ABO incompatibility

ABO incompatibility disease afflicts newborns whose mothers are blood type O, and
who have a baby with type A, B, or AB.
Ordinarily, the antibodies against the foreign blood types A and B that circulate in
mother's bloodstream remain there, because they are of a type that is too large to
pass easily across the placenta into the fetal circulation. Some fetal red cells always
leak into mother's circulation across the placental barrier (mother and fetal blood
theoretically do not mix, but in actuality, they do to a small degree).
These fetal red cells stimulate the formation of a smaller type of anti-A or anti-B
antibody which can pass into the baby's circulation and there cause the destruction
of fetal red cells. The increased rate of destruction of red cells causes a subsequent
increase in waste product production. This excess waste product, bilirubin, can
overwhelm the normal waste elimination processes and lead to jaundice, the
presence of excess bilirubin.

This condition is one of the hemolytic anemias. Jaundice is the most common
problem encountered, which may require phototherapy or even exchange
transfusion.
Anemia sometimes becomes an issue some weeks after the initial jaundice
problems are resolved. This is caused by ongoing faster than normal breakdown of
the baby's fetal cells by the maternal antibodies, which linger in the baby's
bloodstream for weeks after birth. For this reason, babies with ABO incompatibility
disease may need to be tracked with periodic blood counts. If the anemia were to
become severe, a blood transfusion might be required to restore a normal level of
red blood cells in the baby's circulation. Such a transfusion would add blood to the
baby's circulation to prevent possible complications of the anemia (in distinction to
the exchange transfusion, whichreplaces the baby's red cells with adult cells). This
complication is rare; I personally have yet to see a case severe enough to justify
transfusion.
For reasons that are unclear, B-O incompatibility (mother type O, baby type B)
seems to be in general more severe than A-O incompatiblity.

Erythroblastosis fetalis - Overview

Overview
Symptom
Treatment
Prevention
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Alternative Names
Hemolytic disease of the newborn

Definition of Erythroblastosis fetalis:

Erythroblastosis fetalis is a potentially life-threatening blood disorder in a fetus or
newborn infant. This article provides a general overview. For more detailed
information see the specific disorder:

ABO incompatibility
Rh incompatibility
Causes, incidence, and risk factors:
Erythroblastosis fetalis develops in an unborn infant when the mother and baby
have different blood types. The mother produces substances called antibodies that
attack the developing baby's red blood cells.
The most common form of erythroblastosis fetalis is ABO incompatibility, which
can vary in severity.
The less common form is called Rh incompatibility, which can cause very severe
anemia in the baby.

Intrauterine transfusion

Overview

Antibodies

ABO incompatibility - Overview

Symptom
Treatment
Prevention
All Information

Definition of ABO incompatibility:

ABO incompatibility is a reaction of the immune system that occurs if two different
and not compatible blood types are mixed together.

Causes, incidence, and risk factors:

A, B, and O are the three major blood types. The types are based on small
substances (molecules) on the surface of the blood cells. In people who have
different blood types, these molecules act as immune system triggers (antigens).

Each person has a combination of two of these surface molecules. Type O lacks any
molecule. The different blood types are:
Type A (AA or AO molecules)
Type B (BB or BO molecules)
Type AB
Type O

People who have one blood type form proteins (antibodies) that cause their immune
system to react against other blood types. Being exposed to another type of blood
can cause a reaction. This is important when a patient needs to receive blood
(transfusion) or have an organ transplant. The blood types must be matched to
avoid an ABO incompatibility reaction.

For example:
A patient with type A blood will react against type B or type AB blood
A patient with type B blood will react against type A or type AB blood
A patient with type O blood will react against type A, type B, or type AB blood
Because type O lacks any surface molecules, type O blood does not cause an
immune response. This is why type O blood cells can be given to patients of any
blood type. People with type O blood are called "universal donors." However, people
with type O can only receive type O blood.
Since antibodies are in the liquid part of blood (plasma), both blood and plasma
transfusions must be matched to avoid an immune reaction.

Prevention:
Careful testing of donor and patient blood types before transfusion or
transplant can prevent this problem.

Treatment:
Since Rh incompatibility is almost completely preventable with the use
of RhoGAM, prevention remains the best treatment. Treatment of the
already affected infant depends on the severity of the condition.

Mild Rh incompatibility may be treated with:

• Aggressive hydration
• Phototherapy using bilirubin lights

Expectations (prognosis):
Full recovery is expected for mild Rh incompatibility.

Complications:
Possible complications include:

• Hydrops fetalis (potentially deadly fluid build up and swelling in

the baby)
• Kernicterus (brain damage due to high levels of bilirubin)
 • Neurological syndrome with mental deficiency, movement
disorder, hearing loss, speech disorder, and seizures

Jaundice infant

Antibodies

Rh incompatibility - Overview
Overview
Symptom
Treatment
Prevention
All Information

Alternative Names
Rh-induced hemolytic disease of the newborn

Definition of Rh incompatibility:
Rh incompatibility is a condition that develops when a pregnant woman has Rh-
negative blood and the baby in her womb has Rh-positive blood.

Causes, incidence, and risk factors:

During pregnancy, red blood cells from the fetus can get into the mother's
bloodstream as she nourishes her child through the placenta.

If the mother is Rh-negative, her immune system treats the Rh-positive fetal cells as
if they were a foreign substance and makes antibodies against the fetal blood
cells. These anti-Rh antibodies may cross the placenta into the developing baby,
where they destroy the baby's circulating red blood cells.

When red blood cells are broken down, they make bilirubin, which causes an infant
to become yellow (jaundiced). The level of bilirubin in the infant's bloodstream may
range from mild to dangerously high.
First-born infants are often not affected -- unless the mother has had previous
miscarriages or abortions, which could have sensitized her system -- as it takes time
for the mother to develop antibodies against the fetal blood. However, second
children who are also Rh-positive may be harmed.
Rh incompatibility develops only when the mother is Rh-negative and the infant is
Rh-positive. This problem has become uncommon in the U.S. and other places that
provide good prenatal care. Special immune globulins, called RhoGAM, are now
used to prevent RH incompatibility.

Prevention:
Rh incompatibility is almost completely preventable. Rh-negative
mothers should be followed closely by their obstetricians during
pregnancy.

Special immune globulins, called RhoGAM, are now used to prevent RH

incompatibility.

If the father of the infant is Rh-positive or if his blood type cannot be

confirmed, the mother is given a mid-term injection of RhoGAM and a
second injection within a few days of delivery.

These injections prevent the development of antibodies against Rh-

positive blood. However, women with Rh negative blood type must
receive this injection:

• During every pregnancy

• If they have a miscarriage or abortion,
• After prenatal tests such as amniocentesis and chorionic villus
biopsy
• After injury to the abdomen during a pregnancy

Treatment:
Since Rh incompatibility is almost completely preventable with the use
of RhoGAM, prevention remains the best treatment. Treatment of the
already affected infant depends on the severity of the condition.

Mild Rh incompatibility may be treated with:

• Aggressive hydration
• Phototherapy using bilirubin lights

Expectations (prognosis):
Full recovery is expected for mild Rh incompatibility.

Complications:
Possible complications include:
 • Hydrops fetalis (potentially deadly fluid build up and swelling in
the baby)
• Kernicterus (brain damage due to high levels of bilirubin)
• Neurological syndrome with mental deficiency, movement
disorder, hearing loss, speech disorder, and seizures

Erythroblastosis fetalis, photomicrograph

Jaundice infant

Antibodies

Exchange transfusion - series

Rh Incompatibility - series