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HDN
HDN is the destruction of RBCs of the fetus and neonate
by antibodies produced in mother
Sensitization of mother can be from
1. Previous pregnancies/miscarriages
2. Previous Tx
3. During 2nd or 3rd trimester
Can be due to ABO, Rh or other group incompatibilities
Numerous blood group systems
Few are of significant Clinical importance
Two systems are of more practical importance
1. ABO system
2. Rh or rhesus system
Two closely linked genes on Chromosome 1 control the expression
of Rh antigens
Anti-natal
At delivery
Aminocentesis
CVS
Abortion
Ectopic pregnancy
Abdominal trauma during pregnancy
Accidental or in anadvertent Tx
Rh sensitization
Erythroblastosis fetalis
Flow cytometry
Kleihauer-Betke test
Maternal smear within 60 min of delivery
treated with acid
Counterstain
Identification of fetal cells
Vol of fetomaternal hemorrhage = Number of fetal cells x maternal
BV
Number of maternal cells
Peripheral smear
Selection of blood
RBCs must be antigenic negative for the respective
antibodies
CMV negative blood
For premature babies, blood should be irradiated to
prevent Tx associated GVHD
Blood should not contain Hb-S
Blood should be PRBC and not older than 7-10 days
1
First pregnancy
ABO
Rh
Yes
Rare
Yes
Yes
Antibody IgG
Bilirubin at birth
Normal range
Elevated
Anemia at birth
No
Yes
Phototherapy
Yes
Yes
Exchange transfusion
Rare
Sometimes
Intrauterine transfusion
None
Sometimes
Spherocytosis
Yes
Rare
Removal of bilirubin
Removal of sensitized RBCs
Removal of incompatible antibody
Replacement with compatible RBCs
Suppression of erythropoiesis: reduced production of
incompatible RBCs
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