Rhesus Haemolytic Disease Research Articles

Neurosonographic Findings in Infants with Rhesus Hemolytic Disease of Newborn: A Prospective Observational Study

Neurosonographic Findings in Infants with Rhesus Hemolytic Disease of Newborn: A Prospective Observational Study

An ongoing problem: Rhesus hemolytic disease of the newborn - A decade of experience in a single centre

BackgroundThe objectives were to evaluate the descriptive features of newborns with a diagnosis of Rhesus (Rh) hemolytic disease, to determine the morbidity and mortality rates, to evaluate the treatment methods and the factors affecting treatment requirements and clinical outcomes during a ten-year period at a tertiary center. MethodsNewborn infants who had a positive direct Coombs test and/or had a history of intrauterine transfusion (IUT) due to Rh hemolytic disease were included. The data regarding the prenatal, natal and postnatal periods were collected from hospital records. ResultsA total of 260 neonates were included of which 51.2% were female. The mean ± standard deviation gestational age was 36.9 ± 2.7 weeks. The rate of preterm birth was 41.2%. Of 257 mothers whose obstetric medical history could be accessed, 87.2% were multigravida, whereas 76.3% were multiparous. Among mothers who had a reliable history of anti-D immunoglobulin prophylaxis (n=191), 51.3% had not received anti-D immunoglobulin prophylaxis in their previous pregnancies. The antenatal transfusion rate was 31.7% and the frequency of hydrops fetalis was 8.8%. While combined exchange transfusion (ET) and phototherapy (PT) was performed in 15.4% of the babies, the majority either needed phototherapy only (51.1%) or no treatment (33.5%). The mortality rate was 3.8 % (n = 10), and nine babies out of these 10 were those with severe hydrops fetalis. ConclusionThis study showed that Rh hemolytic disease is still a major problem in developing countries. Multiple comorbidities may occur in addition to life threatening complications, including hydrops fetalis, anemia and severe hyperbilirubinemia. High rates of multiparity and low rates of anti-D immunoglobulin prophylaxis are potential barriers for the eradication of the disease. It should be remembered that Rh hemolytic disease is a preventable disease in the presence of appropriate antenatal follow-up and care facilities.

Iron Overload and Anemia in Rhesus Hemolytic Disease of Newborn: A Prospective Observational Study.

This study assessed the prevalence of iron overload in infants born to Rh isoimmunized mothers. Infants born to Rh isoimmunized mothers with Indirect Coomb's Test (ICT) titers ≥1:16 were prospectively enrolled and followed until 3 mo. Hemoglobin and serum ferritin were estimated at birth and 3 mo of age. The outcomes were the incidence of iron overload (at birth and 3 mo), anemia, and the need for transfusions in the first 3 mo. Seventy-four infants were enrolled, nearly half receiving intrauterine transfusion (IUT). Sixty (82.2%) had hyperferritinemia at birth. The median (1st, 3rd quartile) ferritin levels were 456 (321, 631) μg/L. Infants who received IUTs had significantly higher serum ferritin levels at birth. Fifty-one (76.1%) infants had hyperferritinemia at 3 mo. Over three months of follow-up, 53 (71.6%) infants had anemia, of which 33 (48.5%) required packed red blood cells (PRBC) transfusion. These findings suggest that iron overload is common in these infants in the first 3 mo.

Long-Term Growth and Development Monitoring Of Children With Rhesus Hemolytic Disease of The Newborn

Rhesus hemolytic disease of the newborn (RHDN) occurs due to alloimmunization of maternal red blood cells. Complications of RHDN in infants can lead to hyperbilirubinemia, kernicterus, and anemia. In Indonesia, RHDN prevention has not been a common activity so it is very important for pediatricians to recognize early signs of an infant with severe anemia and severe hyperbilirubinemia, to prevent long-term mortality and morbidity. A case with longitudinal observation of long-term growth and development of a child with a history of RHDN has been reported. Throughout the monitoring carried out, the child did not experience serious problems in the medical field but showed disorders or developmental delays that did not improve over time with various therapeutic efforts. Based on a serial monitoring and treatment data that has been carried out on the child, we assumed there has been permanent brain damage caused by hyperbilirubinemia conditions accompanied by co-morbid sepsis. Brain damage is characterized by low DQ values from the beginning, progressive head circumference leads to microcephaly conditions and the presence of brain defects in the form of arachnoid cysts. The management of child development disorders with RHDN to date has not shown encouraging results. Therefore, experts have shifted their focus towards preventive measures, such as intra-uterine fetal transfusion, which has been shown to significantly decrease the occurrence of RHDN-related child development disorders over the past decade.

Rhesus alloimmunization is correlated to necrotizing enterocolitis and respiratory distress: A tertiary center experience

Background Rh alloimmunization occurs in pregnant women who do not express the red blood cell Rh antigen phenotype but carry a fetus that does. The mainstay of treatment is intrauterine blood transfusion (IUT). Necrotizing enterocolitis (NEC) is a rapidly progressive and life-threatening emergency that most commonly affects preterm neonates. It has been noticed that NEC has a predilection toward neonates with rhesus hemolytic disease (RHD) compared to neonates without RHD, particularly among the late preterm to near-term population with a moderate to severe grade of RHD. Methodology This is a retrospective cohort study that included all neonates delivered in our hospital between January 2015 and December 2021,who received IUT due to Rh-isoimmunization, and the control group consisted of neonates, who did not have Rh-isoimmunization and no history of IUT. Neonates were excluded from the study if they met our exclusion criteria. Results During a 7-year study period, a total of 144 neonates were included in the study. Of those, 72 neonates had RHD and received IUT (group 1), while 72 neonates did not have RH isoimmunization and did not receive IUT (group 2). Maternal and neonatal demographic data were similar between the two groups, except for birth weight, which was higher in group 1 (2.49 vs. 2.31 kg, P = 0.025). Ten cases developed NEC (13.89%) in group 1, while there were no cases of NEC in the other group (P = 0.001). We also found that the initial hemoglobin level was lower in group 1 (135.4 vs. 174.3 g/dL) with a P value of <0.001. The duration of respiratory support was significantly higher in group 1 (2.27 vs. 0.319 days; P = 0.006). Neonatal sepsis was more in group 1 (19.44 vs. 1.39%; P = 0.002). There was no significant difference between the two groups in terms of respiratory distress syndrome, intraventricular hemorrhage, and retinopathy of prematurity. Conclusion Neonates with rheus hemolytic disease (RHD) who undergo IUT are at a higher risk of developing NEC and prolonged course of respiratory support. Extra cautions may be necessary when advancing feeding in these patients. A well-designed multicenter prospective trial with an adequate sample size is recommended to validate our result.

Darbepoetin Alfa for Late-onset Anemia in Neonates with Rhesus Hemolytic Disease.

Neonates with Rhesus hemolytic disease can present with anemia beyond 1 wk of age due to bone marrow suppression and low erythropoietin secretion. Erythropoietin stimulating agents (ESA) were tried to manage anemia in these neonates. Darbepoetin alfa (DA) is a long-acting ESA used to treat anemia in premature neonates and in children with chronic kidney disease or on cancer chemotherapy. The authors present their experience of using DA to treat late-onset hyporegenerative anemia in 3 neonates with Rhesus isoimmunization. Darbepoetin alfa 4 mcg/kg was given subcutaneously at a 1-2-wk interval to target hemoglobin of 10-12g/dL. No adverse effects were observed, and the treated infants had a reduced need for the packed red blood cell transfusions.

Late onset anaemia in Rhesus haemolytic disease of the newborn

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Factors affecting the severity of RH Incompatibility newborn

Rh incompatibility is a not common pediatric problem, that cause morbidity and mortality in children, and it is an important cause of hemolysis, anemia and jaundice in newborn. To study Rhesus hemolytic disease, its severity, its complications; to evaluate if ABO incompatibility is protective or not, so to find out the efficacy of anti-D globulin ; to evaluate the efficacy of phototherapy and exchange transfusion as a treatment.
 This study was done on neonates with jaundice, seventy five patients (1-10 days old) who had Rh incompatibility were studied during period from the first of January 2008 to the 30th of June 2008.
 History was taken about age, gender and gestational age of the patients, determination of gestational age and hepatosplenomegally as a cause of extramedullary hematopoiesis. Investigations done for patients were hemoglobin, total serum bilirubin, reticulocyte count, blood group and Rh, and direct coombs test. From 75 patients studied, 55 patients (73%) required treatment for jaundice;25 of them (46%) required only phototherapy due to mild degree of hemolysis, and 30 of them (54%) required exchange transfusion with phototherapy due to severe degree of hemolytic. The remaining 20 patients (27%) required observation alone.
 Family history of previous hemolysis was positive in 44 patients and it was a risk factor for having hemolysis in present pregnancy. Early evaluation of patients for jaundice was useful in early recovery. ABO incompatibility in association with Rh incompatibility was not necessarily protective against hemolysis. The administration of anti-D globulin to the mother within first 72 hours after delivery was protective against sensitization.
 Early and proper management of of Rh incompatibility may reduce need for exchange transfusion. ABO incompatibility was not necessarily protective against hemolysis. Anti-D globulin administered to mothers within 3 days after delivery was protective against sensitization, History of hemolytic in previous siblings is considered as a risk factor for present hemolytic in neonates with Rh incompatibility.

Factors Affecting the Severity of RH Incompatibility Newborn

Rh incompatibility is a not common pediatric problem, that cause morbidity and mortality in children, and itis an important cause of hemolysis, anemia and jaundice in newborn. To study Rhesus hemolytic disease, itsseverity, its complications; to evaluate if ABO incompatibility is protective or not, so to find out the efficacyof anti-D globulin ; to evaluate the efficacy of phototherapy and exchange transfusion as a treatment.This study was done on neonates with jaundice, seventy five patients (1-10 days old) who had Rhincompatibility were studied during period from the first of January 2008 to the 30th of June 2008.History was taken about age, gender and gestational age of the patients, determination of gestational ageand hepatosplenomegally as a cause of extramedullary hematopoiesis. Investigations done for patientswere hemoglobin, total serum bilirubin, reticulocyte count, blood group and Rh, and direct coombs test.From 75 patients studied, 55 patients (73%) required treatment for jaundice;25 of them (46%) required onlyphototherapy due to mild degree of hemolysis, and 30 of them (54%) required exchange transfusion withphototherapy due to severe degree of hemolytic. The remaining 20 patients (27%) required observationalone.Family history of previous hemolysis was positive in 44 patients and it was a risk factor for havinghemolysis in present pregnancy. Early evaluation of patients for jaundice was useful in early recovery. ABOincompatibility in association with Rh incompatibility was not necessarily protective against hemolysis. Theadministration of anti-D globulin to the mother within first 72 hours after delivery was protective againstsensitization.Early and proper management of of Rh incompatibility may reduce need for exchange transfusion. ABOincompatibility was not necessarily protective against hemolysis. Anti-D globulin administered to motherswithin 3 days after delivery was protective against sensitization, History of hemolytic in previous siblings isconsidered as a risk factor for present hemolytic in neonates with Rh incompatibility.

From Tragedy to Triumph: Canadian Connections in the Management of Rhesus Hemolytic Disease of the Newborn

From Tragedy to Triumph: Canadian Connections in the Management of Rhesus Hemolytic Disease of the Newborn

EXCHANGE TRANSFUSION IN NEONATES: AN EXPERIENCE FROM A TERTIARY CARE CENTER IN NORTH INDIA

Background: Blood exchange transfusion (ET) involves replacement of affected neonate’s blood with compatible donor blood. Although the use of ET has decreased over years, it still remains a popular emergency rescue procedure for newborns with severe jaundice. Objective: The study was done to describe the indications and complications associated with ET in a 20 bedded neonatal unit of a tertiary care center in North India. Materials and Methods: This was a retrospective observational cohort study of neonates who underwent ET from July 2014 to May 2019. Demographic profile, indications and etiology, details of ET procedure, and related adverse events were noted from medical records and chart review. Results: Of 2310 admitted neonates, 77 (3.3%) underwent 103 ETs during the study period with an average rate of 23.3 ETs per year. Hyperbilirubinemia was the most common indication for ET in 53 (68.8%) neonates. Rhesus (Rh) hemolytic disease was the single most frequent etiology for hyperbilirubinemia seen in 43 (55.8%) neonates. A total of 77 adverse events related to ET were seen in 53 (68.8%) neonates whereas 17 (22%) had more than one adverse event. The most common complication was thrombocytopenia in 40 (51.9%) neonates. Overall, mortality was 7 (9.1%); none were attributable to ET. Conclusion: The study identifies Rh hemolytic disease of newborn as the most common etiology leading to ET in newborns. Although ET is a relatively safe procedure, the high incidence of adverse events suggests vigilant monitoring and in-depth expertise for performing and managing complications of the procedure.

POSTNATAL OUTCOMES OF INFANTS AFFECTED BY RHESUS HEMOLYTIC DISEASE IN A TERTIARY CARE CENTER IN NORTHERN INDIA

Background: Advances in prenatal and postnatal care of neonates with rhesus hemolytic disease of the newborn (RHDN) have led to improved outcomes. Studies evaluating the postnatal outcomes in rhesus (Rh) isoimmunized infants from developing countries are limited. Objective: The objective of this study was to evaluate the postnatal outcomes of neonates ?32 weeks gestation with RHDN. Methods: A prospective observational study was conducted from July 2014 to June 2016 in a tertiary care neonatal unit in North India. Neonates affected by RHDN were managed as per the standard protocol and were followed up for the first 6 months of life. Primary outcomes were the duration of phototherapy (PT), need for exchange transfusion (ET), occurrence of late-onset anemia, and need for top-up transfusions. Results: A total of 33 newborns with RHDN were included in the study. Median duration of PT was 138 h (interquartile range 64–188) and was inversely correlated with intrauterine transfusion number (Spearman correlation coefficient ?0.46; p=0.02). Of 33 neonates with RHDN, 14 (42.4%) neonates required ET. Late-onset anemia was seen in 25 (75.7%) neonates and 17 (51.5%) required at least one top-up transfusion. Cholestasis was seen in 5 (15.1%) neonates. Conclusions: Despite advances in care, short-term morbidities in neonates affected by RHDN are common and require intensive management.

David John Weatherall: haematologist and geneticist whose work on thalassaemia showed the potential of molecular medicine

Credit: Tom Solomon David Weatherall was an icon of British medicine, a pioneering haematologist and geneticist whose work on thalassaemia showed the potential of applying molecular approaches to clinical medicine...

Hyporegenerative anemia and other complications of rhesus hemolytic disease: to treat or not to treat is the question

Rhesus hemolytic disease of the newborn is rarely found after the implementation of anti-D immunoglobulin prophylaxis. However, it may lead to cholestasis, elevated liver transaminases, iron overload and late hyporegenerative anemia when it occurs. Etiology of this type of anemia is not defined yet and treatment is controversial. It is typically recognized after two weeks of life which is characterized by low hemoglobin and reticulocyte count. We have reported a case of a neonate with Rh hemolytic disease with late hyporegenerative anemia that was noted at day 18 of life. We treated this anemia by erythropoietin (EPO) 250 U/kg three times per week. Two weeks after initiation of erythropoietin treatment, a stable hemoglobin was noted along with an increased reticulocyte count. The patient required one further blood transfusion in the third week of therapy. Other associated findings were self-limited. A year of follow-up showed an appropriate development for age.

Exchange transfusion in initial phase of acute encephalopathy bilirubin of a 7-day old neonate: a case report

Hyperbilirubinemia is a common problem in neonatal period, occurring in 60-70% of term and 80% of preterm infants in the first week of life. The elevation of free unconjugated bilirubin can enter the central nervous system which is noxious to neuron and increase the risk of acute bilirubin encephalopathy (ABE). Risk factors of encephalopathy bilirubin or kernicterus with hemolytic disease such as ABO or Rhesus haemolytic disease, G6PD deficiency. The incidence of ABE is about 0.9/100 000. Clinically bilirubin encephalopathy can be devided into 2 phase, acute and chronic phase. The initial of acute phase is noted by lethargy, hypotonia, decreased movement and poor suck, the symptoms will get worsen if the baby doesn’t get adequte therapy. The main of management ABE is exchange transfusion and continues phototherapy to reduce bilirubin level and prevent further hemolysis.We report a case of exchange transfusion in initial phase of acute encephalopathy bilirubin in a 7-day old neonate with ABO incompatibility, whom had icterus since the first day of life. Other complaints are poor feeding, lethargy and hoarsness of cry since one day before admitted to hospital. He was born from mother with O blood type and positive rhesus. The patient had B blood type with positive rhesus, coomb test was positive and the total bilirubin was 41.49 mg/dL, direct bilirubin was 2.8 mg/dl and indirect bilirubin was 38.69 mg/dL. The patient was treated with exchange transfusion, intensive phototherapy. Â

Rhesus disease: a global prevention strategy

After nearly five decades of effective prophylaxis in high-income countries, the incidence of rhesus haemolytic disease (also known as haemolytic disease of the fetus and newborn) has substantially decreased, and as a result, clinical experience of the disease among health-care providers is insufficient. By contrast, a worldwide study found that rhesus haemolytic disease continues to be a public health problem in low-income and middle-income countries, affecting annually in more than 150 000 children, and causing thousands of stillbirths, neonatal deaths, and cases of hyperbilirubinaemia with its sequelae (kernicterus and bilirubin-induced neurological dysfunction). Solutions to this problem will require the combined and integrated effort of physicians and other health-care workers, international agencies, manufacturers of the prophylactic agent (rhesus immunoglobulin), health policy makers, and governments of low-income and middle-income countries.

Acute hemoglobin increase after transfusion and immunoglobulin for rhesus hemolytic disease of the newborn

We describe two infants with severe hemolytic disease of the fetus and newborn (HDFN) with hepatosplenomegaly treated with intravenous immunoglobulin. Packed red blood cells (PRBC) were transfused resulting in an acute disproportionate increase in hemoglobin with clinical consequences in one case. These cases appear to highlight previously unreported sequelae. We discuss a hypothetical mechanism and suggest that the effect warrants further research as a possible way to decrease the need for and risks of PRBC transfusion in HDFN.

A case of coombs-positive severe late anemia without hyperbilirubinemia, refractory to blood transfusion, improved with immunoglobulin

Rhesus hemolytic disease of newborn is a well-known disease with early and late complications mainly manifesting as severe hyperbilirubinemia requiring prompt treatment such as exchange transfusion and immunoglobulins. We report a case of Coombs-positive severe late anemia without hyperbilirubinemia which presented with features such as sepsis and failure to gain weight. Baby was refractory to blood transfusion initially, but later on successfully improved with immunoglobulins.

Клинико-иммунологическое обоснование внутриутробных гемотрансфузий при гемолитической болезни плода по системе резус

Клинико-иммунологическое обоснование внутриутробных гемотрансфузий при гемолитической болезни плода по системе резус

Clinical characteristics of neonatal hemolytic disease of anti-M or Rhesus system

Objective To analyze the clinical manifestation of hemolytic disease of the newborn (HDN) due to anti-M and Rhesus system. Methods Clinical information was collected and analyzed for three cases with HDN due to anti-M and 64 with Rhesus hemolytic disease, who were admitted to Department of Neonatology, Beijing Children's Hospital Affiliated to Capital Medical University from February 2011 to January 2015, as well as another 28 cases of HDN due to anti-M with complete information retrieved from literature in Wanfang and China National Knowledge lnfrastructure (CNKI) Database from 1992 to 2014. Chi-square test was performed for statistical analysis. Results Two out of the 64 Rh hemolytic babies gave up therapy due to kernicterus and another two out of the 31 MN hemolytic babies, obtained from literature, died 24 h after birth because of anemia or edema, while the rest survived. Although more babies were the first child of the family in HDN due to anti-M than those of Rh hemolytic disease [26%(8/31) vs 9%(6/64), χ2=4.487, P=0.034], but lower incidence of jaundice [81%(25/31) vs 98%(63/64), χ2=9.686, P=0.002], less proportion of presentation of jaundice within 24 h after birth [29% (9/31) vs 64%(41/64), χ2=10.279, P=0.001] and lower positive rate of direct antiglobulin test [39%(12/31) vs 100%(64/64), Fisher exact test, P=0.000] were shown in HDN due to anti-M. No significant difference was found in the incidences of hyperbilirubinemia [58%(18/31) vs 66%(42/64), χ2=0.513], severe hyperbilirubinemia [23%(7/31) vs 36%(23/64), χ2=1.724], anemia [81%(25/31) vs 89%(57/64), χ2=1.253] and severe anemia [29%(9/31) vs 34%(22/64), χ2=0.271] between HDN due to anti-M and Rh hemolytic babies (all P>0.05). Conclusions HDN due to anti-M and Rhesus hemolytic disease can cause severe pathological jaundice and/or anemia in newborns. Indirect antiglobulin test should be offered when direct antiglobulin test is negative which is helpful in the diagnosis of HDN due to anti-M. Key words: Erythroblastosis, fetal; Blood group incompatibility; Rh-Hr blood-group system; MNSS blood-group system