Hemolytic Disease Of The Newborn (HDFN) Group 2 Report PDF

TOPIC: Hemolytic disease of the newborn (ABO, Rh-D, and AnWj Blood Groups) Nonmendelian (Codominance) Each Group must include the following in their report: Disorder background - Eryl Epidemiology, Statistics - Joanna Discussion on the principle of the specific inheritance and mutation - Mari...

TOPIC: Hemolytic disease of the newborn (ABO, Rh-D, and AnWj Blood Groups) Nonmendelian (Codominance) Each Group must include the following in their report: Disorder background - Eryl Epidemiology, Statistics - Joanna Discussion on the principle of the specific inheritance and mutation - Mari Disorder features (signs and symptoms) mine Available Treatment/Management (SAB) Recommendations to peers (Group reflection) - Asia Disorder background 1609s - The earliest account of HDN happened during 1609. A French midwife delivered twin babies; one baby was swollen & died after the birth, the other baby developed jaundice and died a few days after birth. Many similar cases became prevalent during the next 300 years, wherein newborn babies failed to survive. 1930s – It was only during the 1930s when Dr. Louis Diamond identified and clarified the underlying cause of HDN; concluding that the cause of HDN is due to the antibodies from the mother attacking the newborn’s red blood cells. The attack occurs when there’s a detected incompatibility between the mother’s and baby’s blood during pregnancy, causing fetal mortality and morbidity. The paper of Diamond, indicated the relationship among jaundice, anemia, and erythroblast in the circulation, which later referred to the erythroblastosis fetalis. 1940s – Parallel to the findings of Diamond, Landsteiner, another scientist, discovered the RH blood group system and RH-factor, which came from his research studies of rhesus monkeys. Landsteiner research contributed to further understanding of HDN; with the Rh-factor identified, researchers can better explain the newborn hemolytic disease. 1960s – United States and United Kingdom held a trial to test the usage of therapeutic antibodies which aims to remove the antibodies that are causing the occurrence of HDN from the mother’s circulation. The said trial demonstrated how to provide therapeutic antibodies to pregnant women in order to prevent the risk factor of HDN. Epidemiology and Statistics As stated by Hall et al. (2024). When Dr. Louis K. Diamond published about erythroblastosis fetalis in infants based on peripheral smears in 1932, he was the first to define HDFN. There are 1695 HDFN cases for every 100,000 live births, regardless of the reason. About 20% of babies TOPIC: Hemolytic disease of the newborn (ABO, Rh-D, and AnWj Blood Groups) Nonmendelian (Codominance) are born with ABO incompatibility, yet only 1% of these babies go on to develop HDFN. However, with the introduction of RhD-negative immunoprophylaxis (i.e., RhoGAM) in 1968, the prevalence of Rh-induced HDFN has decreased. Since then, there are now 44 cases of Rh-induced HDFN per 100,000 live births, down from 99 cases previously. Despite the increased standardization of RhD immune globulin, between 0.1% and 0.4% of pregnant at-risk women still experience sensitization, most likely from antigens other than RhD. According to research, white male newborns from the West or Midwest had the lowest frequency of HDFN in the US, whereas Black female neonates from southern states have the greatest prevalence. Additionally, HDFN varies by race, with estimates ranging from 50% to 35% for Spanish and French women, 8% for African-American women, 4% for African women, less than 1% for Asian women, and 15% to 16% for White women. Principle Of The Specific Inheritance And Mutation Mode of Inheritance: Nonmendelian (Codominance) “Nonmendelian” - Genetic rulebreakers - They don’t follow the regular rule: Having a dominant allele means the dominant trait will show What is a Mendelian Trait HH or Hh Hair hh Hairless What about Non-Mendelian Traits? BB x WW Chicken Both traits show up Blood type is a phenotype that you can’t tell by looking. Codominance is a non-Mendelian inheritance pattern that occurs when both alleles for a gene are expressed equally in the phenotype of a heterozygote: Explanation In codominance, neither allele is recessive or masked by the other. Both alleles are expressed equally and their features are both seen in the phenotype. Examples Flowers: A cross between a pink and white rhododendron may result in a flower with a mix of pink and white petals. TOPIC: Hemolytic disease of the newborn (ABO, Rh-D, and AnWj Blood Groups) Nonmendelian (Codominance) Blood types: In the human ABO blood type system, the IA and IB alleles are codominant. IA/IB individuals have both the A and the B sugars on their red blood cells and therefore have an AB blood type. Codominance is one of several types of non-Mendelian inheritance, which are cases where traits do not have simple dominant/recessive traits. Other types of non-Mendelian inheritance include incomplete dominance and sex-linked traits. Disorder Features Hemolytic Disease of the Fetus and Newborn (HDFN) is a blood disorder caused by immune-mediated destruction of a baby’s red blood cells (RBCs) due to blood type or Rh factor incompatibility between the mother and baby. It occurs when the mother’s immune system produces antibodies that target fetal RBCs, leading to hemolysis (RBC destruction). This usually arises from blood group incompatibilities between the mother and fetus. The most common causes are Rh-D, ABO, and rarer antigens like AnWj. Main Signs: 1. Anemia: Results from hemolysis of fetal red blood cells (RBCs) due to maternal antibodies. Bone marrow becomes reactive, leading to reticulocytosis (increased immature RBCs in circulation) and the presence of erythroblasts in peripheral blood. The term "erythroblastosis fetalis" originates from this feature. 2. Hyperbilirubinemia: Caused by the breakdown of hemoglobin from lysed RBCs. Excess bilirubin can lead to jaundice and, in severe cases, kernicterus (bilirubin-induced neurological damage). 3. Hydrops Fetalis: A life-threatening condition marked by fluid accumulation in two or more fetal compartments (e.g., abdomen, chest, skin). One can experience severe fetal anemia, which leads to heart failure and generalized swelling. To be specific the symptoms of HDN are as follows: 1. During Pregnancy Typically, the mother experiences no noticeable symptoms. However, prenatal tests may reveal: ○ Yellow-Tinted Amniotic Fluid: This discoloration, often due to bilirubin, suggests rapid breakdown of fetal red blood cells. ○ Fetal Abnormalities: An enlarged liver, spleen, or heart. Fluid accumulation in the abdomen, lungs, or scalp, indicating hydrops fetalis, a condition marked by severe swelling (edema). 2. After Birth Symptoms in the newborn may include: TOPIC: Hemolytic disease of the newborn (ABO, Rh-D, and AnWj Blood Groups) Nonmendelian (Codominance) 1. Pale Skin: Caused by anemia (low red blood cell count). 2. Jaundice: Yellowing of the umbilical cord, skin, and eyes due to high bilirubin levels. Jaundice may not appear immediately but often develops rapidly within 24–36 hours after birth. 3. Enlarged Organs: The liver and spleen may be significantly enlarged. 4. Hydrops Fetalis: Severe cases can involve pronounced swelling and complications related to fluid buildup in multiple body areas. Causes of HDFN 1. Blood Group Incompatibility: Rh Incompatibility: When an Rh-negative mother carries an Rh-positive fetus, maternal antibodies (anti-D) can attack the fetus’s Rh-positive RBCs and trigger maternal anti-D IgG production. Subsequent pregnancies are at higher risk. ○ Features: Severe hemolysis, hydrops fetalis, and neonatal death can occur without intervention. ABO Incompatibility: Common in mothers with blood group O carrying A or B babies. The naturally occurring IgG anti-A or anti-B antibodies may cross the placenta and attack fetal RBCs. Specifically, when a mother with blood type O has a fetus with blood type A, B, or AB, maternal IgG antibodies (anti-A or anti-B) cross the placenta and attack fetal red cells5n omed oss ○ Features: Typically mild, but it can lead to jaundice and mild anemia in newborns. Severe cases are rare because A and B antigens are less well developed on fetal red cells. AnWJ Incompabatibility: AnWj is a high-frequency antigen found on most people's red blood cells. Incompatibility occurs when a mother who lacks the AnWj antigen (AnWj-negative) is exposed to AnWj-positive blood, typically via transfusion or during pregnancy with an AnWj-positive fetus. The maternal immune system develops antibodies against the AnWj antigen. In subsequent pregnancies, these antibodies can cross the placenta and attack the fetus’s AnWj-positive red blood cells. ○ Features: Results in severe fetal anemia and jaundice Diagnosis: Maternal Blood Test:Screens for the presence of antibodies in the mother’s blood that may target fetal red blood cells. Anatomy Ultrasound: A detailed imaging test that evaluates fetal organs. Organ enlargement may indicate anemia in the fetus. Amniocentesis: Involves extracting a small amount of amniotic fluid for laboratory analysis. This helps identify genetic abnormalities and assess fetal health. TOPIC: Hemolytic disease of the newborn (ABO, Rh-D, and AnWj Blood Groups) Nonmendelian (Codominance) Sources: Nationwide Children's. (n.d.). Hemolytic disease of the fetus and newborn (HDFN). Nationwide Children's Hospital. Retrieved November 16, 2024, from https://www.nationwidechildrens.org/conditions/hemolytic-disease-of-the-fetus-and-newborn-hdf n University of Bristol. (2024, September). Researchers discover new details about blood group inheritance. University of Bristol. Retrieved November 16, 2024, from https://www.bristol.ac.uk/news/2024/september/blood-group.html University of Rochester Medical Center. (n.d.). Hemolytic disease of the newborn. University of Rochester Medical Center. Retrieved November 16, 2024, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02 368 Available Treatment/Management During Pregnancy 1. Monitoring: Ultrasound scans may assess fetal blood flow, organ size, and fluid accumulation, crucial for detecting signs like anemia or hydrops fetalis. 2. Intrauterine Blood Transfusions: In cases of severe fetal anemia, red blood cells may be transfused directly into the baby's circulation through the umbilical vein. 3. Early Delivery: If the baby’s condition worsens but the lungs are mature enough, early delivery may be necessary to prevent complications. After Birth 1. Phototherapy: Used to treat jaundice by breaking down excess bilirubin in the baby’s body. 2. Intravenous Immunoglobulin (IVIG): Administered to reduce the destruction of red blood cells, lowering bilirubin levels. 3. Blood Transfusions: Performed if the baby has severe anemia. 4. Exchange Transfusions: This procedure replaces the baby’s blood with donor blood to remove high levels of bilirubin and correct severe anemia. TOPIC: Hemolytic disease of the newborn (ABO, Rh-D, and AnWj Blood Groups) Nonmendelian (Codominance) Preventive measures include administering Rh immunoglobulin (anti-D) to Rh-negative mothers to prevent sensitization, which has significantly reduced the incidence of Rh-related HDN in many regions. However, ongoing management often requires a multidisciplinary team approach to ensure proper prenatal and neonatal care​ Recommendation to Peers: To address Hemolytic Disease of the Fetus and Newborn (HDFN) effectively, several measures can be recommended. Raising awareness about HDFN is equally important. Expecting parents should be educated on the significance of prenatal care and regular checkups, while healthcare providers need training on updated protocols for identifying and managing the disorder. Improved access to care is critical, ensuring that diagnostic tools and Rh immunoglobulin are available, particularly in low-resource settings. Advocacy for health equity is also vital to address racial disparities in HDFN prevalence and outcomes. Postnatal management for affected newborns should include phototherapy to treat jaundice in mild cases and blood or exchange transfusions for severe anemia. Finally, investment in research on rare antigens, such as AnWj, and genetic factors influencing HDFN severity can lead to better diagnostic tools and personalized treatments. By implementing these measures, the risks associated with HDFN can be significantly reduced, improving outcomes for both mothers and infants. Moreover, we recommend to prioritize raising awareness about Hemolytic Disease of the Fetus and Newborn (HDFN) by educating others on the importance of early prenatal screening, such as blood typing and antibody detection. Encourage proactive administration of Rh immunoglobulin (RhoGAM) to Rh-negative mothers as a preventive measure and advocate for equal access to these resources, especially in underserved areas. Promote knowledge-sharing about the latest protocols for managing HDFN and emphasize collaboration to address racial and regional disparities in its prevalence. Lastly, support ongoing research into rare antigens and innovative treatments to improve outcomes for both mothers and newborns. Reference TOPIC: Hemolytic disease of the newborn (ABO, Rh-D, and AnWj Blood Groups) Nonmendelian (Codominance) Dean, L. (2005). Hemolytic disease of the newborn. Nih.gov; National Center for Biotechnology Information (US). https://www.ncbi.nlm.nih.gov/books/NBK2266/ Hall, V., Vadakekut, E. S., & Indirapriya Darshini Avulakunta. (2024, June 7). Hemolytic Disease of the Fetus and Newborn. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557423/?fbclid=IwZXh0bgNhZW0CMTA AAR1GeQ0NSD6u9s3kaKDPJfw5h3Kz64K0Oav5ZtEtwhVHwa9BfHeBdLs9zn0_ aem_5p0nGty_FdKCfQ7ePfgfcg Harbison, C. (2017). Karl Landsteiner (1868-1943) | The Embryo Project Encyclopedia. Embryo.asu.edu. https://embryo.asu.edu/pages/karl-landsteiner-1868-1943 Ross, M. E., Waldron, P., Cashore, W. J., & Antonio, P. (2013). Hemolytic disease of the fetus and newborn. Cambridge University Press EBooks, 65–90. https://doi.org/10.1017/cbo9780511978135.008 Children’s Hospital of Philadelphia. (n.d.). Hemolytic disease of the newborn. https://www.chop.edu/conditions-diseases/hemolytic-disease-newborn Stanford Children’s Health. (2020). Www.stanfordchildrens.org. https://www.stanfordchildrens.org/en/topic/default?id=hemolytic-disease-of-the-n ewborn-hdn-90-P02368 Nationwide Children's. (n.d.). Hemolytic disease of the fetus and newborn (HDFN). Nationwide Children's Hospital. Retrieved November 16, 2024, from https://www.nationwidechildrens.org/conditions/hemolytic-disease-of-the-fetus-and-newb orn-hdfn Stanford Medicine Children's Health. (n.d.). Hemolytic disease of the newborn (HDN). https://www.stanfordchildrens.org/en/topic/default?id=hemolytic-disease-of-the-n ewborn-hdn-90-P02368 TOPIC: Hemolytic disease of the newborn (ABO, Rh-D, and AnWj Blood Groups) Nonmendelian (Codominance) University of Bristol. (2024, September). Researchers discover new details about blood group inheritance. University of Bristol. Retrieved November 16, 2024, from https://www.bristol.ac.uk/news/2024/september/blood-group.html. University of Rochester Medical Center. (n.d.). Hemolytic disease of the newborn. University of Rochester Medical Center. Retrieved November 16, 2024, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&Content ID=P02368 Wagle, S. (2021). Hemolytic Disease of the Newborn: Background, Pathophysiology, Etiology. EMedicine. https://emedicine.medscape.com/article/974349-overview?form=fpf