Erythroblastosis Fetalis

What is erythroblastosis fetalis?

• Erythroblastosis fetalis (e-RITH-ro-blas-toe-sis FEE-tal-is) is a condition that can cause anemia (low red blood cell count) in babies. It is also called hemolytic disease of the newborn. Babies get this condition before they are born. This condition happens when antibodies made by the mother attack the baby's red blood cells. Antibodies are a part of your body's immune system (body's defense). They are special substances made by your body to fight germs and foreign (not you) substances that get into your body. When the mother's antibodies attack the baby's red blood cells, the blood cells swell and burst, and are destroyed.
  
  
• Erythroblastosis fetalis occurs when you and your baby have differences in your blood. When the baby's blood gets into your blood during pregnancy, your body reacts to it as being foreign. When this happens, your immune system makes antibodies against it. These antibodies can cross over to your baby through the placenta (organ in the womb that connects baby to mother). They enter your baby's blood and attack your baby's red blood cells. This may cause severe (very bad) anemia. These antibodies may stay in your baby's blood for some time after he is born.

What causes erythroblastosis fetalis?

• Erythroblastosis fetalis is caused by the red blood cells (RBCs) made by mother and baby being different. There are many ways the RBCs may be different. Incompatible differences are ones that can cause the mother's body to make antibodies against the baby's RBCs. This happens when you have been pregnant before and your immune system was exposed to that baby's blood. Your exposure to that baby's blood may have happened during pregnancy, miscarriage, abortion, or delivery. This past exposure makes your immune system sensitive to the presence of foreign blood. The next time you get pregnant, your body reacts more strongly and makes many more antibodies.
  
  
• The RBC incompatibilities that usually cause erythroblastosis fetalis are called Rh factor and ABO. Rh factor incompatibility happens when you are Rh negative (Rh-) and your baby is Rh positive (Rh+). ABO incompatibility may happen if you and your baby have different major blood types. A, B, and O are the three major blood types. ABO incompatibility is most common when your blood type is O and your baby's is A or B. ABO incompatibilities cause erythroblastosis fetalis more often than Rh factor as there is preventive treatment for Rh factor exposure. Ask your caregiver for more information Rh factor incompatibility or ABO incompatibility.

What problems may come when my baby has erythroblastosis fetalis?

• Before your baby is born: Before your baby is born, he can get severe (very bad) erythroblastosis fetalis. He can get very anemic (have too few RBCs in his blood). He can have problems with his blood circulation (movement of brood through the body) and get heart failure. He can get a condition called hydrops fetalis where his body gets very swollen. He may die before being born or die shortly after being born.
  
  
• After your baby is born: Babies with less severe erythroblastosis fetalis may get jaundice (yellow skin color) days after they are born. This is from the ongoing breakdown of RBCs from the mother's antibodies still in the baby's blood. Some babies go home soon after being born, but have to come back into the hospital for treatment. Babies with more severe erythroblastosis fetalis while in the womb may be born with jaundice. Your jaundiced baby will need treatment to prevent injury from having too much bilirubin. Bilirubin is the yellow substance that causes the jaundice. Ask your caregiver for more information about jaundice in newborns.

What are the signs and symptoms of erythroblastosis fetalis?

Your baby may have one or more of the following:

• Before your baby is born: These may be found by ultrasound exam:
  
  
  • Fast heart rate.
    
    
  • Enlarged organs, such as the heart, liver, or spleen.
    
    
  • Swelling of the whole body.
  
  
• After your baby is born:
  
  
  • Anemia (low red blood cell count). This may cause your baby to be pale.
    
    
  • Enlarged organs, such as the heart, liver, or spleen.
    
    
  • Jaundice (yellowing of the skin or the whites of the eyes). This may be present at birth or appears within 24 hours after birth.
    
    
  • Small red or brown spots, or purple patches on the skin.
    
    
  • Swelling of the whole body.
    
    
  • Trouble breathing.

How is erythroblastosis fetalis diagnosed?

• Before your baby is born: Caregivers will need to know if you have past pregnancies, abortions, miscarriages, or any blood transfusions. Before your baby is born, caregivers may do one or more of the following tests:
  
  
  • Amniocentesis: This test checks for problems in your amniotic fluid (fluid around your baby), such as increased bilirubin level. This may be increased if your baby is getting erythroblastosis fetalis. Using ultrasound guidance, caregivers take a fluid sample by putting a needle through your skin into your uterus (womb). The sample will then be sent to a lab for tests. Repeated amniocentesis may be done to monitor your baby's risk of anemia. Ask your caregiver for more information about amniocentesis.
    
    
  • Fetal blood sampling: This is also called cordocentesis or percutaneous umbilical blood sampling (PUBS). This test may be done to check your baby's blood type and risk of anemia. Caregivers take a sample of your baby's blood from the umbilical cord. Umbilical cord is the cord that connects you to your baby. Using ultrasound guidance, a needle is put through your skin into your uterus, and into the umbilical cord. The sample is sent to a lab for tests.
    
    
  • Ultrasound: This test uses sound waves to show pictures of your baby inside your uterus. Caregivers can learn the age of your baby and see how fast he is growing. Your baby's movement, heart rate, and organs can be seen. Your placenta (organ in the uterus that connects baby to mother) and amniotic fluid may be checked. Doppler ultrasound is a type of ultrasound that may be used to see the blood flow. Caregivers may use this test to check if your baby has anemia. A Doppler ultrasound may be used in place of amniocentesis.
  
  
• After your baby is born: Caregivers may do different blood tests . You and your baby may need blood taken for tests. The blood can be taken from your arm and the umbilical cord of the placenta. Your and your baby's blood may be checked for blood type and the presence of antibodies. You and your baby may need to have blood drawn more than once.

How is erythroblastosis fetalis treated?

• Before your baby is born:
  
  
  • Blood transfusions: Your unborn baby may need to have blood transfusions while still in the womb. These may be given through the umbilical cord.
    
    
  • Preterm delivery: In some situations, your baby may need to be born earlier than expected.
  
  
• After your baby is born: After birth, your baby may have any of the following treatments:
  
  
  • Phototherapy: This treatment uses special bright lights to help break down and get rid of the bilirubin in your baby's body. As his bilirubin level decreases, his skin will lose its yellow color. Depending on how high his bilirubin level is, phototherapy may be used all of the time, or only sometimes. Ask your caregiver for more information about phototherapy for jaundice in newborns.
    
    
  • Immune globulin: Immune globulin given intravenous (IV) is also called IVIG. This medicine helps to keep your baby's RBCs from being damaged by antibodies made by the mother's body. Getting this treatment may reduce his chances of needing an exchange transfusion. Ask your caregiver for more information about how immune globulin medicine may help your baby.
    
    
  • Exchange transfusion: This is a procedure to remove the antibodies attacking his RBCs and some of the bilirubin. Small portions of your baby's blood will be removed and replaced with donor blood. You may be worried that your baby may get AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risks of this happening are rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus. This procedure may need to be done more than once. Ask your caregiver for more information about exchange transfusion in newborns.

How can erythroblastosis fetalis be prevented?

Medical care is very important if your baby is at risk for getting erythroblastosis fetalis. If you put off getting prenatal (before birth) care while you are pregnant, you may increase that risk.

• Screening tests: If you are concerned about having problems, get your ABO and Rh blood types checked before getting pregnant. Otherwise, it may be done as part of your first prenatal visit. If you have been pregnant before or had blood transfusions, you may need additional tests. Caregivers may screen your blood for presence of antibodies to other blood types. Caregivers may want to test the blood of the baby's father for ABO and Rh type. During your pregnancy, your baby's blood may need to tested to check for blood ABO and Rh type. Caregivers may also do a test to see if your blood reacts to your baby's blood.
  
  
• Rh factor treatments: If you and your baby have an Rh type mismatch, you may be given Rh factor immune globulin. This medicine is given to prevent Rh incompatibility from happening. It prevents your body from making antibodies to attack the baby´s RBCs that may get into your blood. This medicine may be given both while you are pregnant and after you give birth. Ask you caregiver for more information about Rho (D) immune globulin.

When should I call a caregiver?

Call if:

• Before your baby is born:
  
  
  • You feel your baby is moving less or is not moving at all.
    
    
  • You develop a fever.
  
  
• After your baby is born:
  
  
  • Your baby develops a fever.
    
    
  • Your baby becomes jaundiced.
    
    
  • Your baby is not feeding well or is urinating less than before.
    
    
  • You are having breastfeeding problems.
    
    
  • By his fourth day of life, your breastfeeding baby has:
    
    
    • Fewer than 4 to 6 urine-soaked diapers in a 24 hour period.
      
      
    • Fewer than 3 to 4 stools (BMs) in a 24 hour period.
    
    
  • You have questions or concerns about your baby's condition, medicine or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• Your baby has jaundice that does not go away or is getting worse.
  
  
• Your baby has trouble breathing.
  
  
• Your baby is having a seizure (convulsion).
  
  
• Your baby is very irritable, fussy, and has a high-pitched cry.
  
  
• Your baby looks very tired or weak, or sleeps more than usual.

Where can I find more information:

Contact the following:

• American Academy of Family Physicians
  11400 Tomahawk Creek Parkway
  Leawood , KS 66211-2680
  Phone: 1- 913 - 906-6000
  Phone: 1- 800 - 274-2237
  Web Address: http://www.aafp.org
  

• American Academy of Pediatrics
  141 Northwest Point Boulevard
  Elk Grove Village , IL 60007-1098
  Phone: 1- 847 - 434-4000
  Web Address: http://www.aap.org
  

• The American College of Obstetricians and Gynecologists
  409 12th Street, SW
  Washington , DC 20090
  Phone: 1- 202 - 638-5577
  Web Address: http://www.acog.org
  

Care Agreement

You have the right to help plan your baby's care. Learn about your baby's health condition and how it may be treated. Discuss treatment options with your baby's caregivers to decide what care you want for your baby.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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