Advertisement

Diagnosis, Treatment, and Prevention of Isoimmune Hemolytic Disease of the Newborn

  • David B. Acker
  • Fredric D. FrigolettoJr.
  • Irving Umansky

Abstract

Progress in understanding and treating hemolytic diseases of the fetus and newborn due to RhO(D) isoimmunization is well documented in the medical literature. Wysowski et al. (1979) noted that the incidence of Rh disease declined from 45 to 21 per 10,000 live births between 1970 and 1975. These data, from a birth defects screening program, if applied to all births in the United States, imply an estimated reduction in the number of newborn infants suffering from Rh isoimmunization from 16,000 to 6000. Similarly, the infant mortality from all hemolytic diseases of the newborn also decreased, from 2.7 per 10,000 live births (a total of 941 deaths) to 0.9 per 10,000 live births (a total of 269 deaths) by 1975. Successful management of erythroblastosis fetalis and almost complete prevention of Rh disease of the newborn are possibilities. To achieve these goals all health care providers must maintain up-to-date knowledge of current treatment and controversies. This chapter will therefore review three broad areas of concern: (1) Counseling the already sensitized patient who desires another pregnancy; (2) evaluation of new methods of management of the affected fetus; and (3) identification of the reproductive events that result in sensitization.

Keywords

Amniotic Fluid Ectopic Pregnancy Spontaneous Abortion Exchange Transfusion Hemolytic Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Acker, D. B., and Frigoletto, F. D., 1982, Rh-isoimmunization, Am. J. Obstet. Gynecol. 143:487.Google Scholar
  2. Acker, D. B., Frigoletto, F. D., Birnholz, J. C., et al., 1980, Ultrasound-facilitated intrauterine transfusions, Am. J. Obstet. Gynecol. 138:1200.PubMedGoogle Scholar
  3. Allen, F. J., Jr., 1954, Erythoblastosis fetalis. IX. The problems of stillbirth, 251:453.Google Scholar
  4. Allen, F. H., and Umansky, I., 1972, Erythroblastosis fetalis, in: Principles and Management of Human Reproduction (D. E. Reid, K. J. Ryan, and K. Benirshke, eds.), p. 811, Saunders, Philadelphia.Google Scholar
  5. Alpern, W. M., 1969, Spectrophotometric analysis of amniotic fluid, in: Rh Isoimmunization and Erythroblastosis Fetalis (A. G. Charles and E. A. Friedman, eds.), p. 114, Appleton-Century-Crofts, New York.Google Scholar
  6. Barclay, G. R., Greiss, M. A., and Urbank, S. J., 1980, Adverse effect of plasma exchange on anti-D production in rhesus immunization owing to removal of inhibitory factors, Br. Med. J. 280:1569.PubMedCrossRefGoogle Scholar
  7. Bevis, D. C. A., 1952, The antenatal prediction of haemolytic disease of the newborn, Lancet 1:395.PubMedCrossRefGoogle Scholar
  8. Bevis, D. C. A., 1953, The composition of liquor amnii in haemolytic disease of the newborn, J. Obstet. Gynaecol. Br. Emp. 60:244.PubMedCrossRefGoogle Scholar
  9. Bevis, D. C. A., 1956, Blood pigments in haemolytic disease of the newborn, J. Obstet. Gynecol. Br. Emp. 63:68.CrossRefGoogle Scholar
  10. Bock, J. E., and Winkel, S., 1976, Follow-up study on infants who received intrauterine transfusions because of severe rhesus hemolytic disease, Acta Obstet. Gynecol. Scand. (Suppl.) 53:37.CrossRefGoogle Scholar
  11. Bowman, J. M., 1967, Neonatal Management, in: Modern Management of the Rh Problem (J. T. Queenan, ed.), p. 267, Hoeber, New York.Google Scholar
  12. Bowman, J. M., 1975, Rh erythroblastosis fetalis 1975, Curr. Probl. Pediatr. Hematol. 1975:29.Google Scholar
  13. Bowman, J., 1976, Winnepeg antenatal prophylaxis trial, in: Symposium on Rh Antibody Mediated Immunosuppression, p. 55, Ortho Diagnostics, Raritan, New Jersey.Google Scholar
  14. Bowman, J. M., 1978a, Suppression of isoimmunization: A review, Obstet. Gynecol. 52:385.PubMedGoogle Scholar
  15. Bowman, J. M., 1978b, The management of Rh isoimmunization, Obstet. Gynecol. 52:1.PubMedGoogle Scholar
  16. Buchanan, D. I., Bell, R. E., Beck, R. P., et al., 1969, Use of different doses of anti-Rh isoimmunisation, Lancet 2:288.PubMedCrossRefGoogle Scholar
  17. Cooperberg, P. L., and Carpenter, C. W., 1977, Ultrasound as an aid in intrauterine transfusion, Am. J. Obstet. Gynecol. 128:239.PubMedGoogle Scholar
  18. Cooperberg, P. L., and Carpenter, C. W., 1978, Real time ultrasound as an aid in intrauterine transfusion, Radiology 127:535.PubMedGoogle Scholar
  19. Fraser, I. D., Bothamley, J. E., Bennett, M. O., et al., 1976, Intensive antenatal plasmapheresis in severe rhesus isoimmunization, Lancet 1:6.PubMedCrossRefGoogle Scholar
  20. Freda, V. J., 1965, The Rh problem in obstetrics and a new concept of its management using amniocentesis and spectrophotometric scanning of amniotic fluid, Am. J. Obstet. Gynecol. 92:341.PubMedGoogle Scholar
  21. Freda, V. J., Gorman, J. G., Pollack, W., et al., 1975, Prevention of Rh hemolytic disease: Ten years’ clinical experience with Rh immune globulin, N. Engl. J. Med. 292:1014.PubMedCrossRefGoogle Scholar
  22. Frigoletto, F. D., Birnholz, J. E., Rothchild, S. B., et al., 1978, Intrauterine transfusion with the use of phased array ultrasonography: A new technique, Am. J. Obstet. Gynecol. 131:273.PubMedGoogle Scholar
  23. Graham-Pole, J., Barr, W., and Willoughby, M. L. N., 1977, Continuous-flow plasmapheresis in management of severe rhesus disease, Br. Med. J. 1:1185.PubMedCrossRefGoogle Scholar
  24. Grimes, D. A., Ross, W. C., and Hatcher, R. A., 1977, Rh immunoglobulin utilization after spontaneous and induced abortion, Obstet. Gynecol. 50:261.PubMedGoogle Scholar
  25. Grimes, D. A., Geary, F. H., and Hatcher, R. A., 1981, Rh-immunoglobulin utilization after ectopic pregnancy, Am. J. Obstet. Gynecol. 140:246.PubMedGoogle Scholar
  26. Hamilton, E. G., 1977, Intrauterine transfusion, Obstet. Gynecol. 50:255.PubMedGoogle Scholar
  27. Hensleigh, P. A., Leslie, W., Dixon, E. Hall, E., Kitay, D. Z., and Jackson, J. E., 1977, Reduced dose of RhQ(D) immune globulin following induced first-trimester abortion, Obstet. Gynecol. 50:261.Google Scholar
  28. Hobbins, J. C., Davis, E. D., and Webster, J., 1975, A new technique utilizing ultrasound to aid in IUT, J. Clin. Ultrasound 4:135.CrossRefGoogle Scholar
  29. Katz, J., and Marcus, R. G., 1972, The risk of Rh-isoimmunization in ruptured tubal pregnancy, Br. Med. J. 3:667.PubMedCrossRefGoogle Scholar
  30. Liggens, G. C., 1966, Intrauterine Transfusion and Erythroblastosis, Report of the 53rd Ross Conference on Pediatric Research, Columbus, Ross Laboratories.Google Scholar
  31. Liley, A. W., 1961, Liquor amnii analysis in the management of the pregnancy complicated by rhesus sensitization, Am. J. Obstet. Gynecol. 82:1359.PubMedGoogle Scholar
  32. Liley, A. W., 1963, Intrauterine transfusion in haemolytic disease, Br. Med. J. 2:1107.PubMedCrossRefGoogle Scholar
  33. Litwak, O., Taswall, H. F., Banner, E. A., et al., 1970, Fetal erythrocytes in maternal circulation after spontaneous abortion, J. Am. Med. Assoc. 214:531.CrossRefGoogle Scholar
  34. Lucey, J. F., 1968, Diagnosis and treatment: Current indications and results of fetal transfusions, Pediatrics 41:139.PubMedGoogle Scholar
  35. Mollison, P. L., 1972, Blood transfusion in Clinical Medicine, 1st ed., p. 628, Blackwell, London.Google Scholar
  36. Ogborn, A. D. R., Hunt, K. M., Gordon, H., 1977, Factors affecting fetal survival after intrauterine transfusion for rhesus isoimmunization, Br. J. Obstet. Gynaecol. 84:665.PubMedGoogle Scholar
  37. Palmer, A., and Gordon, R. R., 1976, A critical review of intrauterine fetal transfusion, Br. J. Obstet. Gynaecol. 83:688.PubMedCrossRefGoogle Scholar
  38. Parkman, R., Mosier, D., Umansky, I., et al., 1971, Graft vs. host disease after intrauterine and exchange transfusion for hemolytic disease of the newborn, N. Engl. J. Med. 1290:359.Google Scholar
  39. Queenan, J. T., 1966, Amniocentesis and transamniotic fetal transfusion for Rh disease, Clin. Obstet.Gynecol. 9:941.Google Scholar
  40. Queenan, J. T., 1969, Intrauterine transfusion, Am. J. Obstet. Gynecol. 104:397.PubMedGoogle Scholar
  41. Queenan, J. T., 1977, Intrauterine Transfusion, in: Modern Management of the Rh Problem, 2nd ed., p. 169, Hagerstown, Maryland.Google Scholar
  42. Queenan, J. T., Shah, S., Kubarych, S. F., et al., 1971, Role of induced abortion in rhesus immunization, Lancet 1:815.PubMedCrossRefGoogle Scholar
  43. Robertson, E. G., Brown, A., Ellis, M. I., et al., 1976, Intrauterine transfusion in the management of severe rhesus isoimmunization, Br. J. Obstet. Gynaecol. 83:694.PubMedCrossRefGoogle Scholar
  44. Rodeck, C. L. H., Holman, C. A., Karnicki, J., et al., 1981, Direct intravascular fetal blood transfusion by fetoscopy in severe rhesus isoimmunization, Lancet 1:625.PubMedCrossRefGoogle Scholar
  45. Stewart, F. H., Burnhill, M. S., and Bozorgi, N., 1978, Reduced dose of Rh-immunoglobulin following first-trimester pregnancy termination, Obstet. Gynecol. 51:318.PubMedCrossRefGoogle Scholar
  46. Umansky, I., and Allen, F. H., 1972, Erythroblastosis fetalis, in: Principles and Management of HumanReproduction (D. E. Reid, K. J. Ryan, and K. Benirshke, eds.), p. 820, Saunders, Philadelphia.Google Scholar
  47. Umansky, I., and Frigoletto, F. D., 1976, Current Uses of RhQ Immune Globulin and Detection of Antibodies, ACOG Technical Bulletin No. 35, January 1976.Google Scholar
  48. Walsh, J.J. and Lewis, B. V, 1970, Transplacental haemorrhage due to termination of pregnancy, J. Obstet.Gynaecol. Br. Comm. 77:133.CrossRefGoogle Scholar
  49. Weinstein, L., 1982, Irregular antibodies causing hemolytic disease of the newborn: A continuing problem, Clin. Obstet. Gynecol. 25:321.PubMedCrossRefGoogle Scholar
  50. Whitfield, C. R., 1970, A three year assessment of an action line method of timing intervention in rhesus isoimmunization, Am. J. Obstet. Gynecol. 108:1239.PubMedGoogle Scholar
  51. WHO, 1971, Prevention of Rh Sensitization, World Health Organization Technical Report Series, No. 468.Google Scholar
  52. Wysowski, D. K., Flynt, W., Golldberg, M. F., et al., 1979, Rh hemolytic disease: Epidemiologic surveillance in the United States, 1968 to 1975, J. Am. Med. Assoc. 242:1376.CrossRefGoogle Scholar

Copyright information

© Aubrey Milunsky 1986

Authors and Affiliations

  • David B. Acker
    • 1
  • Fredric D. FrigolettoJr.
    • 2
    • 3
  • Irving Umansky
    • 4
    • 5
    • 6
    • 7
  1. 1.Departments of Obstetrics-GynecologyBeth Israel Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Department of ObstetricsBrigham and Women’s HospitalBostonUSA
  3. 3.Department of Obstetrics-GynecologyHarvard Medical SchoolBostonUSA
  4. 4.Department of PediatricsHarvard Medical SchoolBostonUSA
  5. 5.Blood Grouping LaboratoryCenter for Blood ResearchBostonUSA
  6. 6.Department of MedicineChildren’s Hospital Medical CenterBostonUSA
  7. 7.Department of HematologyBoston Hospital for WomenBostonUSA

Personalised recommendations