Table of ContentsView AllTable of ContentsCausesSymptomsComplicationsExams and TestsTreatmentPreventionOutlookWhen to See a Provider
Table of ContentsView All
View All
Table of Contents
Causes
Symptoms
Complications
Exams and Tests
Treatment
Prevention
Outlook
When to See a Provider
Timely diagnosis and treatment can help prevent death or lifelong disability that can occur secondary to HDN. Read more to learn about hemolytic disease of the newborn, its risk factors, prevention, and treatment.
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What Causes Hemolytic Disease of the Newborn?
The proteins on the surface of RBCs determine blood type. Every single RBC that a person has in their body has the same blood type. The proteins are defined as A, B, and Rh. A person’s blood type can be identified as A, B, AB, or O (no A or B proteins). Additionally, the presence or absence ofRh proteindetermines whether a person is Rh positive or Rh negative.
When a pregnant person is Rh negative, exposure to a fetus’s Rh positive blood will cause the pregnant person to produce antibodies (immune proteins) against the fetus’s RBCs. This is calledRh sensitization.
This exposure most often happens during labor and delivery.However, it can occur earlier in pregnancy, including during a miscarriage, pregnancy termination,ectopic pregnancy, or an invasive procedure such asamniocentesisor chorionic villus sampling.
The pregnancy in which the first exposure happens usually is not affected.The pregnant person is treated to prevent antibody formation. If antibodies form, they can affect future pregnancies with an Rh positive fetus. The antibodies can cross the placenta and attack the fetus’s blood, resulting in hemolysis.
The most common cause of HDN is Rh incompatibility—when the fetus is Rh positive, and the pregnant person is Rh negative. Other types of blood type incompatibility involving the A and B blood type markers may cause HDN. But the reaction tends to be milder with A or B incompatibility than it is when it occurs due to Rh incompatibility.
Symptoms of HDN
Signs or symptoms of HDN before birth may include:
Complications Associated With HDN
Anemia(low numbers of healthy red blood cells) can be a serious problem, especially when RBCs break down rapidly before the body can replenish them. A deficiency of RBCs may cause insufficient oxygen supply to the body’s organs.
Sometimes a serious complication calledkernicteruscan develop. This is an accumulation of bilirubin in the brain. It can cause permanent brain damage and may lead to learning disabilities, blindness,epilepsy, and an inability to learn how to walk or control physical movements.
High Bilirubin Levels (Hyperbilirubinemia) in Adults and Babies
HDN Exams and Tests
Diagnostic tests that can aid in identifying HDN or some of its complications are:
Other tests that may be necessary if there’s concern about serious complications and organ damage include brain imaging or abdominal computerized tomography (CT) scan.
What Is the Treatment for HDN?
Treatments for HDN include preventive approaches, as well as interventions that can be used if the condition isn’t adequately prevented. Survival has improved as treatments have developed, but life expectancy remains low for babies who develop this condition in areas with low access to treatment.
An Rh negative pregnant person who has developed Rh antibodies will have the pregnancy closely monitored. Ultrasound imaging can assess whether the fetus has signs of anemia.
An amniocentesis may be performed to determine if there is elevated bilirubin in the amniotic fluid surrounding the fetus. The fetus’s umbilical cord blood may also be sampled to check for antibodies, bilirubin, and signs of anemia.
Phototherapy is a type of light therapy that can help the body eliminate excess bilirubin.Babies who have anemia may also need oxygen supplementation, intravenous fluids, and blood pressure management.
Long-Term Care
Treating Each PregnancyPrevention of HDN begins during a first pregnancy for a pregnant person who is Rh negative, even if the pregnancy is not carried to term. Treatment during each pregnancy can prevent the condition from occurring during subsequent pregnancies.
Treating Each Pregnancy
Prevention of HDN begins during a first pregnancy for a pregnant person who is Rh negative, even if the pregnancy is not carried to term. Treatment during each pregnancy can prevent the condition from occurring during subsequent pregnancies.
Can HDN Be Prevented?
While HDN is not common, it is recognized as a serious risk during pregnancy and delivery. Prenatal care routinely includes blood typing, which identifies whether a pregnant person is Rh negative, the biggest risk factor for HDN.
Miscarriage or pregnancy termination can lead to a risk of subsequent HDN, so you might receive RhoGAM if you experience these as well.
When to Talk to a Healthcare Provider
It’s best to get prenatal care as soon as you find out you are pregnant. If you are planning to get pregnant or are at risk of pregnancy, you might be advised to start taking care of your health. This includes starting onprenatal vitaminsand avoiding smoking and alcohol.
During early pregnancy, blood tests will identify your blood type. If you are Rh positive, then there is no need to worry or get treatment to prevent HDN.
If you are Rh negative, it’s highly likely that you could be carrying a fetus who is Rh positive because about 90% of the population is Rh positive.It is a dominant trait (is likely to be expressed in the fetus if the other parent is Rh positive).
Your healthcare providers would schedule your preventive treatment during your pregnancy so that you will not develop antibodies against your fetus’s Rh factor proteins.
If you are Rh negative, you need to consult a healthcare provider during each pregnancy to determine if treatment is needed, even if you are not carrying the pregnancy to term.
Summary
Hemolytic disease of the newborn (HDN) is a rare but serious condition that may develop due to blood type incompatibility between a growing fetus and the pregnant parent. The process and steps that lead to this condition usually involve sequential pregnancies of a pregnant person who is Rh negative.
During the first pregnancy, an Rh negative pregnant person develops antibodies to the fetus’s Rh positive blood. During a subsequent pregnancy, the antibodies will attack the RBCs of the developing fetus, causing hemolysis.
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Myle AK, Al-Khattabi GH.Hemolytic disease of the newborn: a review of current trends and prospects.Pediatric Health Med Ther.2021;12:491-498. doi:10.2147/PHMT.S327032American College of Obstetricians and Gynecologists.The Rh factor: how it can affect your pregnancy.De Winter DP, Hulzebos C, Van ’t Oever RM, De Haas M, Verweij EJ, Lopriore E.History and current standard of postnatal management in hemolytic disease of the fetus and newborn.Eur J Pediatr.2023;182(2):489-500. doi:10.1007/s00431-022-04724-0Mohan DR, Lu H, McClary J, Marasch J, Nock ML, Ryan RM.Evaluation of intravenous immunoglobulin administration for hyperbilirubinemia in newborn infants with hemolytic disease.Children (Basel). 2023;10(3):496. doi:10.3390/children10030496Kasirer Y, Kaplan M, Hammerman C.Kernicterus on the spectrum.Neoreviews.2023;24(6):e329-e342. doi:10.1542/neo.24-6-e329UC San Diego Health.Hemolytic disease of the newborn.de Winter DP, Kaminski A, Tjoa ML, Oepkes D.Hemolytic disease of the fetus and newborn: systematic literature review of the antenatal landscape.BMC Pregnancy Childbirth.2023;23(1):12. doi:10.1186/s12884-022-05329-zNovoselac J, Buzina Marić K, Rimac V, Selak I, Raos M, Golubić Ćepulić B.Significance of immunohematologic testing in mother and newborn ABO incompatibility.Immunohematology.2023;39(2):55-60. doi:10.21307/immunohematology-2023-009
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Myle AK, Al-Khattabi GH.Hemolytic disease of the newborn: a review of current trends and prospects.Pediatric Health Med Ther.2021;12:491-498. doi:10.2147/PHMT.S327032American College of Obstetricians and Gynecologists.The Rh factor: how it can affect your pregnancy.De Winter DP, Hulzebos C, Van ’t Oever RM, De Haas M, Verweij EJ, Lopriore E.History and current standard of postnatal management in hemolytic disease of the fetus and newborn.Eur J Pediatr.2023;182(2):489-500. doi:10.1007/s00431-022-04724-0Mohan DR, Lu H, McClary J, Marasch J, Nock ML, Ryan RM.Evaluation of intravenous immunoglobulin administration for hyperbilirubinemia in newborn infants with hemolytic disease.Children (Basel). 2023;10(3):496. doi:10.3390/children10030496Kasirer Y, Kaplan M, Hammerman C.Kernicterus on the spectrum.Neoreviews.2023;24(6):e329-e342. doi:10.1542/neo.24-6-e329UC San Diego Health.Hemolytic disease of the newborn.de Winter DP, Kaminski A, Tjoa ML, Oepkes D.Hemolytic disease of the fetus and newborn: systematic literature review of the antenatal landscape.BMC Pregnancy Childbirth.2023;23(1):12. doi:10.1186/s12884-022-05329-zNovoselac J, Buzina Marić K, Rimac V, Selak I, Raos M, Golubić Ćepulić B.Significance of immunohematologic testing in mother and newborn ABO incompatibility.Immunohematology.2023;39(2):55-60. doi:10.21307/immunohematology-2023-009
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Myle AK, Al-Khattabi GH.Hemolytic disease of the newborn: a review of current trends and prospects.Pediatric Health Med Ther.2021;12:491-498. doi:10.2147/PHMT.S327032American College of Obstetricians and Gynecologists.The Rh factor: how it can affect your pregnancy.De Winter DP, Hulzebos C, Van ’t Oever RM, De Haas M, Verweij EJ, Lopriore E.History and current standard of postnatal management in hemolytic disease of the fetus and newborn.Eur J Pediatr.2023;182(2):489-500. doi:10.1007/s00431-022-04724-0Mohan DR, Lu H, McClary J, Marasch J, Nock ML, Ryan RM.Evaluation of intravenous immunoglobulin administration for hyperbilirubinemia in newborn infants with hemolytic disease.Children (Basel). 2023;10(3):496. doi:10.3390/children10030496Kasirer Y, Kaplan M, Hammerman C.Kernicterus on the spectrum.Neoreviews.2023;24(6):e329-e342. doi:10.1542/neo.24-6-e329UC San Diego Health.Hemolytic disease of the newborn.de Winter DP, Kaminski A, Tjoa ML, Oepkes D.Hemolytic disease of the fetus and newborn: systematic literature review of the antenatal landscape.BMC Pregnancy Childbirth.2023;23(1):12. doi:10.1186/s12884-022-05329-zNovoselac J, Buzina Marić K, Rimac V, Selak I, Raos M, Golubić Ćepulić B.Significance of immunohematologic testing in mother and newborn ABO incompatibility.Immunohematology.2023;39(2):55-60. doi:10.21307/immunohematology-2023-009
Myle AK, Al-Khattabi GH.Hemolytic disease of the newborn: a review of current trends and prospects.Pediatric Health Med Ther.2021;12:491-498. doi:10.2147/PHMT.S327032
American College of Obstetricians and Gynecologists.The Rh factor: how it can affect your pregnancy.
De Winter DP, Hulzebos C, Van ’t Oever RM, De Haas M, Verweij EJ, Lopriore E.History and current standard of postnatal management in hemolytic disease of the fetus and newborn.Eur J Pediatr.2023;182(2):489-500. doi:10.1007/s00431-022-04724-0
Mohan DR, Lu H, McClary J, Marasch J, Nock ML, Ryan RM.Evaluation of intravenous immunoglobulin administration for hyperbilirubinemia in newborn infants with hemolytic disease.Children (Basel). 2023;10(3):496. doi:10.3390/children10030496
Kasirer Y, Kaplan M, Hammerman C.Kernicterus on the spectrum.Neoreviews.2023;24(6):e329-e342. doi:10.1542/neo.24-6-e329
UC San Diego Health.Hemolytic disease of the newborn.
de Winter DP, Kaminski A, Tjoa ML, Oepkes D.Hemolytic disease of the fetus and newborn: systematic literature review of the antenatal landscape.BMC Pregnancy Childbirth.2023;23(1):12. doi:10.1186/s12884-022-05329-z
Novoselac J, Buzina Marić K, Rimac V, Selak I, Raos M, Golubić Ćepulić B.Significance of immunohematologic testing in mother and newborn ABO incompatibility.Immunohematology.2023;39(2):55-60. doi:10.21307/immunohematology-2023-009
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