Some infants with hemolytic disease of the fetus and newborn (HDFN) may develop severe anemia. If left untreated, the anemia could put them at greater risk of developing myocardial ischemia, which occurs when blood flow to the heart is disrupted in some way.
Severe anemia impairs the heart from pumping blood as normal, restricting the oxygen supply to the body, including the heart itself. This puts strain on the heart and can eventually lead to life-threatening cardiac failure if not urgently treated.
What is HDFN?
Hemolytic disease of the fetus and newborn (HDFN) is an immune-mediated red blood cell disorder that occurs when a baby’s RBCs break down quickly, which is called hemolysis. HDFN is caused by a mismatch between a mother’s and her baby’s blood type (A, B, AB, or O) or Rhesus (Rh) factor (Rh-positive or Rh-negative) during pregnancy.
What is myocardial ischemia?
Myocardial ischemia is a medical condition that occurs when the blood flow to the heart is disrupted, limiting the supply of oxygen-rich blood and other nutrients. It causes the heart to beat faster and with greater effort. This extra strain on the heart may lead to an enlarged heart, fluid building up in the heart causing hydrops fetalis and potentially heart failure.
Learn more about HDFN symptoms and risks
Symptoms of myocardial ischemia
As the heart works overtime to try to meet the body’s oxygen supply, it may suffer from fatigue and increased pressure. The resulting symptoms may include:
Symptoms in a fetus:
- Fast, irregular heartbeat
- Reduced fetal movement
- Fetal distress
- Fluid around the heart, lungs, abdomen
- Heartbeat abnormalities
Symptoms in a newborn:
- Excessive sleepiness
- Poor feeding
- Irritability
- Breathing difficulties
- Fast heartbeat
- Low blood pressure
- Weak pulse
- Cold hands or feet
Treating myocardial ischemia in HDFN
In both fetuses and newborns, early detection and urgent treatment of myocardial ischemia is essential to avoid heart failure, and potentially death. During pregnancy, the standard treatment is intrauterine transfusions (IUTs) to boost blood cells and treat severe anemia, which takes the pressure off the heart. Regular Doppler ultrasounds and ECGs will monitor the fetus and if hydrops fetalis or organ dysfunction is identified and not improving, the decision may be made to deliver the baby early to ensure the best care. This will also depend on the gestational age of the fetus.
Newborns with HDFN, severe anemia and myocardial ischemia will likely be treated in a neonatal intensive care unit. HDFN requires treatment with phototherapy and potentially blood transfusions. Myocardial ischemia and anemia may be treated with blood transfusions, oxygen, diuretics to remove excess fluid and medication to support heart function.
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