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Critical review of haemolytic disease of the newborn - Essay Example

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HDN most frequently occurs when an Rh negative mother has a baby with an Rh positive father. When the baby's Rh factor is positive, like the father's, problems can develop if the baby's red blood cells cross to the Rh negative mother. This usually happens at delivery when the placenta detaches…
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Critical review of haemolytic disease of the newborn
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Download file to see previous pages The mother's immune system sees the baby's Rh positive red blood cells as "foreign." Just as when bacteria invade the body, the immune system responds by developing antibodies to fight and destroy these foreign cells. The mother's immune system then keeps the antibodies in case the foreign cells appear again, even in a future pregnancy. The mother is now "Rh sensitized."
In a first pregnancy, Rh sensitization is not likely. Usually it only becomes a problem in a future pregnancy with another Rh positive baby. During that pregnancy, the mother's antibodies cross the placenta to fight the Rh positive cells in the baby's body. As the antibodies destroy the red blood cells, the baby can become sick. This is called erythroblastosis fetalis during pregnancy. In the newborn, the condition is called hemolytic disease of the newborn. (Vucinovic M, Jadric H, Karelovic D, Roje D, Haspl-Hundric Z, Hrgovic Z, Vucinovic Z, 2004).
Hemolytic disease of the newborn (HDN) occurs due to maternal IgG antibodies crossing the placenta thereby producing hemolysis mainly due to Rh, ABO and Kell groups. A systematic approach to the Rh HDN involves an obstetric history of previous isoimmunized baby, timing and regular monitoring of maternal Rh antibodies and pigment assay of amniotic fluid. Timely decision regarding in utero transfusion and early termination of pregnancy based on the maternal monitoring has radically improved the outcome of these babies. Antenatal prophylaxis with anti D has resulted in great reduction in the magnitude of Rh problem. The fetal blood sampling and in-utero intravenous transfusions has made it possible for almost 100% survival of isoimmunized pregnancies without hydrops. Alternative methods--IVIG and plasma exchange are still of limited application. ABO HDN though common is not a serious form of disease and dose not warrants invasive antenatal monitoring. Anti-Kell is found in patients having received multiple transfusions and the rapid progress of hemolysis in them may not allow such systematic follow up as in Rh HDN. (Narang A, Jain N, 2001).
Antibodies are produced by B lymphocytes. Maturation culminates with migration of the B cells to the reticulo-endothelial tissues of the body including the lymph nodes and parts of the spleen, bone marrow, liver, gastrointestinal tract and other tissues. Antibodies are a miscellaneous mixture of serum globulins and share the ability to bind individually to specific antigens. Those serum globulins with antibody activity are known as immunoglobulins (Ig). All immunoglobulin molecules have common structural features. The part of the molecule that binds to the corresponding antigen is different in each immunoglobulin. The basic ...Download file to see next pagesRead More
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