Teaching hemolytic disease of the newborn (Erythroblastalis fetalis) to undergraduate immunology students through the use of an interactive simulation

Abstract

Abstract Hemolytic disease of the newborn (HDN, Erythroblastalis fetalis) is a potentially fatal condition. It is initiated due to Rhesus (Rh) antigens on fetal red blood cells (RBCs) being seen as foreign by the mothers Rh− immune system. In the first pregnancy, exposure of the maternal immune system to fetal Rh+ RBCs leads to immune activation, IgM production and memory cell formation. A subsequent pregnancy with another Rh+ fetus, activates memory cells, leading to class switching and IgG production, which is placentally transferred to the fetus. Through multiple effector functions, the IgG leads to hemolysis, causing anemia and in severe cases even death of the fetus. The role of the immune response is key to this disease, hence it is taught to undergraduate immunology students at the University of South Australia. Topics include the primary and secondary immune responses, placental transfer of IgG, deletion of self reactive cells and use of mAbs as therapeutic agents are addressed. Experience has shown that students find this topic challenging. In an attempt to enhance understanding, I developed an interactive simulation to teach these principles which was trialed in 2018. The simulation gave students the opportunity to blood group expecting parents and then discuss possible HDN issues and the treatment option. As with other simulations I have generated, (e.g. flow cytometry and mAbs), I suggest this approach is a new approach to teach complex immunological concepts. This approach can enhance student understanding as well as provide a new means of information transferal. The HDN simulation is freely available to all teaching staff who may wish to use it as part of their teaching approach.