KidsMD Health Topics

Our Health Topics

Hemolytic Disease

  • Hemolytic disease of the newborn (HDN), also called erythroblastosis fetalis, is a blood disorder that occurs when the blood types of a mother and baby are incompatible. Our Blood Disorders Center provides comprehensive treatment and management of HDN.

    • HDN is relatively uncommon, affecting approximately 4,000 babies a year in the United States.
    • It is more likely to occur during a mother’s second or subsequent pregnancy.
    • There are two causes, Rh incompatibility and ABO incompatibility.
    • HDN due to Rh incompatibility occurs more frequently.
    • HDN can be treated during pregnancy or after the baby is born.
    • It is very preventable.

    Our patients with Hemolytic disease of the newborn (HDN) are treated through the Blood Disorders Center at Dana-Farber/Boston Children's Cancer and Blood Disorders Center, an integrated pediatric hematology and oncology partnership between Dana-Farber Cancer Institute and Boston Children’s Hospital.

  • What is hemolytic disease of the newborn? 

    Hemolytic disease of the newborn (HDN), also called erythroblastosis fetalis, is a blood disorder that occurs when the blood types of a mother and baby are incompatible. If the baby’s incompatible red blood cells cross over to his mother, through the placenta during pregnancy or at delivery, her immune system sees them as foreign and responds by developing proteins called antibodies to attack and break them down. This can lead to several complications that range from mild to very severe.

    The mother’s immune system also keeps these antibodies in case the incompatible red blood cells appear again, making her “sensitized.” Because of this, HDN is more likely to occur during a mother’s second or subsequent pregnancy, or following a miscarriage or abortion.

    Complications of hemolytic disease of the newborn during pregnancy:

    • Mild anemia: When the baby’s red blood cell count is deficient, his blood cannot carry enough oxygen from the lungs to all parts of his body, causing his organs and tissues to struggle.
    • Hyperbilirubinemia and jaundice: The breakdown of red blood cells produces bilirubin, a brownish yellow substance that is difficult for a baby to discharge and can build up in his blood (hyperbilirubinemia) and make his skin appear yellow.
    • Severe anemia with enlargement of the liver and spleen: The baby’s body tries to compensate for the breakdown of red blood cells by making more of them very quickly in the liver and spleen, which causes the organs to get bigger. These new red blood cells are often immature and unable to function completely, leading to severe anemia.
    • Hydrops fetalis: When the baby’s body cannot cope with the anemia, his heart begins to fail and large amounts of fluid build up in his tissues and organs.

    Complications of hemolytic disease of the newborn after birth:

    • Severe hyperbilirubinemia and jaundice: Excessive buildup of bilirubin in the baby’s blood causes his liver to become enlarged.
    • Kernicterus: Buildup of bilirubin in the blood is so high that it spills over into the brain, which can lead to permanent brain damage.

    What causes hemolytic disease of the newborn?

    A person’s blood type is determined by the presence of two different types of proteins, called antigens. The A, B and O antigens represent the classification of a person’s blood as Type A, B, AB or O. If a person also has the Rh factor antigen, his blood is Rh -positive, and if not, it is Rh-negative.

    Rh incompatibility:

    Hemolytic disease of the newborn most frequently occurs when a mother with Rh-negative blood becomes pregnant by an Rh- positive father, resulting in an Rh-positive baby.

    ABO incompatibility:

    Although it is not as common, hemolytic disease of the newborn can also occur when a mother and baby have incompatible blood types, specifically:

    Mother’s blood type O A B
    Baby’s blood type A or B B A

    Is hemolytic disease of the newborn common?

    Hemolytic disease of the newborn (HDN) is relatively uncommon in the United States due to advances in early detection and treatment, limiting it to approximately 4,000 cases a year. It is more likely to happen during a mother’s second or subsequent pregnancy. HDN due to Rh incompatibility occurs more frequently and is about three times more likely in Caucasian babies than in African-American babies.

    What are the symptoms of hemolytic disease of the newborn?
    The most common symptoms of hemolytic disease of the newborn are:

    • pale skin
    • yellowing of the amniotic fluid, umbilical cord, skin and eyes
    • enlarged liver or spleen
    • severe swelling of the body

    Can hemolytic disease of the newborn be prevented?

    Hemolytic disease of the newborn is very preventable. Today, nearly all women with Rh-negative blood are identified in early pregnancy through blood tests. If a mother is Rh-negative and has not been sensitized, she is usually given a drug called Rh immunoglobulin, or RhoGAM. This specially developed blood product prevents an Rh-negative mother's antibodies from reacting to her baby’s Rh-positive red blood cells. Mothers are typically given RhoGAM around the 28th week of pregnancy and again within 72 hours of giving birth.

  • How does a doctor know that it’s hemolytic disease of the newborn?
    Hemolytic disease of the newborn can be diagnosed during pregnancy or after the baby is born.

    Tests conducted during pregnancy may include:

    After birth, tests may include:

    • complete blood count test for the baby
    • umbilical cord blood test
       
  • Hemolytic disease of the newborn can be treated during pregnancy or after the baby is born.

    • Treatment during pregnancy may include:
    • blood transfusion
    • early delivery of the baby if severe complications arise and baby's lungs are mature

    After birth, treatment may include:

    • blood transfusion
    • intravenous fluids
    • oxygen or mechanical breathing machine
    • exchange transfusion to replace the baby's damaged blood with fresh blood
       
  • Hemolytic disease of the newborn, or RH disease, was first identified in 1932 at Boston Children’s Hospital by Dr. Louis Diamond. He went on to develop the first successful treatment, a transfusion procedure, in the 1940s.

     

    Clinical Trials

    For many children with rare or hard-to-treat conditions, clinical trials provide new options.

Request an Appointment

If this is a medical emergency, please dial 9-1-1. This form should not be used in an emergency.

Patient Information
Date of Birth:
Contact Information
Appointment Details
Send RequestIf you do not see the specialty you are looking for, please call us at: 617-355-6000.International visitors should call International Health Services at +1-617-355-5209.
Please complete all required fieldsThis department is currently not accepting appointment requests onlineThis department is currently not accepting appointment requests online

Thank you.

Your request has been successfully submitted

You will be contacted within 1 business day.

If you have questions or would like more information, please call:

617-355-6000 +1-617-355-6000
close
Find a Doctor
Search by Clinician's Last Name or Specialty:
Select by Location:
Search by First Letter of Clinician's Last Name: *ABCDEFGHIJKLMNOPQRSTUVWXYZ
More optionsSearch
Condition & Treatments
Search for a Condition or Treatment:
Show Items Starting With: *ABCDEFGHIJKLMNOPQRSTUVWXYZ
View allSearch
Visitor Information
U.S. News & World Report 2013-14 | Best Children's Hospitals | Cancer

Dana-Farber/Boston Children's Cancer and Blood Disorders Center

The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO
Close