If you are a mother-to-be, you may have been a little scared when you heard the words 'Erythroblastosis Fetalis'. Or maybe your doctor mentioned it a little while ago when he was talking about your blood type. It can be a bit scary to hear this name. But don't worry, today we will talk about it in a simple way that you can understand. Let's see what it is, why it happens, and how we can protect ourselves from this condition.
What is 'Erythroblastosis Fetalis'?
Simply put, this is a rare, meaning not everyone gets it, complication that can occur during pregnancy. This happens if there is a blood type incompatibility between you and your unborn baby. Not all blood type differences cause problems. However, this risk is especially high if your blood type is `Rh-negative` and your baby's blood type is `Rh-positive`.
Imagine, if you were exposed to this Rh-positive blood, either during a previous pregnancy or during a blood transfusion, your body's immune system (the system that protects us from diseases) can start attacking the baby's red blood cells. As if attacking an enemy. This can cause the baby's red blood cells to become dangerously low. We call this anemia. If this anemia becomes severe, it can be life-threatening for the baby if not treated.
But there's good news! These days, routine tests early in pregnancy can determine your blood type. If you're Rh-negative, doctors can prescribe medication to prevent this problem.
This condition is also called `(alloimmune hemolytic disease of the newborn - HDN)` and `(hemolytic disease of the fetus and newborn - HFDN)`. But when we talk about it, we will use the term `(Erythroblastosis Fetalis)`.
What are the symptoms if the baby has this condition?
Babies born with this condition (Erythroblastosis Fetalis) may show signs of anemia. Some babies may have it mildly, while others may have it severely. Also, the baby may develop jaundice within 24 hours of birth. Here are some of the symptoms:
- Yellowing of the eyes and skin.
- Sudden paleness of the skin.
- The baby feels very lethargic and lifeless (lethargy).
- The heart beats fast (tachycardia).
- Lack of appetite for milk.
In some severe cases, the fetus or newborn may develop a life-threatening condition called ``hydrops fetalis.'' Its symptoms include:
- Body swelling.
- Fluid accumulation in the baby's abdomen, or between vital organs such as the heart and lungs.
Why is this happening? What are the reasons?
This condition, called ``Erythroblastosis Fetalis'', occurs because, as mentioned earlier, your body's immune system attacks the baby's red blood cells.
Our red blood cells have special markers on them. We call them ``antigens.'' Think of these ``antigens'' as labels with names on them. If your immune system recognizes this label, it won't attack those red blood cells.
This is because of the difference in your and your baby's blood types. Blood types are classified based on the ``antigens`` on the surface of red blood cells. There are two main blood types that we are talking about:
- Rh factor: This means whether the blood is positive (+) or negative (-).
- ABO antigens: This means A, B, AB, or O blood type.
If you are pregnant, your immune system, if it does not recognize the ``antigens`` on your baby's red blood cells, will start making ``antibodies`` against them. These ``antibodies`` are what attack those red blood cells. Just like when our body gets a germ that causes illness, our body fights it. But for this to happen, the baby's blood has to come into contact with your blood. Most of the time, this happens when the baby is about to be born. However, sometimes the blood can mix with it before. For example:
- If an abortion occurs.
- If the pregnancy is lost halfway through, it is called ``Miscarriage``.
- In a situation like ectopic pregnancy (the pregnancy is located outside the uterus, such as in a fallopian tube).
- When performing ``(Amniocentesis)`` (a test performed during pregnancy).
- When doing `(Chorionic villus sampling)` (another pregnancy test).
Once your body has produced these `(antibodies)`, it remembers it. If the baby's red blood cells have that `(antigen)` again during the next pregnancy, these `(antibodies)` will go and destroy those cells. We call this destruction of red blood cells `(hemolysis)`.
Main cause: Rh incompatibility
The most serious and well-known cause of this condition is when you are Rh-negative and your baby is Rh-positive. When this happens, your immune system attacks your baby's Rh-positive red blood cells. In a country like America, about 15% of people have Rh-negative blood. In most cases, both the mother and the father, as well as the baby, are Rh-positive.
Usually, this Rh incompatibility does not cause any major problems during the first pregnancy. Even if you are Rh-negative and the baby is Rh-positive, it is rare for your blood to mix with the baby's blood during pregnancy to cause a serious reaction (antibodies). However, once the baby is born, your blood will definitely react with the baby's blood. At that time, if you have not taken medicine to prevent your immune system from attacking it, your body may develop antibodies against the Rh-positive red blood cells.
Then if you get pregnant again, and that baby also has Rh-positive blood type, those antibodies that were made earlier will go and attack that baby's red blood cells. Do you understand?
Other rare blood type incompatibilities
Sometimes, your immune system can attack your baby's red blood cells even though there is a mismatch with a rare red blood cell antigen. This happens if your baby has that rare antigen and you lose it. This happens if you have been exposed to that antigen through a previous pregnancy or blood transfusion and have developed antibodies to it. Some of these antigens are:
- `(Colton)`
- `(Duffy)`
- `(Diego)`
- `(Ee)`
- `(Gerbich)`
- `(H)`
- `(Kell)`
- `(Kidd)`
- `(Lutheran)`
- `(MNS)`
- `(P)`
- `(Xg)`
Blood tests done early in pregnancy can detect whether you are making antibodies against these rare types of red blood cells.
How common is this condition?
Worldwide, about 276 out of 100,000 live births are reported to have pregnancy complications related to Rh blood type incompatibility. According to researchers, if left untreated, there is a 50% chance that the unborn baby will die or develop serious health problems.
But don't worry! With blood type testing and the necessary medication, the worst outcomes can be prevented. In some parts of the world where prenatal care is available, only about 2.5 out of 100,000 births have problems due to Rh incompatibility. This is a major concern in Sri Lanka as well.
How do you find this?
Usually, at antenatal clinics, your blood type and any ``antibodies'' are checked. If you are pregnant and have Rh-negative blood type, your doctor will check for ``antibodies'' against Rh-positive blood. If you don't have those ``antibodies'', your immune system will be given a medicine to stop them from forming.
If the test confirms that you have these antibodies, it means that if the baby is Rh-positive, your immune system is at risk of attacking the baby's red blood cells. Your doctor will then check your antibody levels every few weeks. If your antibody levels are dangerously high, additional tests may be done to see if your baby has anemia, and you may need to have blood transfusions in the womb. If your baby is at risk of being born with severe anemia, your doctor may decide to deliver the baby early.
After the baby is born, the doctor can determine the baby's blood type. This can help determine whether the baby's anemia is due to a blood type incompatibility.
Other tests performed are:
- Complete Blood Count (CBC): This test can check how low the baby's red blood cells are. The lower the level, the more severe the anemia.
- Peripheral Blood Smear (PBS): This involves examining a blood sample under a microscope. This can give an idea of whether the decrease is due to premature destruction of red blood cells (hemolysis).
- Bilirubin test: This checks the level of bilirubin. Bilirubin is a byproduct of the breakdown of red blood cells. High bilirubin levels (hyperbilirubinemia) may indicate that red blood cells are being destroyed.
- Direct Antiglobulin Test (DAT): This test shows whether antibodies are present on the surface of the baby's red blood cells. This means that the mother's immune system is attacking the baby's cells.
What are the treatments?
Treatment depends on whether you are pregnant or have just had a baby.
Treatment during pregnancy
If you have antibodies that put you at risk for Erythroblastosis Fetalis, your doctor will monitor your antibody levels every few weeks. If your antibody levels are high, you may need to have additional ultrasound scans to see if your baby is anemic. If the anemia is severe, your baby may need blood transfusions.
Treatment after the baby is born
Doctors treat newborns with ``Erythroblastosis Fetalis'' by treating anemia and ``hyperbilirubinemia'' (jaundice). Treatment options are:
- Phototherapy: This uses light to treat hyperbilirubinemia. This light converts bilirubin into substances that are easily excreted from the baby's body.
- Blood transfusion: After the baby is born, the baby may need a blood transfusion to ensure that he or she has enough red blood cells.
- Erythropoiesis Stimulating Agents (ESA): These may be an option for treating anemia that is not severe enough to require a blood transfusion. They may need to be given along with iron supplements to help the baby make healthy red blood cells.
In severe cases, the baby may need supportive care, such as a ventilator and IV fluids.
What happens to the baby after this situation?
The results depend on how severe your baby's symptoms are. Severe anemia and hyperbilirubinemia can be fatal if left untreated.
However, babies with Erythroblastosis Fetalis can survive the condition if treated properly. They may need blood transfusions to replenish their red blood cells during pregnancy and/or after birth. The doctor will need to monitor them for several months to make sure there are no problems.
Can't this be prevented?
It is definitely possible! Erythroblastosis Fetalis is a condition that is highly preventable with blood type testing and preventive medication during pregnancy. If you are Rh-negative, you can take Rh immune globulin (RhIg or RhoGAM®) to prevent your body from making antibodies against Rh-positive blood. You need to take this medicine at 28 weeks of pregnancy, within 72 hours of the end of pregnancy (after delivery or miscarriage), and if you have significant bleeding during pregnancy (even in the first trimester).
This only works if you take this medicine before your blood is exposed to Rh-positive blood. That's why it's especially looked at in pregnancy clinics.
Things to ask your doctor
If you have any more questions about this, don't be afraid to ask your doctor or nurse. Here are some examples:
- What is my blood type?
- Are there any ``antibodies'' I should be concerned about?
- Should I be worried about `(Erythroblastosis Fetalis)`?
- Will I need additional monitoring or frequent clinic visits?
- Will I need to take Rh immune globulin (RhIg)?
- When should I make an appointment or seek emergency care?
What happens if the mother is Rh-positive and the baby is Rh-negative?
This is not usually a blood type incompatibility to be concerned about. An Rh-negative fetus does not have the Rh-antigen that the mother's immune system can attack. Unless there are other rare blood type incompatibilities, this should not be a problem.
The most important things to keep in mind
The idea that your own immune system could attack your unborn baby is a scary one. But the good news is that these dangerous blood incompatibilities are not common. And, doctors do their best to prevent these problems from happening. Blood type testing is a mandatory part of prenatal care. Also, monitoring and treating blood type incompatibilities that could pose a risk to your baby is an established part of prenatal care. Your doctor will be with you every step of the way to keep you and your baby safe. So, don't panic unnecessarily, and follow the doctor's instructions carefully. Then you and your baby can both stay healthy!
` Erythroblastosis Fetalis, Rh incompatibility, pregnancy complications, baby's blood type, mother's blood type, anemia, jaundice, RhoGAM
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