. ABO incompatibilityIf your baby is jaundiced after birth, but Rh incompatibility isn’t a concern, the baby may be experiencing problems due to ABO incompatibility. ABO incompatibility occurs most frequently when a mother with an O blood type gives birth to a baby who has an A, B, or AB blood type. Because O blood types may produce both A and B antibodies, the mother’s blood can attack the baby’s. However, these symptoms are generally much milder than a Rh incompatibility. ABO incompatibility can be detected via a blood test known as a Coombs test. This test, along with a test to determine the baby’s blood type, is performed after the baby is born. It can indicate why the baby may appear jaundiced or anemic. These tests are usually done for all babies whose mothers have type O blood. If a baby experiences erythroblastosis fetalis in the womb, they may be given intrauterine blood transfusions to reduce anemia. When the baby’s lungs and heart mature enough for delivery, a doctor may recommend delivering the baby early. After a baby is born, further blood transfusions may be necessary. Giving the baby fluids intravenously can improve low blood pressure. The baby may also need temporary breathing support from a ventilator or mechanical breathing machine. Babies born with erythroblastosis fetalis should be monitored for at least three to four months for signs of anemia. They may require additional blood transfusions. However, if proper prenatal care and postpartum care are delivered, erythroblastosis fetalis should be prevented and the baby shouldn’t experience long-term complications. A preventive treatment known as RhoGAM, or Rh immunoglobulin, can reduce a mother’s reaction to their baby’s Rh-positive blood cells. This is administered as a shot at around the 28th week of pregnancy. The shot is administered again at least 72 hours after birth if the baby is Rh positive. This prevents adverse reactions for the mother if any of the baby’s placenta remains in the womb. |
When can erythroblastosis fetalis not possibly happen in the child of an rh negative mother?
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