Hemolytic disease of the fetus and new born

Hemolytic disease of the fetus and new born

Updated: 07/24/2025

© Jun Wang, MD, PhD

 

General features

  • Caused by maternal antibodies (IgG) against fetal RBCs
  • Most common anti-D (Rh), A, B
  • Anti-D
    • RhD-negative mother, RhD-positive child
    • Usually not first pregnancy (IgM does not cross placenta)
    • Caused by fetal RBCs entered maternal circulation
  • Anti-A or B
    • Group O mother, group A or B child
    • Associated with maternal IgG against A or B antigen 
    • May affect first pregnancy
    • Usually mild (levels of anti-A and anti-B IgG are low, and IgM does not cross placenta)

Clinical features

  • Lead to fetal anemia, hydrops fetalis and death in utero
  • Lead to neonatal anemia, hyperbilirubinemia and kernicterus
  • Extramedullary hematopoiesis, hepatosplenomegaly

Laboratory findings

  • Positive direct antiglobulin test
  • ABO mismatch: antibody screening might be negative
  • Identification of maternal antibodies against child RBCs
  • Anemia with reticulocytosis, spherocytes, polychromasia, and nucleated RBCs
  • Hyperbilirubinemia: unconjugated bilirubincount

Management

  • Intrauterine transfusion
  • Therapeutic plasma exchange
  • Phototherapy to convert serum unconjugated bilirubin to the water-soluble form
  • Double volume exchange transfusion: replacing the baby's total blood volume twice, leaving the intravascular amount the same 
  • Prevention: Intravenous immune globulin (IVIG) at 28 weeks of gestation if Rh- mother with negative anti-D test

 

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