Haemolytic Disease of the Fetus and Newborn: Past, Present and Future Considerations

Abstract

The complex etiology, pathogenesis and management of Hemolytic disease of the fetus and newborn (immune mediated) has drawn keen interest of not only the obstetricians and pediatricians worldwide but has also fascinated immohematologists over decades. Our understanding of this disease has evolved significantly in the recent past and as we usher into the era of precision medicine and molecular testing, the incidence of HDFN has remarkably reduced, especially in the developed countries. It still remains a cause of concern in the developing countries, where it is most commonly associated with Rh 'D' negative antenatal cases. There are multiple factors involved in the pathogenesis of the disease which warrant different diagnostic approaches as well as treatment protocols as per the severity of the disease. In addition to prophylactic administration of Anti-D immunoglobulin, genotype testing will pave the way for future guidelines. With due consideration on cases with specific requirement for molecular testing, a cost-effective approach may be implemented.

Early Hyporegenerative Anemia Complicating Hemolytic Disease of the Newborn Secondary to Rhesus Alloimmunization

“…It was first described in 1932 by Dr. Louis K. Diamond, who originated the term erythroblastosis fetalis after studying the blood smears of severely affected infants [2]. In 1940, Levine discovered the Rh blood group system, and the pathogenesis of this condition was finally confirmed by Chown et al as being the result of the passage of Rh-positive red blood cells from the fetus to the mother's circulation after transplacental hemorrhage [3].…”

“…A study developed by the United States and the United Kingdom in 1966 proved that administering anti-D immunoglobulin soon after delivery prevented the sensitization in D-negative women [3]. After the standardized use of Rh immunoglobulin in rhesus-negative women during the 1970s, the incidence of alloimmunization decreased dramatically from 14% to less than 0.2% at present [4,5].…”