Erythroblastosis fetalis is the destruction of red blood cells in the fetus or newborn by maternal antibodies, caused by blood incompatibility, resulting in symptoms such as yellowish skin, anemia, generalized swelling or accumulation of fluid in the baby’s abdomen.
This disease, also known as hemolytic disease of the newborn, perinatal hemolytic disease or Rhesus disease, generally occurs in the baby of a second pregnancy, when the pregnant woman has Rh-negative blood and had a baby with Rh type blood in her first pregnancy. positive, without having undergone immunoglobulin treatment.
To avoid these complications in the baby, the woman must undergo all prenatal consultations and exams, as it is possible to identify the risk of fetal erythroblastosis, starting treatment, which includes an injection with immunoglobulins to prevent the onset of the condition. illness in the baby. Learn more about treatment to prevent erythroblastosis fetalis.
Symptoms of fetal erythroblastosis
The main symptoms of fetal erythroblastosis are:
- Yellow skin, mucous membranes and eyes, called jaundice;
- Anemia grave;
- Generalized swelling;
- Accumulation of fluid in the abdominal cavity, called ascites;
- Enlargement of the liver and spleen in some cases.
These symptoms are normally identified by a neonatologist after the baby is born, and can range from mild to severe.
When jaundice is not treated properly, the baby may develop kernicterus, caused by the deposition of bilirubin in the nervous system, causing brain damage.
Furthermore, fetal erythroblastosis can also affect the fetus during pregnancy and cause a condition known as hydrops fetalis, which is the most serious form of fetal erythroblastosis and can be identified during prenatal imaging tests. Learn how to identify the symptoms of hydrops fetalis.
How to confirm the diagnosis
The diagnosis of fetal erythroblastosis can be made by the obstetrician during pregnancy through the signs presented by the fetus in the ultrasound examination, in which it can be observed whether there is swelling in the baby and/or accumulation of fluid in the abdomen or other organs.
After birth, the diagnosis is made by the neonatologist through evaluation of symptoms.
In all cases, the doctor must assess the blood compatibility of mother and baby using a blood type test and Coombs test to assess the presence of antibodies.
If the test is positive for antibodies during pregnancy, the doctor must monitor the antibody titer every 4 weeks.
In cases where the titer is greater than 1:16, the doctor must indicate an amniocentesis, and if it is detected that the baby is Rh positive, the obstetrician must screen for fetal anemia through a Doppler examination of the fetus’s middle cerebral artery, every 1 to 2 weeks.
Possible causes
Fetal erythroblastosis is caused by the production of antibodies by a woman who has an Rh-negative blood type, against the red blood cells of a fetus that has an Rh-positive blood type, causing the destruction of these cells.
Some factors may increase the risk of developing erythroblastosis fetalis, such as:
- Movement of red blood cells from the fetus through the placenta into the maternal blood circulation, being greater during childbirth;
- Miscarriage;
- Amniocentesis;
- Vaginal bleeding during pregnancy;
- Ectopic pregnancy;
- Premature placental abruption;
- Trauma abdominal;
- Invasive procedures during pregnancy.
These situations can expose the Rh-negative woman to the Rh-positive blood of the fetus, and thus produce antibodies that can cross the placenta and destroy the fetus’s red blood cells in the next pregnancy, if the baby is Rh-positive.
Furthermore, although it is rarer, this change can also develop when the pregnant woman has received an Rh+ blood transfusion, at any point in her life before becoming pregnant. Therefore, it is important that the obstetrician knows the pregnant woman’s entire history.
How to prevent fetal erythroblastosis
Treatment to prevent fetal erythroblastosis consists of injecting anti-D immunoglobulin, which can be done:
- In the 28th week of pregnancy: especially when the father is Rh+ or when the first child was born with Rh+ type blood and the injection was not given during the first pregnancy;
- 3 days after giving birth: it is done after a first pregnancy in which the baby is born with Rh+ blood and helps prevent the formation of antibodies that could harm a future pregnancy.
If no injection is given and the baby is at high risk of developing erythroblastosis fetalis, the doctor may still try to bring forward the due date, as soon as the baby’s lungs and heart are well developed.
Furthermore, to avoid fetal erythroblastosis and possible complications and sequelae, it is important that women attend all prenatal consultations so that the risk of the disease can be assessed and monitored.
How is treatment carried out after childbirth?
If the mother was not immunized during pregnancy or after giving birth to her first Rh-positive child, and the baby is born with erythroblastosis, the neonatologist will provide some treatments, which vary according to the severity of the symptoms.
Therefore, the doctor may recommend frequent breastfeeding or phototherapy in mild to moderate cases in which the baby has jaundice, to control bilirubin levels in the blood. Another treatment is the application of immunoglobulin directly into the vein.
In more serious cases, blood transfusions may be indicated for the baby or exsanguination, which consists of replacing the baby’s blood with another that is compatible. This process may be repeated for several weeks, until all of the mother’s antibodies have been eliminated.
In some cases, the blood transfusion can be done while the baby is still in the womb, and the doctor may recommend that the birth be brought forward to avoid complications.
