Hemolytic disease of newborns

Hemolytic disease of newborns is a hemomatic jaundice of newborns, caused by an immunological conflict between the mother and the fetus due to incompatibility with red blood cell antigens.

Etiology. The disease is caused by the incompatibility of the fetus and the mother with D-resus or ABO antigens, less often there is incompatibility with other Rh (C, E, c, d, e) or M-, M-, Kell-, Duffy-, Kidd- Antigens. Pathogenesis. Any of these antigens (more often D-Rhesus antigen), penetrating the blood of the Rh-negative mother, causes the formation of specific antibodies in her body. The latter through the placenta enter the blood of the fetus, where the corresponding antigen-containing red blood cells are destroyed.

Clinical picture. There are three forms of hemolytic anemia: edematous, icteric, anemic. Ointment is the heaviest and is characterized by general edema at birth, accumulation of fluid in the cavities (pleural, cardiac pouch, abdominal), sharp pallor with yellowness, enlarged liver, spleen. In blood tests, severe anemia, a significant number of normo- and erythroblasts. The combination of severe anemia and hypoproteinemia contributes to the development of heart failure, which leads to death (in utero or immediately after birth).

Jaundice form is the most frequent clinical form; It manifests itself on the 1-2 day of the child's life. Jaundice is noted, the liver and spleen are enlarged, the pastosity of the tissues is observed. Children are lethargic, adynamic, badly suck. Reflexes are reduced. Anemia is expressed (hemoglobin level below 160 g / l), pseudoleukocytosis, reticulocytosis, erythro- and normoblastosis. A bright ghost is the increased content of indirect bilirubin in the blood (100-265-342 μmol / l and more). Urine is dark, feces of normal color. In the future, there may be an increased content and direct bilirubin. Bilirubin intoxication is characterized by lethargy, regurgitation, vomiting, pathological yawning, decreased muscle tone. Then there are classic signs of a nuclear jaundice: muscle hypertonus, stiff neck, opisthotonus, sharp "brain" cry, hyperesthesia, bulging of the fontanelle, muscle twitching, convulsions, a positive symptom of the setting sun, nystagmus, apnea and complete respiratory arrest. After 2-3 weeks the patient's condition improves, but later signs of cerebral palsy (ateosis, choreoathetosis, paralysis, paresis, delay in psychophysical development, deafness, dysarthria, etc.) are revealed.

Anemic form is the most benign, occurs in 10-15% of cases and is manifested by pallor, poor appetite, lethargy, enlarged liver and spleen, anemia, reticulocytosis, normoblastosis, moderate bilirubin increase.

The diagnosis is based on history and clinical symptoms, blood group and rhesus-affiliation of the mother and child, blood test of the baby, determination, bilirubin level, titer of Rh antibodies or a- and beta-agglutinins in the blood and milk of the mother. For the purpose of antenatal diagnosis, the level of bilirubin in the amniotic fluid and the Rh antibodies are determined.

Differential diagnosis is carried out with hereditary hemolytic jaundice, hemorrhages, polycythemia, jaundice.

Treatment can be both conservative and operative (according to indications). Conservative treatment: IV infusion of 5% glucose solution; ATP, erivit, phenobarbital 10 mg / (kg-day), agar-agar 0.1 g 3 times a day, 12.5% ​​xylitol or magnesium sulfate solution 1 teaspoon 3 times a day, phototherapy (blue lamps Or blue, a session of 3 hours at intervals of 2 hours, just a day the irradiation time is 12-16 hours).

Surgical treatment: absolute indications for a replacement blood transfusion are hyperbilirubinemia above 342 μmol / l, with a rate of bilirubin increase above 6 μmol / (l ч h) and at a level in the cord blood above 60 μmol / l. In most cases, a replacement blood transfusion is performed by the Diamond method via the umbilical vein with a polyethylene or metal catheter. For these purposes, freshly conserved unicellular blood (Rhesus-negative) is used. Calculation-120- 170 ml of blood per 1 kg of body weight.

The course and prognosis of the disease depends on the form. With a bilirubin level of 257-342 μmol / l or more, even if nuclear jaundice has not developed, in almost 1/3 of the children there are deviations in the neuropsychiatric status. If a replacement blood transfusion has been performed, normochromic hypo- or normoregenerative anemia is observed within 1-2 months.

For the prevention of all pregnant women are examined for Rh-belonging. With Rh-negative blood, a titer of antiresus antibodies is determined in a pregnant woman every 1-1.5 months. When the titer is increased, the administration of anti-D-globulin is indicated. It is recommended to save the first pregnancy and break 4-5 years before the next. Children who have had a hemolytic disease of newborns are on dispensary records with a monthly examination of a neurologist, orthopedist, and ophthalmologist. Diversions from vaccinations of up to 1 year are given.