In recent decades, high-income countries have seen a dramatic reduction in the morbidity and mortality rates due to hemolytic disease of the fetus and newborn (HDFN). A better understanding of the disease combined with the implementation of prenatal screening, prevention measures, early detection and timely treatment have all contributed to outcomes.
However, greater healthcare disparities exist in lower-income countries or low-resource areas, which lack the funding, technology and infrastructure to treat and diagnose the disease. In these areas, HDFN is still a major cause of morbidity and mortality.
What is HDFN?
HDFN is a rare red blood cell disorder that occurs when the mother’s red blood cells are incompatible with those of her baby. This mismatch causes the mother to develop antibodiesAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. that cross the placenta and attack her baby’s blood during pregnancy. As the baby’s red blood cells start to break down, the baby can develop severe anemiaAnemia A condition that occurs when the body doesn’t have enough healthy red blood cells to carry oxygen to its tissues. In HDFN, anemia occurs when maternal antibodies destroy fetal red blood cells. and fetalis hydrops (swelling of the tissue and organs). If left untreated, HDFN can result in fetal heart failure and death.
In lower-income countries and areas, a lack of resources has an impact on preventative measures such as screening and specialized care and on the diagnosis and treatment options available.
Diagnosis
In HDFN, early diagnosis and prompt treatment are key to a successful outcome. Without adequate resources, the risk of serious complications for the fetus increases. Diagnosis of HDFN in utero requires close monitoring of the pregnant mother at risk, regular blood tests to check for antibodies against her baby’s red blood cells and a high-resolution ultrasoundUltrasound An imaging test that uses sound waves to monitor fetal growth, development and signs of complications during pregnancy. of the fetus, to check the size of the baby’s organs. If they are enlarged, this is a symptom of HDFN. Another procedure is amniocentesis, which is an expensive medical intervention often not available in lower-income areas.
Treatment
In utero treatment of HDFN involves an intrauterine transfusionIntrauterine transfusion A procedure that delivers donor red blood cells to the fetus through the umbilical vein to treat severe anemia caused by HDFN. (IUTIntrauterine transfusion A procedure that delivers donor red blood cells to the fetus through the umbilical vein to treat severe anemia caused by HDFN.). This involves performing a blood transfusion with an ultrasound-guided needle into the umbilical cord. It is a sensitive medical procedure that requires skill and specialist facilities that are often less available in underserved areas.
Outcomes
If no diagnosis and treatment of a fetus affected by HDFN is possible in utero, possible outcomes include breathing problems, severe anemia and jaundiceJaundice A common symptom of HDFN, jaundice is caused by excess bilirubin and is characterized by a yellow tint to the skin or eyes., hydrops fetalisHydrops fetalis A serious, sometimes fatal condition in which fluid builds up in a baby’s tissues and organs due to severe anemia from HDFN., stillbirth or death soon after delivery. Newborns with symptoms of HDFN require specialized care in a neonatal intensive care unit, with treatment such as phototherapyPhototherapy A treatment that uses special blue light to help newborns break down bilirubin and prevent kernicterus., blood transfusions and exchange transfusions. It is harder to find and access these life-saving facilities in countries and areas with lower resources.
