Erythroblastosis Fetalis
Erythroblastosis fetalis is a condition that causes the mother's red blood cells attack those of the baby as they would any foreign invaders.

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What Is Erythroblastosis Fetalis?

The adult human body is home to trillions of red blood cells (erythrocytes). These blood cells carry oxygen, iron, and many other nutrients to their appropriate places in the body. When a woman is pregnant, it is possible that her baby’s blood type will be incompatible with her own. This can cause a condition known as erythroblastosis fetalis, where the mother’s red blood cells attack those of the baby as they would any foreign invaders.

Also known as hemolytic disease of the newborn, this condition is highly preventable. Catching it early can ensure a successful pregnancy for mother and child. If left untreated, this condition can be life-threatening for the baby.

What Causes Erythroblastosis Fetalis?

There are two main causes of erythroblastosis fetalis: Rh incompatibility and ABO incompatibility. Both are associated with blood type. There are four blood types: A, B, AB, and O. And blood can be either Rh positive or Rh negative. If a person is of blood type A and is Rh positive, he or she has A antigens and the Rh factor antigens on the red blood cell membrane surface. If a person has AB negative blood, he or she has both A and B antigens without the Rh factor antigen.

Rh incompatibility occurs when an Rh-negative mother is impregnated by an Rh-positive father. The result can be an Rh-positive baby. In such a case, the baby’s Rh antigens will be perceived as foreign invaders, the way viruses or bacteria are perceived. The mother’s blood cells attack the baby’s as a protective mechanism that can end up harming the child.

If the mother is pregnant with her first baby, Rh incompatibility is not as much of a concern. However, when the Rh-positive child is born, the mother’s body creates antibodies against the Rh factor, which will attack the blood cells if she becomes pregnant with another Rh-positive baby.

Another type of hemolytic disease of newborns is ABO blood type incompatibility. This occurs when a mother’s blood type of A, B, or O is not compatible with a baby’s. This condition is considered less harmful and threatening to the baby than Rh incompatibility. However, babies can carry rare antigens that can put them at risk for erythroblastosis fetalis, including Kell, Duffy, Kidd, Lutheran, Diego, Xg, P, Ee, Cc, and MNSs antigens (Dulay 2014).

How Is Erythroblastosis Fetalis Diagnosed?

To diagnose erythroblastosis fetalis, a doctor will order a routine blood test during an expectant mother’s first visit. This will test for the mother’s blood type, and it will determine whether she has anti-Rh antibodies in her blood from a previous pregnancy. If she has Rh-negative blood and Rh-antibodies, the father’s blood will be tested. She will be tested again at between 18 to 20 weeks of pregnancy and again at 26 to 27 weeks.

The fetus’s blood type is rarely tested. It is difficult to test a fetus’s blood type, and doing so can increase the risk for complications. Instead, a mother’s blood is continually tested for antibodies throughout her pregnancy—approximately every two to four weeks. If the antibody levels start to rise, a physician may recommend a test to detect fetal cerebral artery blood flow, which is not invasive to the baby. If the baby’s blood flow is affected, erythroblastosis fetalis is suspected.

If a baby is jaundiced (appears yellow in skin color due to a build-up of bilirubin) after birth, but Rh incompatibility is not suspected, the baby may be experiencing problems due to ABO incompatibility. This occurs most frequently when a mother with an O blood type gives birth to a baby who has an A, B, or AB blood type. Because O blood types have both A and B antigens, the mother’s blood can attack the baby’s. However, these symptoms are generally thought to be much milder than an Rh incompatibility.

ABO incompatibility can be detected via a blood test known as a Coombs’ test, which is performed after the baby is born. This can indicate why a baby may appear jaundiced or anemic.

What Are the Symptoms of Erythroblastosis Fetalis?

Babies who experience erythroblastosis fetalis symptoms may appear swollen, pale, and/or jaundiced after birth. A physician may find that the baby has a larger-than-normal liver or spleen. Blood tests can also reveal that the baby has anemia or a low red blood cell count.

Babies can also experience a condition known as hydrops, where fluid starts to accumulate in spaces where fluid is normally not present. This includes spaces in the abdomen, heart, and lungs. This symptom can be harmful because the extra fluid places pressure on the heart and affects its ability to pump.

How Is Erythroblastosis Fetalis Treated?

A preventive treatment known as RhoGAM, or Rh immunoglobulin, can reduce the mother’s body’s reaction to the baby’s Rh-positive blood cells. This is administered as a shot at around the 28th week of pregnancy. The shot is administered again at least 72 hours after birth if the baby is Rh positive. This prevents adverse reactions for the mother if any of the baby’s placenta remains in the womb.

If a baby experiences erythroblastosis fetalis in the womb, he or she may be given intrauterine blood transfusions to reduce anemia. When the baby’s lungs and heart mature enough for delivery, a physician may recommend delivering the baby early (University of Rochester Medical Center, 2014).

After a baby is born, further blood transfusions may be necessary. Giving the baby fluids intravenously can improve low blood pressure. The baby may also need temporary breathing support from a ventilator or mechanical breathing machine.

What Is the Prognosis for Erythroblastosis Fetalis?

Babies born with erythroblastosis fetalis should be monitored for at least three to four months for signs of anemia (Widness, J., n.d.). They may require additional blood transfusions. However, if proper pre-natal care and postpartum care are delivered, the baby should not experience long-term complications.

Written by: Rachel Nall, RN, BSN
Edited by:
Medically Reviewed by: George Krucik, MD, MBA
Published: May 20, 2014
Published By: Healthline Networks, Inc.
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