WHAT YOU NEED TO KNOW: What is erythroblastosis fetalis? Erythroblastosis fetalis is also called hemolytic disease. Babies develop this condition before they are born. Erythroblastosis fetalis occurs when you and your baby have different blood types. When your baby's blood mixes with your blood during pregnancy, your immune system reacts by making antibodies against it. Antibodies are a part of the body's immune system that fight germs and substances that do not belong in the body. These antibodies can cross over to your baby through the placenta. They enter your baby's blood and attack your baby's red blood cells (RBCs), causing them to break down. This may cause severe anemia (low RBC count). Anemia makes it difficult for the RBCs in your baby's blood to carry enough oxygen to his body. What causes erythroblastosis fetalis? Certain incompatibilities (differences) in blood type can cause erythroblastosis fetalis. One type of incompatibility happens because you are Rh negative (Rh-) and your baby is Rh positive (Rh+). Another type, called ABO incompatibility, happens because you and your baby have different major blood types. A, B, and O are the 3 major blood types. ABO incompatibility is most common when your blood type is O and your baby's blood type is A or B. What are the signs and symptoms of erythroblastosis fetalis? - Before your baby is born:
- Fast heart rate
- Enlarged organs, such as the heart, liver, or spleen
- Swelling of your baby's body
- After your baby is born:
- Pale skin caused by anemia
- Jaundice (yellowing of your baby's skin or the whites of his eyes)
- Small red or brown spots, or purple patches on your baby's skin
- Swelling of your baby's body
- Trouble breathing
How is erythroblastosis fetalis diagnosed? - Before your baby is born: Healthcare providers will need to know if you have past pregnancies, abortions, miscarriages, or any blood transfusions. Before your baby is born, healthcare providers may do any of the following tests:
- Amniocentesis: This test checks for problems in your amniotic fluid (fluid around your baby), such as increased bilirubin level. Using ultrasound guidance, healthcare providers 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. This test may be repeated to monitor your baby's risk of anemia.
- Fetal blood sampling: This test may be done to check your baby's blood type and risk of anemia. Healthcare providers take a sample of your baby's blood from the umbilical cord. The 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. Healthcare providers can learn the age of your baby and see how fast he is growing. The ultrasound shows your baby's movement, heart rate, and organs. Your placenta and amniotic fluid may be checked. A Doppler ultrasound may be used to see his blood flow. Healthcare providers 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: Healthcare providers may do several blood tests. You and your baby may need to have blood drawn more than once 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.
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:
- Phototherapy: This treatment uses light to turn bilirubin into a form that your newborn's body can remove. One or more lights will be placed above your baby. He will be placed on his back to absorb the most light. Your baby may also lie on a flexible light pad, or his healthcare provider may wrap him in the light pad. Eye covers may be used to protect his eyes from the light.
- Immune globulin: Immune globulin given through an IV is also called IVIG. This medicine helps to keep your baby's RBCs from being damaged by your antibodies. This treatment may help prevent the need for an exchange transfusion.
- Exchange transfusion: This is a procedure that removes the antibodies that are attacking his RBCs and some of the bilirubin. Small portions of your baby's blood will be removed and replaced with donor blood. This procedure may need to be done more than once.
What are the risks of erythroblastosis fetalis? - Your baby may have breathing or other problems if he was born earlier than expected. An IVIG may cause an infection. A reaction to IVIG may cause breathing problems, seizures, liver problems, or kidney problems. Exchange transfusions may cause an infection, bleeding, or heartbeat or breathing problems. They may also cause decreased blood flow to his intestines. These problems can be life-threatening.
- Without treatment, your baby may have anemia that can lead to decreased oxygen to his brain, heart, and other organs. Your unborn baby may get hydrops fetalis, a condition that causes his body to swell with fluid. This may cause bleeding or heart failure. Bilirubin levels that get too high can cause hearing loss or brain damage, and may be life-threatening.
How can erythroblastosis fetalis be prevented? - Screening tests: Get your blood type checked before you get pregnant. You can also have it checked during your first prenatal visit. You may need additional tests if you have been pregnant before or had blood transfusions. Healthcare providers may screen your blood for antibodies to other blood types. Healthcare providers 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 be tested to check for blood ABO and Rh type. Healthcare providers may also do a test to see if your blood reacts to your baby's blood.
- Rh factor treatments: You may be given Rh factor immune globulin if you and your baby have different Rh blood types. This medicine is given to prevent erythroblastosis fetalis. This medicine may be given while you are pregnant and after you give birth.
When should I contact my healthcare provider? - 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 develops jaundice.
- Your baby is not feeding well or is urinating less than before.
- You have breastfeeding problems.
- By his fourth day of life, your breastfeeding baby has either of the following:
- Fewer than 4 to 6 wet diapers in a period of 24 hours.
- Fewer than 3 to 4 bowel movements in a period of 24 hours.
- You have questions or concerns about your baby's condition or care.
When should I seek immediate care or call 911? - Your baby has jaundice that does not go away or gets worse.
- Your baby has shortness of breath.
- Your baby is having a seizure.
- Your baby is very irritable, fussy, and has a high-pitched cry.
- Your baby looks very tired or weak, or sleeps more than usual.
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