Premature Birth Complications: Short and Long-Term Health Effects
Understanding Hemolytic Anemia In Newborns
Hemolytic disease of the newborn is a type of anemia that begins during pregnancy. It can cause serious illness in a newborn, but it may be diagnosed during prenatal screening and treated to avoid complications.
Hemolytic anemia is low hemoglobin caused by the destruction of your red blood cells.
In newborns, hemolytic anemia can result from a mismatch between maternal and fetal blood types. This mismatch provokes the maternal immune system to attack fetal red blood cells.
The resulting hemolytic disease of the fetus and newborn (HDFN) can cause your baby to develop anemia and jaundice. Symptoms can begin during pregnancy or after delivery, and range from mild to life threatening.
However, doctors can screen, identify, and closely monitor pregnancies at high risk of HDFN. Preventive therapy is also available for some blood group mismatches.
If your baby has been diagnosed with hemolytic disease of the newborn, effective treatment is available.
Learn more about hemolytic anemia.
When you're pregnant, some of your antibodies cross the placenta and enter your baby's bloodstream to help protect your newborn.
But if your baby has a different blood type than you, this can become a problem. In this case, your antibodies can attack your baby's red blood cells, causing hemolytic disease of the fetus and newborn (HDFN), also known as erythroblastosis fetalis.
We're all born with blood type O, A, B, or AB, determined by the antigen proteins on our red blood cells. Everyone's blood is also either positive or negative for the Rhesus (Rh) antigen. There are also many less-common blood group antigens.
ABO blood type mismatch occurs in up to 25% of pregnancies. But HDFN only develops in about 1% of these pregnancies, usually when birth parents with type O blood carry babies with blood type A or B. This type of HDFN is caused by pre-existing, naturally occurring anti-A or B antibodies found in people with type O blood.
Rh antigen mismatch happens when an Rh-negative parent carries an Rh-positive baby. In Rh mismatches, HDFN is triggered by fetomaternal hemorrhage. If even a tiny amount (as little as 0.1 mL) of Rh+ fetal blood enters the maternal bloodstream during the pregnancy or delivery, the maternal immune system can recognize it as foreign and begin producing antibodies against the baby's red blood cells.
To help prevent and monitor for HDFN, your doctor will test your blood type, Rh antigen, and red blood cell antibodies early in your pregnancy.
Symptoms of HDFN can appear during pregnancy or after birth.
During pregnancy, babies with HDFN can develop:
Newborns with HDFN might also have:
Jaundice is yellow discoloration of the skin and eyes caused by excess bilirubin in the bloodstream. Many healthy newborns develop mild jaundice.
But in HDFN, many red blood cells are bursting and rapidly releasing their bilirubin, so jaundice can quickly become severe. Left untreated, this can lead to neurologic complications (kernicterus).
During pregnancy, doctors will review your medical and obstetric history, determine your blood type, and check for pre-existing red blood cell antibodies that could affect your baby.
If your tests reveal a risk for HDFN, your doctors might:
If you have type O blood but otherwise normal prenatal testing, your baby's blood type and direct antibody test will still be checked shortly after birth to check for newborn hemolytic disease.
If your newborn develops symptoms of HDFN, doctors will monitor blood counts and bilirubin levels, and order further blood tests to clarify the diagnosis.
If your newborn has received a diagnosis of HDFN, doctors may recommend:
When HDFN is diagnosed prenatally, doctors will monitor using ultrasounds, amniocentesis, and fetal and maternal blood tests. Depending on severity, doctors might recommend:
Left untreated, HDFN can result in marked anemia and/or jaundice. In the most severe cases, this results in hydrops fetalis, organ failure (including heart failure), and brain damage.
The good news is that when HDFN is identified early and treated promptly, doctors can help manage any risks to your baby.
Some circumstances increase the risk of HDFN:
With advances in prenatal screening and treatment, the outlook is good for most babies with hemolytic disease.
Research has shown that 94% of fetuses diagnosed with HDFN will survive with treatment (including intrauterine transfusions). Even in cases with prenatal evidence of early hydrops fetalis, survival is 74%.
A 2023 study found that 22% of newborns with HDFN required phototherapy for jaundice, 1% required blood transfusion, and 0.5% required exchange transfusion or IVIg infusion.
What's the most common cause of hemolytic disease in newborns?Though it's declined since the advent of RhoGAM, Rh antigen incompatibility remains the most common cause of serious HDFN.
The number of people with Rh-negative blood types varies between countries around the globe ranging from 2.4% to 17%. With prenatal screening and RhoGAM treatment, about 1 per 3000 Rh-negative birthing parents still develop Rh antibodies, placing their future pregnancies at risk of HDFN.
The most common cause of HDFN overall is ABO blood group incompatibility. But because maternal A/B antibody levels can be low, and fetal red blood cells do not express A/B antigen at a high level, this type of HDFN is often milder.
Is hemolytic anemia of the newborn life threatening?Severe HDFN can lead to critical anemia and hydrops fetalis, which is a life threatening condition. However, treatment is readily available and can significantly reduce the risk to your baby.
Hemolytic disease of the fetus and newborn (HDFN) occurs during pregnancy when your antibodies cross the placenta and attack your baby's red blood cells. This process can be triggered by a variety of different blood antigen mismatches between you and your baby but is most often due to ABO or Rh incompatibility.
Signs and symptoms of HDFN can begin in utero or neonatally. They include fetal or newborn anemia, hyperbilirubinemia, and in severe cases, life threatening hydrops fetalis.
With prompt identification and treatment, the majority of babies with HDFN survive and thrive.
World Malaria Day 2024: 10 Signs And Symptoms Of Malaria
6. Loss of Appetite: A sudden loss of appetite is commonly seen in people suffering from malaria, resulting in weight loss and nutritional deficiencies if left untreated.
7. Jaundice: In severe cases of malaria, jaundice may develop because of liver dysfunction. Yellowing of the skin and whites of the eyes can occur, along with dark urine and pale stools.
8. Enlarged Spleen: The spleen plays an important role in the body's immune response to malaria infection. In some cases, the spleen may become enlarged, causing abdominal discomfort and tenderness.
9. Confusion and Delirium: In severe cases, malaria can affect the brain, causing confusion, delirium, seizures, and coma. These neurological symptoms are serious and require immediate medical attention.
10. Anemia: Malaria parasites destroy red blood cells, causing anemia in affected people. Symptoms of anemia include weakness, dizziness, and shortness of breath.
Can Cholecystitis Cause Jaundice?
Cholecystitis, or gallbladder inflammation, can sometimes cause jaundice if something blocks the flow of bile from the gallbladder.
Cholecystitis refers to inflammation of the gallbladder. There are several possible causes, the most common of which is gallstones.
Sometimes, gallstones pass on their own. However, when they get stuck and block the ducts through which bile usually travels, this can lead to jaundice.
This article will discuss jaundice and cholecystitis, signs, treatment, outlook, and frequently asked questions.
Jaundice is a yellowing of the skin and eyes from an accumulation of excess bilirubin in the body.
Bilirubin is a waste product that results from the death of old or damaged red blood cells.
Usually, the liver converts bilirubin into a water-soluble state known as conjugated, or direct bilirubin. This allows it to mix with bile and exit the body through the stool and urine.
The liver makes bile, which the gallbladder then stores. During food intake, the gallbladder releases bile to help digest certain foods.
Cholecystitis can cause jaundice because of how it interferes with how the gallbladder usually secretes bile.
The gallbladder can concentrate bile and form sludge or stones, which can cause blockages in the typical drainage of bile.
The gallbladder wall can then become swollen and inflamed, which doctors call cholecystitis.
The most common cause of cholecystitis is gallstones. Other possible causes include:
Learn more about cholecystitis.
Jaundice makes a person's skin and the whites of their eyes look yellow, though skin color changes may be less noticeable in darker skin.
Some of the signs of jaundice and cholecystitis are the same, including:
Symptoms of cholecystitis also include:
Since removed gallstones often recur after about 1 year, the preferred treatment for cholecystitis with gallstones is to remove the entire gallbladder. This type of surgery is called a cholecystectomy.
Doctors can perform a laparoscopic cholecystectomy, which involves removing the gallbladder through a small incision. They can also perform an open cholecystectomy, which involves a larger incision, and bile duct explorative procedures to remove stones.
For those unable to undergo surgery, doctors may recommend placing a cholecystostomy tube. They insert this tube from the skin in the upper abdomen, and it drains the contents of the gall bladder.
If a bacterial infection is present, doctors can prescribe antibiotics.
Without treatment, acute cholecystitis can progress to gallbladder tissue death and perforation. Gallbladder perforation refers to a hole in the gallbladder, and this can lead to sepsis, shock, and death.
However, with surgery to remove the gallbladder, the outlook is usually positive.
There are some risks relating to surgery:
In addition, about 10% of people experience post-cholecystectomy syndrome (PCS). With PCS, individuals continue to experience some of their pre-surgery pain and gastrointestinal symptoms.
The following are answers to common questions about jaundice and cholecystitis.
What happens to the liver in cholecystitis?When acute cholecystitis occurs with gallstones, impaired liver function can occur.
A cause is gallbladder infection that reaches the liver through lymph circulation or the bile duct.
Which bilirubin is elevated in cholecystitis?Cholecystitis features elevated conjugated bilirubin levels. This is the bilirubin that the liver has converted to a water-soluble form, in preparation for secretion via bile into the stool.
Because cholecystitis hinders the gallbladder's ability to secrete bile for digestion and waste elimination, the conjugated bilirubin builds up instead of leaving the body.
How do doctors diagnose cholecystitis?To diagnose cholecystitis, doctors will take a complete medical history and perform a physical examination, blood tests, and imaging tests, which may include ultrasound, CT scan, or hepatobiliary scan.
Cholecystitis can sometimes cause jaundice. This can occur when the liver sustains an injury or when gallstones prevent bile from clearing bilirubin from the body.
Doctors can treat cholecystitis with surgery and prescribe antibiotics if an infection is present.
While sometimes gallstones can pass on their own, untreated cholecystitis can lead to severe consequences if it progresses.
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